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In this article, we analyze in the Malian context the link between the structure of the shareholding and the sustainability of companies based on data from the census of industrial enterprises of the Ministry of Trade and Industry, 2015. The results show that Mali’s economic opening option in the 1980s, strengthened in the 1990s following the implementation of the Structural Adjustment Programs, resulting in the state’s withdrawal from the management of enterprises, have enabled the emergence of private enterprises in almost all sectors of economic activity. However, shareholding in industrial enterprises has suffered from poor governance. It also shows that the number of women entrepreneurs is close to that of men. Between 2010 and 2014, the majority of shareholders are in the agri-food sector. The majority of the investment is in the metal and metallurgical sector.

International audience

International audience; BackgroundSurgical site infection (SSI) largely implicates the patient's endogenous skin microbiota. Perioperative disinfection protocols do not follow a general agreement.AimTo compare antisepsis and skin protection protocols on quantitative analysis of recolonization in the operating room at regular time-steps. The study hypothesis was that one protocol would be more effective than others.MethodsA single-centre prospective interventional study was conducted between January and June 2019. Healthy volunteers were randomized between protocols and served as their own controls. The protocols began ahead of scheduled orthopaedic surgery with a preoperative shower, mechanical cleansing, application of major antiseptics (alcoholic Bétadine™ 5% or alcoholic chlorhexidine 0.5%), sterile draping, then adhesive draping (3M™ Steri-Drape™ or iodine-impregnated 3M™ Ioban2™). Sampling was by swabbing in the operating room at 30 min intervals up to 90 min after draping. Cultures were performed under aerobic and anaerobic conditions. Qualitative and quantitative (cfu/mL) bacteriology was performed in the laboratory by direct reading on the blood agar plates.FindingsThirty subjects were included; none was lost to follow-up or excluded from analysis. Bacterial load before manipulation (T0) was significantly higher in males (P < 0.0001) despite a significantly shorter shower-to-sampling interval (P = 0.03). Smoking (P = 0.85), body mass index (P = 0.38), and depilation (P = 0.50) did not significantly affect preoperative load. Mean load increased significantly under all protocols up to T90 min, without significant superiority for any one protocol. Associated Bétadine™/Ioban™ showed the lowest T90 load, and chlorhexidine alone the highest, but without significant difference. Isolates at T0 were predominantly healthy skin commensals: coagulase-negative staphylococci, micrococci, and coryneforms.ConclusionNo one protocol demonstrated superiority, whether in immediate bactericidal action or in preventing skin recolonization in the operating room. Further studies are needed to define generally agreed protocols for SSI risk management.

Introduction Subdural empyema (SDE) is a rare complication of chronic subdural hematoma (CSDH) surgery. We introduced antibiotic prophylaxis (AP) for this procedure in 2014 following a morbidity-mortality conference (MMC) in our department. We report the results of retrospective data analysis to assess the effect of systematic AP and to identify risk factors for SDE. Material and methods Two hundred eight patients were recruited between January 2013 and December 2015; 5 were excluded for incomplete data: 107 without and 96 with AP (n = 203). SDE was confirmed by clinical examination, imaging and bacteriological analysis. Comparisons between AP−(no cefuroxime) and AP+ (cefuroxime) groups were made with Chi2 test and Student's t-test. Results One empyema was found in each group, indicating that AP had no effect (P = 1). The only criterion associated with SDE for these two patients was a greater number of reoperations for CSDH recurrence (P = 0.013). Discussion The incidence of postoperative empyema was 1%, similar to the range of 0.2%–2.1% reported in the literature. This rare incidence explains why we found no significant effect of AP. The medical decision taken at the MMC did not help to reduce the rate of postoperative SDE. MMCs can help to define factors associated with adverse surgical events and identify opportunities for improvement. Conclusion AP, introduced after an MMC, did not impact SDE rates. In practice, AP should be required only in case of reoperation for CSDH recurrence. However, we still continue to use AP following the MMC considering different parameters discussed in the manuscript.

