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Motivated by the problem (1.1) in [5], in this paper, we prove the existence and uniqueness of solutions for the following system of fractional differential equations with four point boundary conditions:$$\left\{\begin{array}{l}D^\alpha x(t)+f\left(t, y(t), D^\delta y(t)\right)=0, t \in J \\D^\beta y(t)+g\left(t, x(t), D^\sigma x(t)\right)=0, t \in J \\x(0)=y(0)=0, x(1)-\lambda_1 x(\eta)=0, y(1)-\lambda_1 y(\eta)=0 \\x^{\prime \prime}(0)=y^{\prime \prime}(0)=0, x^{\prime \prime}(1)-\lambda_2 x^{\prime \prime}(\xi)=0, y^{\prime \prime}(1)-\lambda_2 y^{\prime \prime}(\xi)=0\end{array}\right.$$where $3

Objectif?: Mesurer l’incidence des bacteriemies nosocomiales (BN) dans les services a haut risque et decrire les portes d’entree, les germes et l’evolution clinique.Methodes?: Une etude longitudinale a ete menee du 1er mars au 31 mai 2005 dans six services a haut risque du CHU de Casablanca.Resultats?: Au total, 61 BN ont ete diagnostiquees, 34,4 % des patients sont decedes. L’incidence cumulee etait de 9,60 % en reanimation adulte, 2,70 % en reanimation pediatrique et 6,46 % en hemato-oncologie. Dans 5 % des cas, la bacteriemie etait reliee a la presence d’un catheter veineux central. Les germes les plus frequents etaient Staphylococcus coagulase negative (19,3 %) et Acinetobacter baumanii (13,2 %).Conclusion?: L’incidence retrouvee etait elevee et la mortalite forte, concordantes avec celles des pays en developpement. Ces resultats permettront de mettre en place un programme de prevention cible et d’evaluer l’efficacite des interventions.Prat Organ Soins. 2012;43(1):19-24

A previous study showed that B:4:P1.15 was the most frequent phenotype of Neisseria meningitidis isolated in Casablanca (Morocco). To determine if there was an epidemic clone, MLST and PFGE were used to compare 13 B:4:P1.15 strains isolated from September 1999 to December 2000. MLST showed 4 Sequence Types (ST): ST-33 was the most frequent ST (9/13 strains) and 4 strains belonged to 3 newly described STs. Twelve stains belonged to ST-32 complex, and one strain presenting a new ST (ST-2502) did not belong to any known ST complex. The analysis by PFGE showed that the strains were subdivided into 7 clusters, and that there was no epidemic clone. MLST is useful for long-term epidemiological studies on N. meningitidis strains from varied geographical origins. PFGE seemed to be well adapted to the comparison of a small number of strains isolated during a short period within a defined community.

Twenty-nine extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae strains (14 Klebsiella pneumoniae, 10 Escherichia coli and five Citrobacter diversus) isolated from April to July 1996 from faecal carriers in a surgical intensive care unit at the university hospital of Casablanca (Morocco) were studied. Plasmid content and DNA macrorestriction polymorphism determined by pulsed-field gel electrophoresis (PFGE) were used to compare the strains. Restriction profiles of total genomic DNAs cleaved by XbaI and compared by PFGE revealed nine, four and two clones in K. pneumoniae, E. coli and C. diversus, respectively. Plasmid profile analysis of ESBL-producing strains of K. pneumoniae showed that only seven of 14 isolates had a plasmid; four different plasmid profiles were observed. Three different plasmid profiles were observed in E. coli and two in C. diversus. Plasmids responsible for ESBL production could be transferred by conjugation to E. coli K(12) J53-2 from all E. coli isolates and from four of seven K. pneumoniae. No plasmid transfer could be obtained from C. diversus strains. Restriction enzyme digests of plasmids from transconjugants (four transconjugants of K. pneumoniae and five transconjugants of E. coli) showed different patterns. In the surgical intensive care unit where the survey was conducted, the dissemination of ESBLs was due to a mix of strain spread and strain diversity rather than to plasmid dissemination.

An experimental investigation and a detailed kinetic model of the bulk free radical polymerization of styrene initiated by diperoxyester initiators are presented. The experiments were conducted through the full conversion range at various temperatures and initiator concentrations. It is shown that the employing of such initiators leads to the formation of polymers having substantially higher molecular weight and narrower molecular weight distribution than those obtained by the conventional monofunctional initiators. The current investigation has also found that high monomer conversion and high molecular weight can be obtained simultaneously within a reduced reaction time period. Model predictions were compared with experimental data and were found to be in agreement.

