Search

Introduction Leclercia adecarboxylata is a ubiquitous aerobic, motile, gram-negative bacilli. The human gastro-intestinal tract is known to harbor this rarely opportunistic microorganism. We describe a rare case of invasive infection with a gastrointestinal starting point due to L. adecarboxylata in a patient with Hirschsprung disease. Case report It is about a newborn female who was admitted on the 3rd day of life to the neonatal intensive care unit for intestinal obstruction. On the 9th day of life, while managing the neonatal obstruction, the patient developed febrile peaks. Cytobacteriological examination of cerebrospinal fluid, blood cultures and culture of umbilical vein catheter allowed the exclusive isolation of Leclercia adecarboxylata. It was producing extended spectrum beta-lactamase and was treated with intravenous imipenem. After favourable evolution, the patient was transferred to the pediatric surgery department. There, she was diagnosed with Hirschsprung disease. Discussion Knowledge of the route of transmission of L. adecarboxylata is limited and the possible source of the infection is unclear. However, the authors describe three hypotheses of contamination of our propositus. In our patient, one or more of these routes of contamination would be possible. Indeed, bacteremia could occur as a result of a bacterial translocation across the mucosal barrier of the colon altered by Hirschsprung disease, antibiotic use and feeding practices. Conclusion Infection with L. adecarboxylata revealed a wide range of infection. It has only recently been acknowledged as an emerging pathogen. Further studies of the pathogenesis and risk factors are required., Highlights • Leclercia adecarboxylata is Gram-negative bacillus as a member of the Enterobacteriaceae family. • Infection with this rarely pathogenic microorganism has been limited to a small number of case reports. Of these, only few reports implicate the gastrointestinal tract as the focus of infection. • Bacteremia could occur as a result of a bacterial translocation across the mucosal barrier of the colon altered by Hirschsprung disease, antibiotic use and feeding practices. • As the number of L. adecarboxylata infections continues to expand so does our insight into its pathogenicity and role in human clinical infections. Further studies of the pathogenesis and risk factors are required.

Shewanella putrefaciens is a Gram-negative bacillus and marine pathogen that rarely causes disease in humans. We report the first Moroccan case of multidrug-resistant Shewanella putrefaciens bacteremia and describe the bacteriological, clinical, and antibiogram characteristics of this isolate, which was repeatedly isolated from the blood of a 66-year-old hypertensive man who underwent femoral coronary angiography after a myocardial infarction.

BackgroundTuberculosis represents a serious public health problem and a significant diagnostic and therapeutic challenge worldwide. Molecular diagnostic techniques are crucial in the World Health Organization’s new tuberculosis control strategy.This study aims to evaluate the performance of GeneXpert MTB/RIF (Cepheid Sunnyvale, CA, United States) in diagnosis of extra-pulmonary tuberculosis then compare it’s performance in detecting Rifampicin resistance to GenoType MTBDRplus (HAIN Life Sciences, Nehren, Germany).MethodsSamples from pulmonary and/or extra-pulmonary origins were analysed in a 21 months retrospective study. Samples were sent to the bacteriology laboratory forMycobacterium tuberculosisdetection using conventional bacteriological and molecular methods (GeneXpert MTB/RIF and MTBDRplus). Sensitivity and specificity were calculated for the stained smear and GeneXpert according to culture (Gold Standard) as well as for GeneXpert MTB/RIF in both negative and positive microscopy tuberculosis cases. Data’s statistical analysis was performed with SPSS13.0 software.ResultsSeven hundred fourteen patients’ samples were analysed; the average age was 47.21 ± 19.98 years with a male predominance (66.4%). Out of 714 samples: 285 were from pulmonary and 429 were from extra-pulmonary origins. The positivity rates for microscopy, GeneXpert MTB/RIF and culture were 12.88, 20.59 and 15.82%, respectively. These rates were 18.9, 23.85 and 20.35% for pulmonary samples and 9.71, 18.41 and 12.82% for extra-pulmonary samples, respectively. The sensitivity and specificity of GeneXpert MTB/RIF were almost the same in both pulmonary and extra-pulmonary samples (78.2 and 90.4%) and (79,3 and 90.3%) respectively.Rifampicin resistance rate found by GeneXpert MTB/RIF was 0.84%. Comparison of Rifampicin resistance obtained by GeneXpert MTB/RIF and Genotype MTBDRplus, showed 100% agreement between the two techniques for studied samples.ConclusionsThis confirms GeneXpert MTB/RIF advantage for tuberculosis diagnosis, particularly extra-pulmonary tuberculosis with negatively stained smear. The performance of GeneXpert and Genotype MTBDRplus are similar in detection of Rifampicin resistance. However, variability of detection performance according to tuberculosis endemicity deserves more attention in the choice of screening techniques of Rifampicin resistance, hence the interest of conducting comparative studies of detection performance under low and medium endemicity on large samples of tuberculosis populations.