Background: The purpose of this study was to report the findings of the local maternal deaths surveillance and response (MDSR) committee in the health district of Municipality V of the district of Bamako. Methods: It was a retrospective study over a period from January 2009 to December 2017. We have compiled all the findings of the local MDSR committee from the health district of Municipality V. The data was generated from the Local Health Information System (LHIS). We made a simple entry of text and tables using Word and Excel software. Results: During the study period, the maternal mortality ratio (MMR) was 219/100,000 live births. The study was about 140 cases of maternal deaths that occurred in health facilities. The middle age of the patients was 28.01 years. Most of the deaths occurred in the postpartum period, with 106 cases. In 92.12%, the deaths were from direct obstetric causes (DOC), including hemorrhage 70%, eclampsia 7.85%, obstructed labor 7.14%. Seven deaths (5%) were from indirect obstetric causes (IOC), including anemia 3.57% and malaria 1.73%. In 2.58%, the deaths were from undetermined causes. Deaths were preventable in 80%. The response included, among other things, the notification of cases and the implementation of the recommendations made. In 70% of cases, the recommendations issued were implemented. Conclusions: The MMR remains high in Municipality V of the district of Bamako. These deaths were mostly from DOCs, with hemorrhage as the main cause. These deaths were mostly preventable.

Introduction Midwifery students in France are requested to be vaccinated against influīenza every year before the winter epidemic. The rationale is to protect pregnant women and newborns, the “frail” populations with whom students are in regular contact. The aims of the present study were to assess the prevalence of influenza vaccination among midwifery students and to identify the obstacles to its implementation. Method This is a descriptive study carried out by questionnaire among all midwifery students enrolled in one of the 35 midwifery schools in France for the year 2018-2019. Results The 1092 questionnaires received showed that 47.9% of the students had been vaccinated during the previous winter, mainly in order to protect their patients. For those who had not been vaccinated, the main obstacles were a lack of time (64.7%), the vaccine was considered to be ineffective (57.3%) and forgetting to be vaccinated (43.4%). Most students reported that a midwifery school-based vaccination session would be effective in improving coverage. The decision to take up vaccination was influenced by the opinion of the student's entourage and information received in class. Conclusion Although the objectives of vaccine protection have not yet been achieved, influenza vaccination is not compulsory and midwifery students are free to choose. Students should be provided with all the information necessary to make their decision, including education on the subject, and have easy access to vaccination.

Biofilm in endoscopes is a major problem that can result in failure of disinfection. We studied the survival of K. pneumoniae in a biofilm formed on endoscope tubes subjected to combined chemical and physical stresses. We monitored bacterial survival in the biofilm after the action of 1% and 2% GTA either immediately or after 15 days of desiccation and described the ability of surviving bacteria to recolonize endoscope tubing in a dynamic model. There were surviving bacteria after 5-min exposure to 2% and 1% GTA. The percentage of survivors after 2% and 1% GTA was greater when the GTA treatment was performed after 15 days of prior desiccation of the biofilm. The survivors were able to recolonize and reform biofilm on abiotic surfaces probably because of the survival of persisters in a viable but non-culturable state in the biofilm. Our findings emphasize that the current guidelines on endoscope reprocessing should be strictly followed but that once constituted the biofilm in endoscope tubing will be very difficult to eradicate with present practices.