We report here an evaluation of the dissemination of nim genes, encoding 5-nitroimidazoles resistance, among Bacteroides clinical strains isolated in Morocco. This study was done using a PCR method. Among 60 strains studied, nine contain a copy of a nim gene. The sequence determination of these genes showed that they are homologous to three nim genes previously characterized in strains isolated in France: nimB (five genes), nimC (three genes), and nimA (one gene). Although the nimA and nimC genes were previously identified on plasmids pIP417 and pIP419, respectively, we found here that they have a chromosomal location. The MICs of three 5-nitroimidazole antibiotics (metronidazole, ornidazole, and tinidazole) of the nim gene-containing strains were very low (0.5-2 microg/ml), indicating that the nim genes were not efficiently expressed in these clinical isolates.

Resume Objectif – Nous rapportons la resistance a 11 antibiotiques de 156 souches de Staphylococcus aureus isolees a partir d'infections communautaires et de 189 isolees d'infections hospitalieres durant deux periodes au centre hospitalo-universitaire Ibn Rochd de Casablanca. Materiel et methodes – La resistance a la methicilline a ete detectee par screening en milieu gelose additionne de 6 mg/L d'oxacilline. La resistance aux autres antibiotiques a ete determinee par la technique de diffusion selon les normes NCCLS. Resultats – La resistance a la methicilline etait de 1,9% et de 45% chez S. aureus isole des infections communautaires et des infections hospitalieres respectivement. Les SARM sont multiresistants (gentamicine 84,7%, cotrimoxazole 51,2%, erythromycine 44,7%, acide fucidique 45,9%, ciprofloxacine 83,5%), et ont ete frequemment retrouvees dans les services de chirurgie (46,2%) durant la premiere periode et dans les unites de soins intensif (61%) durant la seconde periode. Les souches sont le plus souvent isolees a partir des hemocultures (34,1%), du pus (34,6%) et des pelevements bronchiques (27,1%).

Objective: Resistance of Enterococcus faecalis to antibiotics has considerably increased and led to therapeutic difficulties. The purpose of our study is to specify the factors of risk of the Enterococcus faecalis infection in a neonatal intensive care unit and to determine the sensitivity of isolate strains. Methods: We retrospectively analyzed 29 cases, collected during 1996 and 1997. Two groups were compared according to χ2 test: group 1 (acquisition of Enterococcus faecalis infection), group 2 (asymptomatic bacteremia). The determination of isolate strains was based on the method of disks. Results: The dominant clinical picture was severe in 38% ( 11 29 ) of the cases. In 31% ( 9 29 ) of cases, neurologic symptomes were predominant, and in 28% ( 8 29 ) a respiratory distress was observed. The risk factors for acquiring an Enterococcus faecalis infection were the administration of large spectrum antibiotics in 14 15 (93%) for group 1 vs 6 14 (43%) for group 2, and the frequent use of buccopharyngeal aspirations: 6 15 (40%) for group 1 vs 1 14 (7%) for group 2. Enterococcus faecalis were resistant to penicillin G in 50%, to amoxicillin in 34%, and exhibited a high level of resistance to gentamicin in 87%; no case of resistance to vancomycin was observed. Mortality rate was 20% ( 3 15 ) in group 1 and 7% ( 1 14 ) in group 2. Conclusion: Enterococcus faecalis is a frequent cause of septicemia in critically ill newborns. The prevention of nosocomial infection by using the hygiene measures and a rational prescription of the antibiotics is underlined.

Resume Introduction Les concentres plaquettaires contamines sont une cause de septicemie liee a la transfusion. L'incidence varie de 0 a 10 % selon les etudes. Le but de ce travail est de faire une etude prospective sur la prevalence de la contamination bacterienne des unites plaquettaires standards preparees au Centre regional de transfusion sanguine de Casablanca. Materiel et methode Durant 15 mois et demi, 3 458 concentres de plaquettes standards ont ete analyses. Apres homogenisation entre le contenu de la poche et le boudin, un cinquieme du boudin contenant du concentre plaquettaire a ete preleve chaque jour durant cinq jours et inocule dans deux tubes contenant 2,5 mL de bouillon tryptocaseine soja. L'un est incube a 37 °C, l'autre a temperature ambiante pendant 24 heures. L'identification des germes a ete realisee par des methodes bacteriologiques standards. Resultat Vingt-cinq (0,72 %) des 3458 concentres de plaquettes standards se sont reveles contamines; 22 (88 %) d'entre eux avaient ete stockes trois jours ou plus. Les bacteries retrouvees sont: 14 Staphylococcus coagulase negative, deux Staphylococcus aureus, un Streptococcus alphahemolytique, quatre Bacillus cereus, un Enterobacter cloacae, un Escherichia coli et deux Xanthomonas maltophilia. Conclusion L'incidence rapportee dans cette serie (0,72 %) est superieure a celle rapportee par la plupart des auteurs (0,02–0,11 %). Cela est du au fait qu'il s'agit d'une analyse prospective systematique en dehors de tout signe clinique d'appel.