The cytobacteriological examination of urine (CBEU) is the most prescribed test in a microbiology laboratory. The objectives of this work were to present our experience in carrying out the CBEU and to share one of the means that we consider very useful in the daily practice of this crucial analysis. This is a 28-month prospective study (March 2016 to June 2018). The CBEU was carried out in accordance with the recommendations of the medical microbiology referential (REMIC). Antibiotic susceptibility was studied in accordance with the recommendations of the l'European committee on antimicrobial susceptibility testing (EUCAST). Cultures were positive for urinary tract infection in 5.09% (n=769) of cases and for colonization in 4.88% (n=737) of cases. E. coli alone accounted for 57.8% (n=850) of all isolates. In our experience, the display of the interpretation flowchart at the bench level, as well as the availability of clinical information and cytology results when examining urocultures, allows our technicians to decide, independently, what action to take for each CBEU according to the particular context of the patient for whom it has been prescribed. Similarly, this flowchart allows the unique microbiologist in the laboratory to contextually interpret each CBEU.

Disseminated cryptococcosis is a rare fungal infection, which mainly occurs in immunocompromised patients, and the diagnosis is difficult. Therefore, it is less likely to be considered in immunocompetent patients. Here, we present a case of fatal cryptococcal infection of the pleural fluid and ascites in a patient seronegative for HIV. The patient was a 45-year old man who was followed for Crohn's disease and treated with steroids and an immunosuppressant (azathioprine). The culture of pleural and ascites fluids showed the presence of yeasts colonies identified as Cryptococcus neoformans. Bacteriological examination of the blood culture or cerebrospinal fluid (CSF) was not prescribed. The HIV serology was negative. At the fourth day of treatment, the patient died because of the deterioration of neurological and hepatocellular functions. The main diagnostic problems that led to this fatal outcome were non-suspicion of an at-risk patient, lack of microbiological analysis of the blood or CSF, and inadequate antifungal therapy.

INTRODUCTION: Escherichia coli is the most commonly isolated species in both community and healthcare-associated infections. Our study's purpose was to determine the rates of antibiotic resistance of E. coli isolates in hospital and community populations, track the kinetics of resistance rates of E. coli isolates to major antibiotics, particularly those prescribed for urinary tract infections and study the occurrence and evolution of multi-resistant phenotypes. METHODS: We conducted a retrospective study at the Bacteriological Department of the Mohammed V Military Hospital of Instruction, over a period of 7 years. All isolates of E. coli from inpatients and outpatients were included. Identification of bacterial isolates was based on culture, morphological and biochemical identification characteristics. Antibiotic susceptibility was studied using the Mueller Hilton agar diffusion method by using OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST/CA-SFM 2019. RESULTS: The rate of resistance of E. coli isolates to 3(rd) generation cephalosporins, imipenem and fluoroquinolones was 12%, 1% and 34%, respectively. The difference between the resistance rates of inpatient and outpatient E. coli isolates was statistically significant for most antibiotics (p