Resume Objectifs La perfusion en service de soins, a fortiori en reanimation, est un processus complexe pouvant etre a l’origine de nombreux risques pour le patient. Dans le cadre de la demarche institutionnelle d’amelioration de la qualite et de la securite des soins, une cartographie des risques lies a la perfusion a ete realisee. Methodes L’analyse a cible les situations de perfusion intraveineuses chez l’adulte, la methode d’evaluation des risques a priori a ete appliquee et un groupe de travail multidisciplinaire constitue. Resultats Pour l’ensemble du processus de perfusion (prescription, preparation et administration), 43 risques ont ete identifies. L’evaluation de ces risques et des moyens de maitrise existants a montre que 48 % d’entre eux avaient une forte criticite nette pour le patient. Des actions correctives et/ou preventives ont ete mises en œuvre pour les 20 risques consideres comme les plus critiques pour limiter leur occurrence et leur gravite, et ameliorer leur niveau de maitrise. Un plan d’action institutionnel a ete elabore, puis valide en Commission du medicament et des dispositifs medicaux steriles. Conclusion Cette cartographie a permis de realiser un etat des lieux exhaustif des risques potentiels lies a la perfusion. A l’issue de ce travail, des groupes pluridisciplinaires ont ete mis en place pour travailler sur les differentes thematiques et des reunions trimestrielles ont ete instaurees pour suivre l’avancee des differents projets. Une cartographie des risques sera realisee en pediatrie, puis en service d’oncologie ou le risque lie a la manipulation de produits toxiques est omnipresent.

International audience; Bacterial resistance to carbapenem, which is mainly due to the successful dissemination of carbapenemase-encoding genes, has become a major health problem. Few studies have aimed to characterize the level of resistance in the environment, notably in hospital wastewater, which is a likely hotspot for exchange of antibiotic resistance genes.In this work, we looked for the presence of imipenem-resistant bacteria and imipenem in the effluent of the teaching hospital of Clermont-Ferrand, France. Selective growth of bacteria from 14-day old biofilms formed in the pipe sewer showed that 22.1% of the isolates were imipenem-resistant and identified as Aeromonas (n = 23), Pseudomonas (n = 10), Stenotrophomonas (n = 4) and Acinetobacter (n = 1). Fifteen of these strains harbored acquired carbapenemase-encoding genes blaVIM (n = 11), blaOXA-48 (n = 2), blaGES (n = 1), blaNDM (n = 1). All isolates also harbored associated resistances to aminoglycosides, fluoroquinolones and/or tetracyclin. S1-nuclease pulsed-field gel electrophoresis analysis of eight selected isolates showed that four of them harbored one to two plasmids of molecular weight between 48.5 Kb and 194 Kb. In vitro transformation assays evidenced the presence of blaVIM and blaNDM on plasmids with the blaVIM harboring 80 Kb plasmid having conjugative capacity.The predicted environmental concentration of imipenem in the hospital effluent was 3.16 μg/L, suggesting that biofilm bacteria are subjected to sub-MICs of imipenem within the effluent. However, no imipenem molecule was detected in the hospital effluent, probably owing to its instability: in vitro assays indicated that imipenem's biological activity was no longer detectable after 45 h of storage. However, the predictive value of the hazard quotient relative to the development of resistance was >1.0 (HQr = 28.9 ± 1.9), which indicates a possible risk.The presence of carbapenemase-encoding genes in hospital effluent biofilm strains and their ability to transfer are therefore a potential hazard that should not be neglected and points to the need for monitoring antibiotic resistance in hospital wastewater.

The CS child, aged 9, is evacuated from a health center located 200km away from Ouagadougou (capital of BF) for decompensated heart failure. Clinically we noted a syndrome of congestive heart failure. No obvious cause has been found outside of the advancing age of parents (50 years) and the potential risks of rubella infection. A Doppler echocardiography revealed a fistula aorto-pulmonary 17mm wide associated with a pericardial effusion of average circumferential abundance and a dilation of the left ventricular. Pulmonary radiography showed a large cardiomegaly and left pleurisy. The discovery of congenital heart disease between 2 and 4 years is very rare but the prognosis is good with surgical treatment.L'enfant C.S âgée de 9 ans est évacuée d'une formation sanitaire située à 200km de Ouagadougou (capitale du BF) pour cardiopathie décompensée. Cliniquement est noté un syndrome d'insuffisance cardiaque globale. Aucune cause évidente n'est retrouvée en dehors de l'âge avancé des parents (50 ans environ) et des risques potentiels d'infection rubéolique. L'échocardiographie Doppler révèle une fistule aorto-pulmonaire large de 17mm associée à un épanchement péricardique de moyenne abondance circonférentielle et une dilatation du ventricule gauche. La radiographie pulmonaire a noté une volumineuse cardiomégalie et une pleurésie gauche. Cette cardiopathie congénitale de découverte habituelle entre 2 et 4 ans est très rare et de pronostic favorable avec le traitement chirurgical.