During 1994, 10 isolates of extended-spectrum β-lactamase-producing Salmonella typhimurium were recovered from children transferred to our hospital from two different centers. Two additional isolates were recovered from two nurses from one of these centers. The aim of this study was to determine if there is any relationship between these isolates. The characterization was done by phenotypic and genotypic methods: biotyping, phage typing, antibiotic susceptibility pattern determination, plasmid analysis, ribotyping (by the four endonucleases Eco RI, Sma I, Bgl II, and Pvu II), pulsed-field gel electrophoresis (PFGE) of genome macrorestriction patterns with Xba I, and randomly amplified polymorphic DNA (RAPD) pattern determination (with the three primers 217 d2, B1, and A3). The same biotype, the same serotype, and an identical antibiotype were found. All isolates were resistant to oxyimino-β-lactams, gentamicin, tobramycin, and sulfamethoxazole-trimethoprim. All isolates showed an indistinguishable pattern by ribotyping and very similar patterns by PFGE and RAPD. The overall results indicated the spread of a closely related strain of S. typhimurium in children and nurses.

Resume Les septicemies communautaires a Pseudomonas aeruginosa sont rares chez le nourrisson sans deficit immunitaire apparent. Dans une etude retrospective de cinq cas colliges entre 1988 et 1994 dans le service de maladies infectieuses pediatriques du centre hospitalier de Casablanca, nous avons etudie quelques aspects cliniques, therapeutiques et evolutifs de cette infection souvent fatale. L'âge moyen etait de 6 mois, avec quatre filles pour un garcon. L'ecthyma gangrenosum etait present chez tous les malades. P. aeruginosa a ete isole chez tous les malades au niveau du sang et deux fois au niveau du liquide cephalorachidien. Il etait toujours sensible a la ceftazidime et n'etait resistant a la gentalline qu'une fois sur cinq. Trois deces par choc septique ont ete observes.

Resume Notre etude rapporte 94 cas de MNN bacteriennes observees sur une periode de 10 ans (1985–1994). La meningite purulente represente 8 % de l'ensemble de la pathologie infectieuse neonatale hospitalisee au cours de la meme periode. Le tableau clinique a l'admission est particulierement severe comportant des signes de MNN dans 38 cas (40 %), un tableau de septicemie neonatale dans 9 cas (10 %) et un tableau d'infection neonatale dans 47 cas (50 %) comportant des signes peu specifiques. L'etude du liquide cephalo-rachidien confirme le diagnostic en montrant un liquide le plus souvent purulent, trouble ou louche dans 60 cas (64 %). L'examen direct, la culture et la recherche des antigenes solubles au niveau du LCR permettent d'isoler le germe en cause dans la plupart des cas. L'origine de l'infection peut etre soit maternelle debutant la plupart du temps dans les 4 premiers jours de vie (MNN precoce) dont les germes en cause sont des BGN dans 20 cas/22, soit 90 %, soit exogene debutant au-dela des 4 premiers jours de vie (MNN tardive) dont les germes en cause sont les BGN (43 %), le streptocoque B (29 %) et la Listeria (11 %). Il ressort de cette etude que le retard du diagnostic, la virulence du germe, la prematurite et l'hypotrophie sont des elements de mauvais pronostic. Il est donc necessaire d'entrevoir une strategie de prevention des meningites neonatales. Celle-ci reside dans la surveillance des grossesses et l'amelioration des conditions d'accouchement.

The objective of this study was to describe the evolution over time of serotypes and antimicrobial resistance of Streptococcus pneumoniae isolates responsible for invasive pneumococcal disease (IPD) in children ≤5 years in Casablanca (Morocco), before vaccine introduction. Isolates recovered from cases of IPD in children ≤5 years during two study periods (1994–2001 and 2006–2010) were compared in terms of serotypes and antimicrobial susceptibility. Serogrouping was done using Pneumotest Kit and serotyping was done by the Quellung capsular swelling. Antibiotic susceptibility pattern was determined by Etest method. The theoretical coverages of the 7-, 10- and 13-valent pneumococcal vaccines were determined. A total of 85 and 102 isolates were studied for the two periods, respectively. During the first period, the most prevalent serogroups/serotypes were 5, 7, 1, 14, 6, 23, 19, 2, 15 and 18, whereas during the second study period, the most frequent were 19, 14, 6, 23, 5, 1 and 18. From 2006 to 2010, serotype 19A accounted for 7.8% of the isolates, whereas serogroups 33 and 22 were rarely isolated (1% each). Assuming cross protection among serogroups, the respective coverage rates for the first vs. second periods reached 40% vs. 53.9% for PCV7, 74.1% vs. 71.6% for PCV10 and 75.3% vs. 82.4% for PCV13. The prevalence of penicillin-nonsusceptibility increased (22.4% vs. 48.5%) as well as the levels of penicillin-resistance (5.9% vs. 15.8%). Penicillin-nonsusceptibility was relatively low across both study periods in serogroups 7, 15, 1 and 5, whereas it was high in serogroups 14, 19 and 23. In conclusion, serotype fluctuations and increases in antibiotic resistance of S. pneumoniae occurred in Casablanca before vaccine introduction. Both of these variations are probably linked to the increase in antibiotic use that has occurred in Casablanca over time. There is a need for a continuous surveillance to assess the vaccine formulations, monitor vaccine impact and to guide treatment recommendations.