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

Background and Purpose:The presence of yeasts in the urine is not synonymous with urinary tract infectionsinceit can result insimple colonization or contamination. Regarding this, it is required to further clarify the epidemiological profile of funguria. Accordingly, the present study was conducted to establish the epidemiology of funguriainthe Mohammed VI Teaching Hospital of Oujda, Morocco. Materials and Methods:This retrospective studywas conducted onall urine samples sent for cytobacteriological examination to amicrobiology laboratoryover a period of 28 months(i.e., from March 2016 to June 2018). After the removal of duplicates, the urinesampleswere treated according to the recommendations of the medical microbiology standards. Results:A total of15,165 urine sampleswerecollected. Urinary colonization accounted for 4.94% (n=749) of cases. The infections of the urinary tract accounted for 5.35% (n=811) of cases. Microbial isolates (n=1,669) in colonization and urinary tract infections were dominated by bacteria (93.47%, n=1,560). Furthermore, the yeasts accounted for 6.53% (n=109) of the isolates. Candidaalbicanswas isolated from56.88% (n=62) of funguriacases. Theriskfactors forfunguriain our series wereessentially old age, admission tointensive care unit, and broad-spectrum antibiotic therapy. Conclusion:The current level of knowledge about the clinical situations leading to funguria with the improvement and popularization of efficient identification techniques for yeasts other than C. albicans should redress the epidemiology of funguria.This should allow the knowledgeable societies to establish the rules of interpreting the cytobacteriological examination of the urine in case of funguria, as for bacteriuria.

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

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

Brucellosis is the most prevalent bacterial zoonosis worldwide. The WHO estimates that the infection is responsible for more than 500 000 cases per year across the world [1]. Hematological complications like mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia and thrombocytopenia are less frequently encountered [2]. We are reporting the case of a 73 year old male patient, with pancytopenia that revealed acute brucellosis. Following 6 weeks of antibiotic therapy, our patient showed favorable clinical outcome, and the complete blood count returned to normal. Acute brucellosis should be highly suspected in patients with pancytopenia.

Introduction:l´infertilité du couple est devenue ces dernières années un problème de santé publique, dont l´origine peut être féminine, masculine ou mixte. L´origine masculine est incriminée dans 40% des cas. Au Maroc, la plupart des publications ont été axées sur les étiologies et les facteurs de risque de l´infertilité masculine. L´objectif de notre étude est l´évaluation de la prévalence de l´infertilité masculine et le profil des paramètres spermatiques chez les hommes infertiles ou à risque d´infertilité au sein d´un hôpital tertiaire à Rabat. Méthodes:analyse de 482 patients adressés pour bilan d´infertilité du couple ou dans le cadre du bilan préopératoire d´une varicocèle ou d´une ectopie testiculaire. Les données démographiques, les facteurs de risque d´infertilité, le caractère primaire ou secondaire de l´infertilité ont été enregistrées pour chaque patient. Les paramètres spermatiques ont été étudiés et interprétés selon les normes actualisées de l´OMS en 2010 avec études des facteurs associés à leur perturbation. Résultats:l´âge moyen des patients était de 35,35±8,81 ans. L´infertilité était primaire dans 61,8%. Les facteurs de risque d´infertilité les plus fréquemment retrouvés sont le tabac suivi par la varicocèle et l´infection. Le spermogramme était perturbé dans 53,1%. L´anomalie la plus fréquente était la perturbation de la vitalité (36,9%) suivie par la concentration spermatique (29,7%) et la morphologie (29,3%). L´âge était le seul facteur ayant un impact significatif sur le spermogramme (p=0,002). Les anomalies de la mobilité se voient à partir de 31 ans, la vitalité est perturbée à 34 ans, la morphologie à 35 ans et la concentration à 37 ans. L´azoospermie a été retrouvée dans 16,4% essentiellement associée à l´infertilité primaire. L´oligo-asthéno-tératospermie était l´association la plus représentée (26,2%). Conclusion:l´infertilité masculine est fréquente dans notre contexte, l´âge étant son principal facteur de risque. La mobilité est le paramètre le plus précocement atteint.