CA, 14 old years, female, born last uterine siblings of 9 children, 4 died of various causes, was admitted in the pediatric service of CHU-YO for functional impairment of the lower limbs. Physical examination revealed swelling and deformation harsh, uneven surfaces, the circumferential upper and lower limbs and lumbar spine associated with spastic paraplegia. Sphincter disturbances accompany this clinical picture. The radiographic bone marrow hypertrophy individually with images of exostosis at the epiphyses. Multiple exostosis or BESSEF Hogen's disease is rare and has a reserve functional prognosis because of outcome of low spinal cord compression and vascular compression. We felt it appropriate to bring this case discovered during our clinical practice because of its rarity and the risk of malignant degeneration.CA, âgée de 14 ans, de sexe féminin, dernière née d'une fratrie utérine de 9 enfants dont 4 sont décédés de causes diverses, est admise dans le service de pédiatrie du CHU-YO pour impotence fonctionnelle des membres inférieurs. L'examen physique révèle des déformations et des tuméfactions dures, à surfaces irrégulières, circonférentielles aux membres inférieurs et supérieurs et au rachis dorsolombaire associées à une paraplégie spasmodique. Des troubles sphinctériens accompagnent ce tableau clinique.La radiographie osseuse individualise une hypertrophie osseuse avec des images d'exostose au niveau des épiphyses.Affection rare, l'exostose ou maladie des exostoses multiples de BESSEF HOGEN a un pronostic fonctionnel réservé du fait des compressions médullaires basses et vasculaires. Nous avons jugé opportun de rapporter ce cas découvert lors de notre pratique clinique à cause de sa rareté et du risque de dégénérescence maligne.

The retroperitoneal teratoma is a rare congenital tumor, accounting for only 1-10% of retro primitive peritoneal tumors in children; its extension endo canal is still much rarer. There is a female; the diagnosis can be done either by prenatal obstetric ultrasound, or more often in the neonatal period. Or it can go unnoticed and is discovered in adulthood. We report a case of a 6-month infant, male, no particular history that has a gradual onset flaccid paraplegia from birth and anesthesia of both lower limbs, spinal MRI and abdominal CT showed a large retroperitoneal fibrosis solido heterogeneous right lesion containing calcification and fatty component with intraductal extension for a teratoma. Histological examination confirmed the diagnosis. The purpose of this observation is to show you the contribution of CT in the diagnosis of teratoma in its rare localization.

BACKGROUND AND STUDY AIMS: Infection is a re-cognized complication of endoscopic retrograde cholangiopancreatography (ERCP). We describe the epidemiologic and molecular investigations of an outbreak of ERCP-related severe nosocomial infection due to Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL). PATIENTS AND METHODS: We conducted epidemiol-ogic and molecular investigations to identify the source of the outbreak in patients undergoing ERCP. We carried out reviews of the medical and endoscopic charts and microbiological data, practice audits, surveillance cultures of duodeno-scopes and environmental sites, and molecular typing of clinical and environmental isolates. RESULTS: Between December 2008 and August 2009, 16 patients were identified post-ERCP with Klebsiella pneumoniae that produced extended-spectrum beta-lactamase type CTX-M-15. There were 8 bloodstream infections, 4 biliary tract infections, and 4 cases of fecal carriage. The micro-organism was isolated only from patients who had undergone ERCP. Environmental investigations found no contamination of the washer-dis-infectors or the surfaces of the endoscopy rooms. Routine surveillance cultures of endoscopes were re-peated-ly negative during the outbreak but the epidemic strain was finally isolated from one duodenoscope by flushing and brushing the channels. Molecular typing confirmed the identity of the clin-ical and environmental strains. Practice audits showed that manual cleaning and drying before storage were insufficient. Strict adherence to reprocessing procedures ended the outbreak. CONCLUSIONS: The endoscopes used for ERCP can act as a reservoir for the emerging ESBL-producing K. pneumoniae. Regular audits to ensure rigorous application of cleaning, high-level disinfection, and drying steps are crucial to avoid contamina-tion.