To analyze trends of antibiotic resistance rates in Streptococcus pneumoniae from 1998 to 2008 in Casablanca (Morocco).The antibiotic resistance levels of 955 consecutive nonduplicate isolates were studied using E test and disc diffusion methods. Results were interpreted following Clinical and Laboratory Standards Institute guidelines (2005). Analysis was done according to three periods (1998-2001; 2002-2005; 2006-2008), age, and site of infection.Penicillin nonsusceptibility (PNS) increased significantly over time (15.6%, 17.8%, and 24.8%; p=0.003). Levels of PNS have changed as well: in 2006-2008, 9.1% of the isolates had an MIC ≥2 μg/ml versus 7.7% in 2002-2005 and 3.4% in 1998-2001. The PNS increase was particularly marked in pediatric isolates (21.4%, 25.5%, and 43.3%; p=0.001). There was no significant difference between the rates of PNS in invasive and noninvasive isolates from children, whereas in adults noninvasive isolates were more penicillin nonsusceptible. Amoxicillin and ceftriaxone nonsusceptible isolates were very rare. An increase of resistance rates was also noticed for erythromycin (9.4%, 12.2%, and 14.4%), tetracycline (20%, 18.6%, and 30.5%), and chloramphenicol (5.6%, 5.6%, and 8.1%). Trimethoprim-sulfamethoxazole resistance rates remained stable (22.8%, 20%, and 23.8%). Proportions of dual nonsusceptibility to penicillin and erythromycin, increased from 5.6% to 8.9%. Multiple drug resistance (resistance to 3 or more antibiotic classes) was found in 0%, 2.4%, and 7.7% of all isolates, respectively.The results reported here maybe useful for guiding update of treatment recommendations and suggest the need for continuous surveillance. Increase of antibiotic resistance correlated with antibiotic consumption, stressing the need for elaboration of antibiotic policy in Morocco.

Worldwide spread of antibiotic resistance in Streptococcus pneumoniae is a major problem. However, data from West and North African countries are scarce. To study the level of resistance and compare the situations in different cities, a prospective study was conducted in Abidjan (Ivory Coast), Casablanca (Morocco), Dakar (Senegal), and Tunis (Tunisia), from 1996 to 1997. The resistances to eight antibiotics of 375 isolates were studied by E test, and the results were interpreted using the breakpoints recommended by the National Committee for Clinical Laboratory Standards. Overall, 30.4% of the isolates were nonsusceptible to penicillin G (25.6% were intermediate and 4.8% were resistant). Amoxicillin (96.3% were susceptible) and parenteral third-generation cephalosporins (92.7%) were highly active. Resistance to chloramphenicol was detected in 8.6% of the isolates. High levels of resistance were noted for erythromycin (28%), tetracycline (38.3%), and cotrimoxazole (36.4%). Resistance to rifampin was rare (2.1%). There were significant differences in resistance rates between individual countries. Multiple resistance was more frequent in penicillin-nonsusceptible isolates than in penicillin-susceptible isolates. Recommendations for treatment could be generated from these results in each participating country.

A total of 2,725 healthcare workers in 8 Mediterranean countries replied to a self-assessment questionnaire that assessed their perceptions on hand hygiene. Responses revealed that rates of hand hygiene compliance before patient contact were significantly less than rates after patient contact (P < .001) and that use of soap and water was preferred over use of alcohol-based hand rub. These findings suggest that self-protection could be a major subliminal driver for performance of hand hygiene.

A structured self-assessment questionnaire was distributed to 8 southern and eastern Mediterranean hospitals to identify perceived obstacles to hand hygiene (HH). An insufficient number of sinks and alcohol handrub stations was rated by the vast majority of respondents as the most critical impediment, whereas improved availability of HH products was deemed the key intervention to increase compliance. The least importance and relevance were given to HH auditing and collegial reminders. While initiatives to improve HH compliance clearly must address infrastructural inadequacies, sociocultural issues also need to be considered when transposing initiatives found to be successful in Western countries to less-developed regions, to ensure that campaigns are not compromised by perceptual undercurrents.