The pre-analytical step of the cytobacteriological examination of urine (CBEU) is one of the most critical in microbiology. The objectives of our study were to determine the rate of urinary contamination and to analyze the factors that would facilitate this in order to propose solutions to this problem. METHOD This is a 26-month descriptive study including all CBEU requests to our laboratory. Urine was treated in accordance with the recommendations of the medical microbiology recommendations. Urine was considered contaminated in the case of polymorphic culture with at least three different types of germs with a count from 103 CFU/mL. RESULTS We collected 16,412 CBEU requests. Urine was contaminated in 4,830 cases (29.43%). Of the contaminated urine, 39.23% (n=1,895) was from emergency departments, 79.44% (n=3,837) was collected in the middle of the stream, 69.83% (n=3,373) was from a female patient and 16.34% (n=789) was from children under the age of 5. DISCUSSION AND CONCLUSION To reduce urine contamination, quality instructions describing sampling procedures should be available and samples in the middle of the stream and through the collection adhesive bags should be replaced by sus-pubic puncture samples in children, whenever the profit/risk ratio of this method is favourable.

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

Pasteurella multocida can cause serious infections after dog or cat bite. We report here a rare case of hand infection caused by P. multocida consecutive to an injury by a thorn of the prickly pear. It caused an amputation of the distal phalanx of the thumb in a trisomic patient. It is about a 27-year-old man who was admitted to the hospital with swelling and intense pain of the left hand. He reported a sting by a thorn of prickly pear 15 days before. The patient was admitted to proceed with operative irrigation and debridement. The pus was collected for microbiological examination. Microscopic examination after Gram staining revealed small Gram-negative coccobacilli, associated to polymorphonuclear reaction. Culture have objectivated Pasteurella multocida. The isolated strain was susceptible to betalactamins. Patient was treated with ampicillin. Well-conducted antibiotics and repetitive local cares have not prevented local lesions from progressing to necrosis of the soft parts of the thumb and osteitis of the distal phalanx of the thumb. The patient underwent a necrosectomy and an amputation of the distal phalanx. Ampicillin was replaced by amoxicillin/clavulanic acid and after 15 days, progression was clinically and microbiologically favorable. In the case we report, since the patient does not report any exposure or contact with animals, the thorn prick is the source of infection. It was contaminated from the animal reservoir. Taking into account the monomicrobism of the infection, treatment with aminopenicillins was sufficient. Our propositus came to the hospital 15 days after the inoculation of the bacterium. This duration appears to be very late in relation to the acute character of pasteurellosis. This was probably the main reason why the local infection evolved towards osteoarticular complications. That's why, we should consider Pasteurella multocida in case of infection by inoculation, even in the absence of contact with the animals.

Background The aim of this study is to establish the bacterial epidemiology of chronic osteoarticular infections in adults, to study the susceptibility of the isolated strains to antibiotics and to demonstrate the influence of osteosynthesis material thereon. Patients and methods This is a retrospective study of 78 months, from January 2006 to June 2012, providing bacteriological samples from patients with osteitis and osteoarthritis in the Mohammed V military teaching hospital of Rabat. Isolation and identification of bacteria were made by bacteriological classical techniques. The antimicrobial susceptibility testing of the isolates was performed by disk diffusion agar method, as recommended by the Committee of the susceptibility of the French Society for Microbiology (CA-SFM). Results We collected 234 cases, 53% (n = 124) of patients without osteosynthesis material (group A) and 47% (n = 110) patients with osteosynthesis material (group B).We isolated 371 bacteria which 51.49 (n = 191) in group A and 48.51% (n = 180) in group B. Gram-positive cocci were the most frequent (n = 234), followed by the Gram-negative bacilli (n = 114) and the Gram-positive bacilli (n = 19). Our study shows that the rate of resistance to antibiotics in strains obtained from patients with osteosynthesis material is higher compared to those obtained from patients without osteosynthesis material. Conclusions Chronic OA infection in adults is difficult to diagnose and treat. Its good management must be multidisciplinary.