Background Human adenovirus (HAdV) infections, while common in infancy and childhood, occur rarely in the neonatal period but may be fatal. Objectives To describe a transmission of HAdV from a patient with fatal pneumonia to heath-care workers that could be considered as a model of respiratory virus transmission in a care unit. Study design Case report with virologic studies. Results A 10-day-old neonate developed pneumonia with acute respiratory distress, external pulmonary bleeding and coagulopathy and died 36 h after admission of multivisceral failure. An adenovirus was isolated from pulmonary biopsy and detected by PCR in blood and respiratory secretions. Ten days later, three members of medical staff in charge of this infant, who used neither masks nor glasses for close patient contact, developed keratoconjunctivitis. Molecular analysis of the infant's and one of the pediatrician's isolates identified a species D HAdv and showed 100% identity, thereby demonstrating viral transmission. Conclusion In view of the serious outcome, HAdV infections should be considered in the differential diagnosis of pneumonia in neonates. This case illustrates the epidemic potential of viruses with respiratory transmission and underlines the importance of complying with standard precautions to prevent viral spread in routine practice.

A comprehensive set of 443 1D gene sequences (encoding the VP1 capsid protein) was analyzed to investigate the phylogenetic relationships and evolutionary patterns among strains of human echovirus 30 (E30; genus Enterovirus, family Picornaviridae) characterized over 50 years. Maximum-likelihood (ML) phylogenetic trees of complete and nonredundant 1D gene sequences (total length = 876 nucleotides) showed evidence of distinct lineages related to the isolation period of virus strains. Virus transportation was confirmed as a major epidemiological factor in the appearance of epidemics since recurrence of aseptic meningitis outbreaks in a given geographic area was associated with distinct E30 variants detected earlier in distant regions. Detection of the codon changes associated with E30 evolution was investigated with methods implemented in the Datamonkey web server. Evolution of the 1D gene was dominated by continual negative (purifying) selection against nonsynonymous substitutions at most codon sites, as determined by dN/dS ratio. Amino acid polymorphism was maintained at a limited number of sites (10/292) in the VP1 protein (within loops connecting β strands and C-terminus). Amino acid changes are allowed at these sites because they are likely exposed on the virion particle and nonsynonymous substitutions are observed in the corresponding codons because negative selection is relaxed.

Problem statement: This study was carried out to demonstrate that the severity of Cassava Mosaic Disease (CMD) in Togo, is not only influenced by synergism between cassava Begomoviruses in presence, but essentially by recombination between the different Begomoviruses infecting cassava. Approach: Foliar samples presenting typical biological features of Begomoviruses infection were collected from cassava and wild infected plants from different regions of Togo and analysed by PCR targeting the Coat Protein (CP). The PCR products obtained from different isolates of two major Begomoviruses species infecting cassava in Togo were then sequenced and compared with the sequenced of the African cassava mosaic Begomoviruses identified to date and available in NCBI GenBank database by phylogenetic analysis. Results: The results indicate that not only the two major Begomoviruses could be in synergistic interaction in infected cassava in Togo as it has been shown between African Cassava Mosaic Virus (ACMV) and East African Cassava Mosaic Virus (EACMV) elsewhere, but could also create recombinants which would be highly interfering in the development of symptom severity in the country. Conclusion/Recommendations: The study confirmed the assumption that the symptom severity in cassava fields in Togo is rather caused by recombination between different Begomoviruses in presence than by synergistic interaction. More investigations should be done to give insight to this founding.

Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available > 24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.