The Mediterranean region has been identified as an area of hyper-endemicity for multi-resistant hospital pathogens. To better understand potential drivers behind this situation, we attempted to correlate already published meticillin-resistant Staphylococcus aureus (MRSA) data from 27 hospitals, participants in the Antibiotic Resistance Surveillance & Control in the Mediterranean Region (ARMed) project, with responses received from the same institutions to questionnaires which dealt with various aspects of infection control and antibiotic stewardship. No difference could be ascertained between high and low prevalence hospitals in terms of scores from replies to structured questions regarding infection control set-up, hand hygiene facilities and antibiotic stewardship practices. However, we did identify differences in terms of bed occupancy and isolation facilities. Hospitals reporting frequent episodes of overcrowding, particularly involving several departments, and which found regular difficulties sourcing isolation beds, had significantly higher MRSA proportions. This suggests that infrastructural deficits related to insufficient bed availability and compounded by inadequate isolation facilities could potentiate MRSA hyper-endemicity in south-eastern Mediterranean hospitals.

The prevalence of multiply resistant organisms (MROs) reported from south-eastern Mediterranean hospitals highlights the need to identify possible contributory factors to help design control interventions. This was investigated through a structured questionnaire, which examined infection control and antibiotic stewardship practices in hospitals participating or collaborating with the Antibiotic Resistance SurveilLance & Control in the Mediterranean Region (ARMed) project. A total of 45 hospitals (78.9% of invited institutions) responded to the questionnaire; 60% indicated that they faced periods of overcrowding when available bed complement was insufficient to cope with hospital admissions and 62% reported difficulties in isolating patients with MROs due to lack of available beds. Most hospitals relied mainly on washing to achieve hand hygiene, whether by non-medicated or disinfectant soaps. Dependence on solid bars of soap (28.9%) and cloth towels (37.8%) were among the problems identified as well as inconvenient distances of sinks from patient beds (66.6%). Alcohol hand rub was the predominant hand hygiene product in only 7% of hospitals. Programmes for better antibiotic use were mostly limited in scope; 33.3% reported having antibiotic prescribing guidelines and 53.3% of hospitals fed back resistance rates to prescribers. Auditing of antibiotic consumption, whether institution- or unit-based, was carried out in 37.8% of responding hospitals. Multi-faceted approaches aimed at improving isolation of patients with MROs, increasing the emphasis on hand hygiene by encouraging greater use of alcohol hand rubs and introducing effective antibiotic stewardship programmes should be encouraged in south-eastern Mediterranean hospitals.

Using IS6110 RFLP, 61 isolates recovered from new cases of pulmonary tuberculosis (TB) were compared from September to December 1999 in Casablanca, Morocco, a city with a high incidence of TB. The majority of the isolates (92%) harboured 6-14 copies of IS6110. The minimal fraction of patients in groups of recently acquired infection is 13.1%. This preliminary study showed that IS6110 RFLP is a suitable method for finger-printing Mycobacterium tuberculosis in Casablanca. The unexpectedly low level of recent transmission of TB found in this study deserves further studies involving higher numbers of isolates recovered during a longer recruitment period.

Summary Introduction The increased incidence of nosocomial infections by multi-drug resistant Acinetobacter baumannii creates demand on the application of some combinations of older antimicrobials on that species. We conducted the present observational study to evaluate the efficacy of intravenous and aerosolized colistin combined with rifampicin in the treatment of critically patients with nosocomial infections caused by multiresistant A. baumannii . Patients and methods Critically ill patients with nosocomial infections caused by A. baumannii resistant to all antibiotics except colistin in a medical intensive care unit. Diagnosis of infection was based on clinical data and isolation of bacteria. The bacterial susceptibilities to colistin were tested. Clinical response to colistin+rifampicin was evaluated. Results Twenty-six patients (43.58±18.29 years, Acute Physiology and Chronic Health Evaluation II Score (APACHE II): 6.35±2.99), of whom 16 cases of nosocomial pneumonia treated by aerosolized colistin (1×10 6 IU three times/day) associated with intravenous rifampicin (10mg/kg every 12h), nine cases of bacteraemia treated by intravenous colistin (2×10 6 IU three times/day) associated with intravenous rifampicin (10mg/kg every 12h) in which three cases associated with ventilator associated pneumonia and one case of nosocomial meningitis treated by intrathecal use of colistin associated with intravenous rifampicin. The clinical evolution was favourable for all ill patients. Concerning side effects, we have noticed a moderate hepatic cytolysis in three patients. Conclusion This is the first clinical report of colistin combined with rifampicin for treatment of A. baumannii infection. Despite the lack of a control group and the limited number of patients, the results seem to be encouraging.

A previous study showed that B:4:P1.15 was the most frequent phenotype of Neisseria meningitidis isolated in Casablanca (Morocco). To determine if there was an epidemic clone, MLST and PFGE were used to compare 13 B:4:P1.15 strains isolated from September 1999 to December 2000. MLST showed 4 Sequence Types (ST): ST-33 was the most frequent ST (9/13 strains) and 4 strains belonged to 3 newly described STs. Twelve stains belonged to ST-32 complex, and one strain presenting a new ST (ST-2502) did not belong to any known ST complex. The analysis by PFGE showed that the strains were subdivided into 7 clusters, and that there was no epidemic clone. MLST is useful for long-term epidemiological studies on N. meningitidis strains from varied geographical origins. PFGE seemed to be well adapted to the comparison of a small number of strains isolated during a short period within a defined community.