Resume Saccharomyces cerevisiae est une levure cosmopolite, largement utilisee dans l’industrie agroalimentaire et pharmaceutique. Son incidence en pathologie humaine est rare, mais reste probablement sous-estimee par rapport a la vraie situation. Cette levure est consideree actuellement comme pathogene emergent et opportuniste. Les facteurs de risque sont l’immunodepression et le port de dispositif intravasculaire. Les fongemies sont les formes cliniques les plus frequentes. Nous rapportons le premier cas d’infection invasive a S. cerevisiae decrit au Maroc puis proposons une revue de la litterature des cas decrits dans le monde. Il s’agit d’un patient âge de 77 ans sans antecedents pathologiques notables, qui etait hospitalise pour une stenose digestive haute secondaire a une tumeur gastrique infranchissable metastatique. Son histoire etait marquee par la survenue d’un etat de choc septique dont le bilan etiologique a permis l’isolement de S. cerevisiae dans ses urines et son sang, avec comme arguments de confirmation du caractere invasif : presence de plusieurs facteurs de risque chez le patient, examen microbiologique direct positif, culture abondante et exclusive de S. cerevisiae a partir des prelevements. L’identification d’espece a ete confirmee par l’etude des caracteres biochimiques de la levure isolee. La confirmation d’infection a S. cerevisiae necessite une suspicion clinique chez le patient presentant des facteurs de risque, mais aussi un diagnostic microbiologique correct.

Objectives.We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU) of Mohammed V Military Teaching Hospital of Rabat (Morocco).Methods.The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance.Results.During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases withAcinetobacter baumanniibeing the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and 100% of carbapenemase inAcinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases.Conclusions.Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality.

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

The objectives of our work were to establish the epidemiological and bacteriological profile of female urinary tract infection at the Mohammed VI University Hospital of Oujda (Morocco), and then to study the drug resistance of the bacterial strains isolated. This is a retrospective study over 36 months including urine samples from patients hospitalized or consulting at the CHU Mohamed VI of Oujda (Morocco). Urines were processed according to the recommendations of the Medical Microbiology Reference (REMIC) and the EUCAST (European Committee on Antimicrobial Susceptibility Testing). We collected 12556 requests for CBEU from different departments. At the top of the list was the emergency department with a rate of 37% (n= 4666) followed by outpatient clinics (33.1%; n=4226). 5% (n=630) of the CBEU were positive. Escherichia coli (E. coli ) dominated the epidemiological profile with a rate of 72.50% (n=482). E. coli was resistant to penicillins in 69.50% (n=299) of cases, protected penicillins in 34.80% (n=149), third generation cephalosporins (C3G) in 9% (n=38), fluoroquinolones in 17.5% (n=73), Trimethoprim-Sulfamethoxazole in 46% (n=196) of cases and gentamicin in 12% (n=51) of cases. None of the strains were resistant to carbapenems. Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.

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

Background Post cardiac surgery mediastinitis is the major infectious complication, despite the development of surgical techniques and the application of strict preventive measures. The Haemophilus influenzae mediastinitis is very rare. The mediastinitis caused by the association between Haemophilus influenzae and Aggregatibacter aphrophilus has never been described to our knowledge. Case presentation We report the case of an exceptional combination of Haemophilus influenzae and Aggregatibacter aphrophilus in a patient operated for single bypass which is complicated by mediastinitis the 10th day after the surgical act. Conclusion The conclusion to be drawn from this work is to think in unusual seeds in case of mediastinitis post cardiac surgery for the elaboration of recommendations for antibiotic prophylaxis.

Brucellosis is the most frequent bacteria zoonosis in the world, with more than half a million new cases each year [1] . It is also the most significant zoonos in the edge of the Mediterranean Sea [2] . This zoonosis is capable of affecting humans and cause polymorphic clinical manifestations. In Morocco, the southern regions are the main affected areas [3] . We are reporting the observation of a 17-year-old male patient, who presented a febrile meningeal syndrome for 9 months without sensitivo-motor deficit. Tuberculosis is frequently evoked in such clinical presentations because Morocco is an endemic country, brucellosis is therefore often forgotten. The results of lumbar puncture, magnetic resonance imaging (MRI) and especially serology aided to conclude to a neuro-brucellosis. The outcome was favourable with antibiotic therapy.