Resume Objectifs L’objectif principal de notre etude etait de determiner les motivations pour ou contre la vaccination antigrippale du personnel du CHU de Clermont-Ferrand afin d’augmenter l’efficacite des campagnes de prevention. Patients et methodes Un autoquestionnaire a choix multiples a ete delivre aux 7601 salaries du CHU en mai 2005. Il recueillait les caracteristiques socioprofessionnelles de la personne, son statut vaccinal et ses motifs de vaccination, de non-vaccination ou d’abandon de la vaccination antigrippale. Resultats Le taux de reponse a ete de 26,5 % avec 2011 autoquestionnaires retournes representatifs de la population du CHU. Le taux de vaccination en 2004 a ete de 36,35 %, avec un lien fort entre vaccination et infection grippale anterieure ( p Conclusions L’objectif de couverture vaccinale de 75 % des professionnels, souhaite par la HAS, necessite une adhesion active des salaries. L’efficacite des futures campagnes pourrait viser a ameliorer les connaissances, en insistant sur le jeune âge des populations touchees par le virus. Le manque de temps invoque peut etre pallie en poursuivant les vaccinations sur site, la nuit et avec des plages horaires plus larges.

Summary Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2 h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259 ± 68 and 244 ± 69 min for groups S and R respectively ( P = 0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2 h, 4 h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2 h and 4 h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol.

Infusion in care units, and all the more in intensive care units, is a complex process which can be the source of many risks for the patient. Under cover of an institutional approach for the improvement of the quality and safety of patient healthcare, a risk mapping infusion practices was performed.The analysis was focused on intravenous infusion situations in adults, the a priori risk assessment methodology was applied and a multidisciplinary work group established.Forty-three risks were identified for the infusion process (prescription, preparation and administration). The risks' assessment and the existing means of control showed that 48% of them would have a highly critical patient security impact. Recommendations were developed for 20 risks considered to be most critical, to limit their occurrence and severity, and improve their control level. An institutional action plan was developed and validated in the Drug and Sterile Medical Devices Commission.This mapping allowed the realization of an exhaustive inventory of potential risks associated with the infusion. At the end of this work, multidisciplinary groups were set up to work on different themes and regular quarterly meetings were established to follow the progress of various projects. Risk mapping will be performed in pediatric and oncology unit where the risks associated with the handling of toxic products is omnipresent.

Switzerland yearly produces more than 260,000 Mg of compost, two thirds of which is recycled in agriculture and horticulture. This research was undertaken to examine the forms and availability of inorganic P (Pi) in Swiss composts made from solid kitchen and garden wastes using the isotopic exchange kinetic technique, a sequential Pi extraction and magic angle spinning (MAS) solid-state 31P nuclear magnetic resonance (NMR) spectroscopy. The different approaches described in this paper demonstrate the presence of a complex mixture of Pi species in the studied composts. Isotopic exchange experiments and sequential extraction showed that these composts contained relatively large concentrations of rapidly available Pi. Significant correlations were observed between the concentration of water-soluble Pi (Cp), and the total N, C and P content of composts suggesting that organic substances partly controlled the amount of rapidly available Pi. Significant correlations were observed in alkaline composts between the amount of Pi which can not be exchanged within 3 months and the total P and Ca content. In alkaline composts solid-state MAS 31P NMR results suggested the presence of a range of slightly soluble and poorly crystallized Ca-P compounds such as apatites or octacalcium phosphates and of organic P compounds. The slowly or non-exchangeable Pi present in these composts could therefore be bound to Ca in the form of apatites or octacalcium phosphates.