Fast, accurate diagnosis is necessary for rapid treatment of patients and to prevent the spread of Mycobacterium tuberculosis strains. The rate of recovery, mean time to detection and contamination rates of the Mycobacteria Growth Indicator Tube (MGIT) were compared with Lowenstein-Jensen (LJ) medium for mycobacterial cultures performed on 405 clinical specimens decontaminated by the trisodium phosphate method without benzalkonium chloride. The recovery rate of M. tuberculosis using MGIT was 45/61 (73.8%) compared with the reference LJ. The mean times to detection of M. tuberculosis in smear-positive specimens were 11.9 days with MGIT and 20 days with LJ. For smear-negative samples, the mean times were respectively 18.6 and 31 days, and the contamination rates were respectively 4% and 1.2%. When the trisodium phosphate decontamination method is used, MGIT cannot be used alone for isolation of mycobacteria, but may be used in combination with LJ.

Since antigenic characterization and antibiotic susceptibility testing are useful for generating prophylactic recommendations and treatment guidelines, a total of 163 Neisseria meningitidis isolates obtained between January 1992 and September 2000 at the microbiology laboratory of the IbnRochd University Hospital of Casablanca, Morocco, were serogrouped, serotyped, serosubtyped and tested for their susceptibility to five antibiotics. Serogroup B was detected most frequently (75.5%), followed by serogroup A (13.5%). The phenotype B:4:P1.15 represented 74.8% of all serogroup B isolates. Seven (4.3%) isolates demonstrated decreased susceptibility to penicillin G. All isolates tested were susceptible to cefotaxime, chloramphenicol and rifampin. All isolates were inhibited by spiramycin at a concentration of 0.4 mg/l.

Isolates of extended-spectrum beta-lactamase (ESBL)-producing Salmonella typhimurium were recovered from children admitted to the IbnRochd University Hospital of Casablanca in 1994. These isolates produced TEM-3 as shown by PCR, isoelectric focusing and sequencing. Production of TEM-3 and resistance to gentamicin were encoded by a 10 kb plasmid that could be transferred by conjugation and transformation. This report extends the list of ESBLs produced by S. typhimurium and stresses the need for continuous surveillance of non-typhoidal Salmonella to adapt antibiotic treatment and preventive measures.

The serotypes and the levels of antibiotic resistance of 59 Streptococcus agalactiae isolates from neonates in Casablanca, from February 1992 to July 1997, were studied. Most of the isolates (86.4%) were recovered from early-onset disease. The serotype distribution was as follows: serotype III 39%; serotype Ia 32.2%; and serotype V 10.2%. All strains were susceptible to penicillin G, cefotaxime and ampicillin, whereas 1 strain was resistant to erythromycin. No high level of resistance to gentamicin was detected. A vaccine should comprise the most prevalent serotypes and also provide protection against serotype V disease. The antibiotic susceptibility patterns reported here support the recommended treatment and prophylaxis of invasive group B Streptococcal disease.

Platelet concentrates contaminated with bacteria are a main source of transfusion-associated sepsis. Several studies have reported a very wide incidence (0-10%) of contamination. The aim of this study is to assess the prevalence of bacterial contamination of standard platelet units at the regional blood transfusion center in Casablanca.During 15.5 months, 3,458 platelet concentrates (PCs) were analysed. The plasma from the bag and the tube was homogenised. One-fifth of the tube contents were inoculated every day for five days in two tubes containing 2.5 mL of Tryptic soy broth. One tube was incubated at room temperature and the other at 37 degrees C for 24 hours. The bacteria were identified by standard procedures.Twenty-five (0.72%) of 3,458 platelet bags were contaminated. Twenty-two bacteria (88%) were found in the platelet bags stored three days or more, of which 14 (56%) were Staphylococci coagulase negative, two Staphylococcus aureus, one alpha-haemolytic Streptococcus, four bacillus cereus, one Enterobacter cloacae, one Escherichia Coli and two Xanthomonas maltophilia.The incidence reported in this series is higher than that reported by most authors.