Background This study aims to assess the susceptibility of Acinetobacter baumannii isolates to the antiseptics and disinfectants commonly used, and to the non-approved product. Methods This is a prospective study carried out from February to August 2015, in the Bacteriology department of Mohammed V Military Teaching hospital of Rabat on A.baumannii isolates collected from colonized and/or infected patients and environmental samples. The antiseptics and disinfectants susceptibility testing was assessed using the micromethod validated in our department. The antiseptics and disinfectants studied were: 70% ethyl alcohol, chlorhexidine, povidone-iodine, didecyldimethylammonium chloride and a commercial product which was presented as a hospital disinfectant (non-registered product). Results Povidone-iodine, 0.5% chlorhexidine digluconate, 70% ethyl alcohol and didecyl dimethyl ammonium chloride in combination with N- (3-aminopropyl) -N-dodecylpropane-1, 3-diamine were effective against all the 81 A.baumannii isolates tested, and their logarithmic reduction ≥ 5 were observed in 100% of the isolates in their undiluted form. The strains isolated from patients were more resistant than environmental strains: at a dilution of ½ for 70% ethyl alcohol (37.77% vs 11.11%, p = 0.007) and at a dilution of 1/10 (100% vs 69.44%, p

Background: The resistance to antimicrobial among patients with late Ventilator-associated pneumonia (VAP) has become increasingly more common in many ICUs in Morocco. There are scarce studies assessing VAP importance in Morocco. The aim of this study is to determine the bacterial ecology and resistance profile of late VAP in intensive care units in an academic hospital of Rabat. Methods: A total of 215 sputum samples were collected from endotracheal aspirate in patients with diagnosis of late VAP during the study period, defined from April 1st 2012 to April 2013. The bacteriology interpretations was done following the Referential of Medical Microbiology (REMIC 2010) and were quantitatively cultured with a cut-off of ≥ 10 UFC/ml for endotracheal aspiration samples. Results: Overall, the Gram-negative bacilli (GNB) represent 81.42% of isolates, while Gram-positive was less represented with a rate of 18.56%. Non-lactose fermenting GNB made up the half of pathogens with the rate of 55.23% and the prevalence of Enteric GNB reaches 26.19%. Pseudomonas aeruginosa is the most isolates with the rate of 28.57%, followed by Acinetobacter baumannii (24.76%), Staphylococcus aureus (9.5%) and Klebsiella pneumonia (8.09%). A high level of multi-drug resistance pathogens was found with a rate of 39.52%. They included Pseudomonas aeruginosa (14.28%), Acinetobacter baumannii (19.04%) and Klebsiella pneumonia (5.71%) whereas all S. aureus were methicillin-sensitive. Conclusion: The local bacterial pathogens isolates displayed high levels of antibiotic resistance. Enteric GNB naturally resistant to Polymyxin E and Corynebacterium species are likely to be emerging pathogens. This study significantly highlights the need to take into account these potentially drug-resistant isolates when making empiric antibiotic treatment.

Tuberculosis (TB) is a global public health problem endemic to Morocco. While extrapulmonary TB uncommonly presents in osteoarticular anatomic locations, tarsal or metatarsal osteitis can occur when TB presents in the tarsal bones. Clinical symptoms are often insidious causing a delay in diagnosis that may lead to bone destruction. While diagnosis can be guided by X-ray imaging, bacteriologic and histologic examination of the tissue allows for pathogen isolation, identification of the bacillus and strain sensitivity to antibacillary treatment.We report a rare case of navicular osteitis associated with tarso-metatarsal arthritis caused by tuberculosis in a 68-year-old man. This case illustrates an exceptional location of osteoarticular TB and support diagnostic difficulties encountered: (i) imaging is not specific; (ii) lesions are paucibacillary which reduces conventional microbiological methods sensitivity and (iii) the peripheral location of the Koch bacillus within the lesion dictates surgical biopsy than percutaneous puncture. We recommend testing for tuberculosis in any case of chronic osteolysis and/or arthritis of the foot, especially in TB endemic countries.