Wide variation in results exists in the literature on the effectiveness of composts to sustain the phosphorus (P) nutrition of crops. The aim of this work was to assess the importance of some soil and composts properties on the utilization of compost-P by white clover (Trifolium repens L.). This study was carried out with samples collected from four composts made from solid kitchen and garden wastes, and with two soil samples taken from the A horizon of a P-rich sandy acidic Dystrochrept and of a P-limited clayey calcareous Eutrochrept. Changes in the amount of inorganic P (Pi) isotopically exchangeable within 1 min (E1min) were measured during 32 weeks in incubated soil-composts or soil-KH2PO4mixtures where P sources had been added at the rate of 50 mg P kg−1 soil. Uptake of compost-P or KH2PO4-P by white clover was measured on the same amended soils during 16 weeks. In both soils, the application of composts resulted after 32 weeks of incubation in E1min values ranging between those observed in the control without P and those observed in the KH2PO4treatment, i.e., in values ranging between 4.2 and 5.9 mg P kg−1 in the sandy acidic soil and between from 1.6 to 4.3 mg P kg−1 in the clayey calcareous soil. The total coefficient of utilization of compost-P (CU-P) by white clover reached values in both soils for the four composts ranging between 6.5% and 11.6% of the added P while in the presence of KH2PO4 the CU-P reached values ranging between 14.5% in the clayey calcareous soil and 18.5% in the sandy acidic soil. Results obtained in the sandy acidic soil suggest, that white clover initially used a fraction of the rapidly exchangeable compost P, while at a latter stage plant roots enhanced the mineralisation of compost organic P and took up a fraction of the mineralized P. These relations were not observed in the clayey calcareous soil probably because of its high sorbing capacity for P. In the sandy acidic soil, composts application increased the uptake of soil P by the plant from 31.4 mg P kg−1 soil in the control without P to values ranging between 37.9 to 42.7 mg P kg−1 soil in the presence of composts. This indirect effect was related to a general improvement of plant growth conditions in this soil induced by compost addition (from 9.9 g DM kg−1 soil in the control without P to values ranging between 14.0 to 16.1 g DM kg−1 soil in the presence of composts) and/or to the release of Al- or Fe bound soil P to the solution due to soil pH increase following compost application. Finally the total coefficient of utilization of P (CU-P) derived from KH2PO4 and composts was related to the total amount of N exported by white clover in the P-limited clayey calcareous soil but not in the P-rich sandy acidic soil. This suggests that in a soil where N2 biological fixation is limited by low P availability, the CU-P of a compost by white clover is not only related to the forms of P present in the compost but also to its effect on N nutrition. However, it is not clear whether this improved N nutrition was due to compost mineralisation, or to an indirect compost effect on the N2 biological fixation.

Resume Objectif Evaluer l'efficacite et les difficultes liees a l'utilisation d'un etui a usage unique recouvrant les lames de laryngoscope afin de prevenir leur contamination. Type d'etude Etude prospective, bacteriologique, virologique et clinique. Materiel Etui translucide en polyethylene, recouvrant la lame du laryngoscope, livre dans un conditionnement propre non sterile (Prolam ™ , Peters). Methodes 1) Controle de sterilite par mise en culture d'un liquide de rincage des dispositifs avant utilisation. 2) Etude in vitro d'impermeabilite au poliovirus par RT-PCR. 3) Evaluation clinique. Apres 200 intubations orotracheales realisees par 12 medecins, et 15 infirmieres anesthesistes, ceux-ci ont rempli un questionnaire portant sur la facilite d'utilisation du dispositif. Resultats L'etude bacteriologique des dispositifs avant utilisation a montre un taux de contamination acceptable. La protection de la lame a l'egard des virus a ete totale pendant les 12 heures de l'essai. Sur le plan de l'utilisation, le dispositif a ete facilement adapte sur la lame de laryngoscope dans 98 % des cas. L'introduction dans la bouche a ete aisee dans 94 % des cas. Les conditions de visualisation ont ete bonnes ou excellentes dans 83 % des cas. Les operateurs ont eprouve des difficultes a intuber la trachee dans 16 % des cas. Conclusion Cet etui de lame de laryngoscope est un dispositif de prevention des infections croisees lors de l'intubation tracheale qui est simple, efficace, facile d'utilisation et peu onereux.