Extended-spectrum b-lactamases (ESBLs) derive mainly from TEM and SHV b-lactamases. These enzymes confer resistance to all oxyimino cephalosporins and monobactams except cephamycins and carbapems. ESBLs are often encoded by large plasmids that carry resistance determinants to multiple antibiotics and spread among the members of the Enterobacteriaceae. Since the first outbreak of Klebsiella pneumoniae expressing an extended-spectrum beta-lactamase reported in 1984, nosocomial infections due to Enterobacteriaceae species which produce ESBLs have been generally recovered from patients hospitalized in intensive care units. The most frequently isolated ESBL-producing strains belong to the genus Klebsiella, Escherichia, Enterobacter and Proteus; ESBLs are rarely associated with the genus Salmonella. The first Salmonella were detected in France in 1984 (Salmonella typhimurium), in Tunisia in 1988 (Salmonella wien) and in Argentina in 1991 (Salmonella typhimurium). In 1994, 10 isolates of Salmonella typhimurium expressing an extended-spectrum beta-lactamase were isolated for the first time from 10 children hospitalized in a pediatric unit of the hospital Ibn-Rochd, Casablanca. Previous study showed that all isolates belonged the same serotype, and biotype, and showed a resistance to oxyimino beta-lactams, gentamycin, tobramycin and trimethoprim-sulfamethoxazole but remained susceptible to tetracycline, chloramphenicol and quinolones. Oxyimino beta-lactams resistance determinant of all strains of Salmonella typhimurium was transferred by conjugation to Escherichia coli; Resistance to gentamycin and trimethoprim-sulfamethoxazole was also cotransferred. In this study, we characterized the relationship between all isolates by comparing plasmid profiles and patterns of proteins because there appear to be the more effective method for evaluating epidemiologic relationship between Salmonella species, and the protein profiles method has been used for many bacterial species. These two methods have the advantages of speed and simplicity. All isolates presented the same plasmid pattern characterised by three plasmids and the same pattern of proteins composed of 36 bands. We concluded by combining results that this outbreak involved the spread of the same strain of Salmonella typhimurium between the ten children. As this type of resistance is easily transferred by these isolates to other bacterial species, the major risk would be its transfer to Salmonella typhi.

Sporadic reports from centres in the south and east of the Mediterranean have suggested that the prevalence of antibiotic resistance in this region appears to be considerable, yet pan-regional studies using comparable methodology have been lacking in the past. Susceptibility test results from invasive isolates of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Enterococcus faecium and faecalis routinely recovered from clinical samples of blood and cerebrospinal fluid within participating laboratories situated in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey were collected as part of the ARMed project. Preliminary data from the first two years of the project showed the prevalence of penicillin non-susceptibility in S. pneumoniae to range from 0% (Malta) to 36% (Algeria) [median: 29%] whilst methicillin resistance in Staphylococcus aureus varied from 10% in Lebanon to 65% in Jordan [median: 43%]. Significant country specific resistance in E. coli was also seen, with 72% of isolates from Egyptian hospitals reported to be resistant to third generation cephalosporins and 40% non-susceptible to fluoroquinolones in Turkey. Vancomycin non-susceptibility was only reported in 0.9% of E. faecalis isolates from Turkey and in 3.8% of E. faecium isolates from Cyprus. The preliminary results from the ARMed project appear to support previous sporadic reports suggesting high antibiotic resistance in the Mediterranean region. They suggest that this is particularly the case in the eastern Mediterranean region where resistance in S. aureus and E. coli seems to be higher than that reported in the other countries of the Mediterranean.

Resume Vingt malades adultes atteints de meningite purulente ont recu un traitement a base d'amoxicilline a raison de 1,5 g par voie intraveineuse en 2 injections espacees de 4 heures, puis par voie orale a la dose de 150 mg/kg/jour des la 8eme heure. L'apyrexie a ete obtenue en 5,4 jours en moyenne. La duree du traitement est de 7,4 jours en moyenne. L'evolution est favorable dans tous les cas et tous les malades guerissent sans sequelles ; aucune rechute n'a ete notee. Les taux d'amoxicilline rachidiens (pics et taux residuels) sont superieurs aux CMI des germes habituellement responsables des meningites purulentes de l'adulte. Ce relais oral precoce peut avoir un interet en cas d'abord veineux difficile ou en cas de foyers epidemiques.

The pharmacokinetics of amoxycillin in the CSF following intravenous and oral administration at a 150 mg/kg per day or 250 mg/kg per day dosage in the treatment of purulent meningitis is described. A significant correlation between meningeal inflammation and CSF levels of amoxycillin were observed, including a correlation between the initial neurological state and the outcome of the Illness. Despite the early introduction of oral therapy and the reduction in dosage following meningeal and pneumococcal meningitis, no treatment failures could be attributed to this therapeutic regime. Such a treatment schedule, moreover, reduces the risk of superinfection in hospital as well as the cost of treatment and aids the comfort to the patient. La pharmacocinétique de l'amoxicilline dans le liquide céphalo-rachidien suivant des administrations intra-veineuses et orales de 150 mg/kg/j ou 250 mg/kg/j lors des méningites purulentes est décrite. Une corrélation significative entre l'inflammation méningée et les taux intra-rachidiens d'amoxicilline, de même entre l'état neurologique initial et l'issue de la maladie sont observées. En dépit de la précociteé du relais oral, et de la réduction des posologies lors des méningites à méningocoque, et pneumocoque, aucun échec ne peut être attribué à ce protocole thérapeutique. Ce protocole efficace réduit de plus les risques de surrinfections hospitalières et le coût du traitement, et augmente le confort du malade.