L’Arcanobactérium haemolyticum (A.haemolyticum) est un bacille à Gram positif. L’homme en est le principal réservoir. C’est un pathogène opportuniste essentiellement chez l’immunodéprimé, et qui peut être responsable d’infection au niveau de la peau et du pharynx chez les sujets sains, surtout chez les enfants et les adolescents. Il peut causer des surinfections des ulcères chroniques, et occasionnellement des infections invasives. Sa détection au niveau des cultures reste toujours difficile car il simule de nombreuses bactéries auxquelles il est souvent associé dans les produits pathologiques. Et Il n’existe pas de recommandations concernant l’étude sa sensibilité aux antibiotiques. Les bactériémies àArcanobactérium sont rares, à notre connaissance, seize cas ont été décrits dans la littérature. Nous rapportons, un autre cas de bactériémie à A.haemolyticum, secondaire à une surinfection d’escarres fessières.The Pan African Medical Journal 2016;25

Treatment ofAcinetobacter baumanniimeningitis is an important challenge due to the accumulation of resistance of this bacteria and low meningeal diffusion of several antimicrobial requiring use of an antimicrobial effective combination to eradicate these species. We report a case ofAcinetobacter baumanniimultidrug-resistant nosocomial meningitis which was successfully treated with intravenous and intrathecal colistin associated with rifampicin.

Objective Actinomyces spp. are often underestimated as causes of central nervous system infection because they are not looked for routinely and are difficult to detect. We try to determine the optimal management of these problematic intracranial infectious diseases in neurosurgical practice. Methods Five cases of intracranial suppurations due to Actinomyces spp. treated between December 2007 and February 2009 are reported. The relevant clinicobacteriologic features and treatment outcomes are analyzed. Results There were two brain abscesses, two subdural empyemas, and one frontal sinus pyomucocele with intracranial extension. Among them, three cases were previously operated and two patients were previously treated for otorhinolaryngeal infection. All cases were immunocompetent. In addition to Actinomyces sp., three patients had coinfectious bacteria ( Pseudomonas aeruginosa , Staphylococus warneri , and Escherichia coli ). Complete resolution of the infection was achieved by means of aggressive surgical treatment and relatively short course of antibiotic therapy with a full recovery. Conclusion Actinomycotic focal cerebral infections may occur with greater frequency than previously recognized. Polymicrobial bacteria may be seen. This rare anaerobic organism should be considered in patients with a history of head trauma, previous surgery, or otorhinolaryngeal infection who present with a long duration of neurologic symptoms with or without an accompanying fever. Patients may be candidates for surgical debridement with relative shorter term of antibiotic therapy (ciprofloxacin).

Background Escherichia coli (E. coli) is the most commonly isolated bacteria in human pathology. In Morocco the data concerning the nature and the rates of antibiotic resistance of E. coli in both hospitals and city environment remains relatively poor and needs further investigations. Methods During a 16 months period, E. coli isolates were collected from different culture specimens received in the Bacteriology Department of the Military teaching Hospital Mohammed-V-Rabat for routine diagnostic purposes. E. coli isolates were identified and their antimicrobial susceptibility pattern was determined. Results A total of 1369 E. coli isolates comprising 33 % (1369/4110) of culture-positive samples were consecutively collected. Isolates of E. coli were, in 40.5 % (554/1369) of cases from hospitalized patients and in 59.5 % (815/1369) of cases from outpatients. Urine isolates represented 82 % (1123/1369) of the cases. High rates of resistance were found for amoxicillin (42.5 %), cefalotin (30.4 %), norfoloxacin (29.9 %) and sulfamethoxazole (37.7 %). The detection rate of ESBL was 6.1 % (85/1369). In hospitalized patients 11.9 % of the isolates of E. coli (66/554) had an ESBL phenotype while in outpatients cases only 2.3 % of isolates of E. coli (19/815) had this phenotype. Conclusions Our findings suggest that more judicious use of antibiotics is needed especially in probabilistic treatment. The emergence of ESBL in the Moroccan cities is an indicator of the severity of this problem that is not limited to health care facilities.

Introduction : Analyse du profil bacteriologique des pieds diabetiques pris en charge a l'hopital militaire de Rabat et son influence sur l'antibiotherapie de premiere intention. Methodes : Etude prospective non randomisee etalee sur 18 mois, ayant concerne 105 patients. Apres recueil des donnees et en attente des resultats bacteriologiques nos patients ont ete divises en deux groupes: un groupe a ete mis sous Amoxicilline + Acide clavulanique + Gentamycine (59 patients) et un groupe sous Ertapeneme±Gentamycine (46 patients). Resultats : L'etude a regroupe 85 hommes et 20 femmes (sexe ratio=4.26). L'âge moyen est de 64.4 ans. La gangrene a ete observee chez 79% des malades ; elle etait humide-donc surinfectee en principe- dans 43% des cas. Par ailleurs, 67% des malades ont un chiffre de globules blancs 12000 definissant une infection severe. L'osteolyse a ete mise en evidence chez 27% de nos patients. Parmi les differentes techniques de prelevements: 81% ont ete profonds dont 21% de biopsie osseuse per operatoire et 14% de prelevements combines. 42% de ces prelevements sont poly microbiens et 21% sont steriles. Les resultats bacteriologiques viennent confirmer la predominance des bacteries aerobies a Gram positif. Le taux de remplacement de l'Ertapeneme est de 22% contre un taux de 50% pour l'Amoxiclav. Conclusion : L'antibiotherapie ne doit etre instauree qu'en cas d'infection du pied diabetique diagnostiquee sur les criteres cliniques etablis par les consensus internationaux recents. Le respect des mesures de lutte contre la diffusion de la resistance bacterienne s'avere primordiale.

We report a rare case of Corynebacterium bovis septicemia about a 65 year old man who received prolonged antibiotic treatment with colistin, imipenem and fosfomycin. We discuss in this work the circumstances of emergence of C. bovis infection through a literature review.

Mediastinitis is a rare and serious nosocomial complication of cardiac surgery. It is estimated at less than 2% of cases of median sternotomy. We report the case of a postoperative mediastinitis due to Candida tropicalis. A 9-month-old baby was operated for complete repair of tetralogy of Fallot in which we isolated C. tropicalis from sternal purulent fluid and blood culture. The child did not survive, despite the initiation of antifungal therapy. The management of this type of infection requires an early diagnosis and an appropriate prolonged treatment, associated with effective preventive measures.

Objective. To study the sensitivity level of extended spectrum beta-lactamase-producing Enterobacteriaceae to Carbapenems (Imipenem, Ertapenem) marketed in Morocco and discusses the place of Ertapenem in the treatment of extended spectrum-beta-lactamase-producing. Materials and Methods. A retrospective study of 110 extended spectrum beta-lactamase-producing Enterobacteriaceae. Isolates obtained from blood cultures, superficial and deep pus, and catheters were conducted. The minimum inhibitory concentrations of Imipenem and Ertapenem were done by the E-test. The modified Hodge test was conducted for resistant or intermediate strains. Results. 99.1% of isolates were susceptible to Imipenem. For Ertapenem, 4 were resistant and 4 intermediate. The modified Hodge test was positive for all 08 isolates. A minimum inhibitory concentration comparison of K. pneumoniae, E. cloacae, and E. coli for Imipenem has noted a significant difference between E. cloacae on one hand and E. coli, K. pneumoniae on the other hand ( 𝑃 < 0 . 0 1 ). No significant difference was noted for minimum inhibitory concentration of Ertapenem. Conclusion. Our results confirm in vitro effectiveness of Ertapenem against extended spectrum beta-lactamase-producing Enterobacteriaceae as reported elsewhere. However, the emergence of resistance to Carbapenems revealed by production of carbapenemases in this study confirmed a necessary bacteriological documented infection before using Ertapenem.