The immunological detection of soluble pneumococcal polysaccharide antigens in pathological products is of importance in the direct diagnosis of meningitis or pulmonary infections. We have developed a double antibody sandwich ELISA method using a biotin-avidin system using antibodies constituted with a mixture of IgGs from pooled and/or monospecific antipneumococcal sera provided by the Danish Statens Seruminstitut. The sensitivity of this rapid ELISA method was optimized with purified capsular polysaccharides of the 24 main pneumococcal serotypes. With incubation steps of 30 min at 37 degrees C for the antigens and the conjugates, the detection limit was close to 1 ng/ml for 75% of the purified polysaccharides. A retrospective study of 46 CSF samples established the validity of the assay. This type of modified ELISA system represents a specific, sensitive and rapid procedure for the potential detection of capsular soluble antigens of all pneumococcal serotypes.

Resume Le but de cette etude prospective est d'estimer le taux de colonisation de la femme marocaine par Listeria monocytogenes et pr Streptoccocus agalactiae. Malgre l'utilisation de techniques fines, aucune souche de L. monocytogenes n'a ete isolee a partir de 261 prelevements. Le taux de portage global de streptocoque B est de 20,7%. L'influence de differents facteurs (grossesse, âge de la grossesse, contraception, partie du cycle) sur le portage est analysee. Le traitement des infections dues au streptocoque B est discute grâce aux resultats des tests de sensibilite aux antibiotiques. A la lumiere d'une revue de la litterature, la prophylaxie est analysee.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs≤4mg/L. The isolates were also highly sensitive to ciprofloxacin, except in Kenya, Morocco, and Tunisia, where relative resistance to this drug was noted. Susceptibility to rifampin and fusidic acid seems to be correlated with the clinical use of these compounds. Only 46% of 59 MRSA strains analyzed were susceptible to rifampin, fusidic acid, and ciprofloxacin. The majority (>60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

Measurement of cerebrospinal fluid lactic acid by an enzymatic test has been evaluated in 164 patients. The upper limit of normal CSF lactate was 300 mg/l. The CSF lactate level is useful for differential diagnosis between partially treated pyogenic meningitis and tuberculous meningitis. The increase of CSF lactate is not specific for meningitis and must be interpreted taking into account the clinical situation.

The pharmacokinetics of amoxycillin in the CSF following intravenous and oral administration at a 150 mg/kg per day or 250 mg/kg per day dosage in the treatment of purulent meningitis is described. A significant correlation between meningeal inflammation and CSF levels of amoxycillin were observed, including a correlation between the initial neurological state and the outcome of the illness. Despite the early introduction of oral therapy and the reduction in dosage following meningeal and pneumococcal meningitis, no treatment failures could be attributed to this therapeutic regime. Such a treatment schedule, moreover, reduces the risk of superinfection in hospital as well as the cost of treatment and aids the comfort to the patient.

Pefloxacin, which has been shown to have a high in vitro activity against Salmonella spp., was compared to cotrimoxazole in the treatment of typhoid fever in adults. In a prospective, randomized trial, 42 patients with bacteriologically documented typhoid fever received either 400 mg pefloxacin b.i.d. or 160/800 mg cotrimoxazole b.i.d. Duration of treatment was 14 days in both groups. All patients were cured without experiencing a relapse or becoming a salmonella carrier. Apyrexia and resolution of digestive and neurological symptoms were obtained in a significantly shorter time with pefloxacin than with cotrimoxazole. Pefloxacin was well tolerated and more effective than cotrimoxazole in the treatment of typhoid fever.

Summary Rotavirus antigen was detected by ELISA or latex technique in faecal specimens of 64 (20%) out of 327 children hospitalized with acute diarrhoeal disease during a 12-month period in Casablanca, Morocco. The rotaviral diarrhoeas were more frequent in autumn and winter, but more geographically limited during these seasons. Nine different electrophoretypes (A-I) were observed in 38 of the rotavirus-positive samples containing sufficient viral RNA to give a visible electrophoretic pattern. Two ≪long≫ types, A and B, accounted for 74% of all rotaviruses identified. Over the one-year period. a clear shift in the predominant electrophoretype was observed between the autumn-winter (type A) and summer period (type B). Six additional electrophoretypes co-circulated in association with type A, whereas only one case of type E was recognized during the summer in association with type-B outbreak. Vomiting and severe dehydration were more prevalent in the rotavirus antigen-positive children and, although not statistically proven, in the electrophoretype A group.

A prospective study of pediatric diarrhea was conducted in Casablanca. An etiologic agent was found in 67,8% of 87 ill participants. Rotavirus was the most common cause while Campylobacter jejuni, reported as Rotavirus for the first time in Morocco, was isolated in 11% of the patients.