Because of their high concentrations in organic matter and nutrients, composts have been used as soil amendments for years. However, information on their P availability is scarce. The effect of the composting time on phosphate exchangeability of composts was assessed on three substrates (House Refuse Compost, HRC; Sewage Sludge Compost, SSC; and Food Waste Compost, FWC) using the isotopic exchange kinetic method proposed by Fardeau (1996). Results were then interpreted by a pluricompartmental analysis and compared to those yielded by a sequential extraction. Preliminary results confirmed that the isotopic exchange kinetic method was appropriate to assess phosphate exchangeability of composts. Composts were shown to have a low buffering capacity (r(1)/R) for inorganic P (Pi) and high concentration in water extractable Pi (Cp) and in Pi isotopically exchangeable within 1 min (E1min) compared to soils. Their concentra tion in Pi isotopically exchangeable between 1min and 3 months (Ei1min−3months) and in Pi which cannot be exchanged within three months (E>3months) was a function of their origin. Composting of HRC, SSC, and FWC, systematically led to decreases in Cp and E1min with time and in some cases to increases in Ei1min−3months and/or in E>3months. These changes were related to the leaching of water soluble Pi from the HRC and FWC composts and, for the SSC and FWC composts, to the formation of phosphate precipitates with Ca, Mg and/or Fe during composting. Most of the changes in Pi exchangeability occurred during the first month of composting, i.e., during the most intense period of organic matter mineralisation. The slight increase in total organic P content observed after 180 d of composting in FWC and SSC indicates that the immobilisation of P in orga nic forms was not a major pathway for P transformation.

International audience; To characterize a CTX-M-15-producing Klebsiella pneumoniae isolate that was identified during an outbreak involving 16 patients who had undergone endoscopic retrograde cholangiopancreatography between December 2008 and August 2009. The strain was also detected in one endoscope used for these examinations. Disc diffusion assays, MICs and isoelectric focusing were used to characterize the plasmidic CTX-M-15 β-lactamase. PCRs were used to check for the presence of genes associated with virulence or antibiotic resistance. Antibiotic tolerance tests and plasmid transfer were carried out in both planktonic and biofilm conditions. The strain belonged to sequence type 14 and to the virulent capsular serotype K2, but produced little glucuronic acid. It contained a 62.5 kb conjugative plasmid carrying the bla(CTX-M-15), bla(OXA-1) and aac(6')-Ib-cr genes and harboured few virulence genes (uge, wabG, kfu and mrkD). The strain was highly resistant to cefotaxime (MIC 516 mg/L) and the presence of this antibiotic at sub-MIC concentrations enhanced biofilm formation. The isolate was susceptible to ofloxacin (MIC 2 mg/L), but the bactericidal effect of this antibiotic was greater in planktonic cultures and 6 h old biofilm than in 24 or 48 h old biofilms. The K. pneumoniae strain was notable for its ability to transfer its plasmid, especially in biofilm conditions, in which the rate of plasmid transfer was about 0.5/donor. These findings demonstrate the ability of this strain to survive in a hospital environment and to transfer its extended-spectrum β-lactamase-encoding plasmid.

Background and study aims Infection is a recognized complication of endoscopic retrograde cholangiopancreatography (ERCP). We describe the epidemiologic and molecular investigations of an outbreak of ERCP-related severe nosocomial infection due to KLEBSIELLA PNEUMONIAE producing extended-spectrum beta-lactamase (ESBL). Patients and methods We conducted epidemiologic and molecular investigations to identify the source of the outbreak in patients undergoing ERCP. We carried out reviews of the medical and endoscopic charts and microbiological data, practice audits, surveillance cultures of duodenoscopes and environmental sites, and molecular typing of clinical and environmental isolates. Results Between December 2008 and August 2009, 16 patients were identified post-ERCP with KLEBSIELLA PNEUMONIAE that produced extended-spectrum beta-lactamase type CTX-M-15. There were 8 bloodstream infections, 4 biliary tract infections, and 4 cases of fecal carriage. The microorganism was isolated only from patients who had undergone ERCP. Environmental investigations found no contamination of the washer-disinfectors or the surfaces of the endoscopy rooms. Routine surveillance cultures of endoscopes were repeatedly negative during the outbreak but the epidemic strain was finally isolated from one duodenoscope by flushing and brushing the channels. Molecular typing confirmed the identity of the clinical and environmental strains. Practice audits showed that manual cleaning and drying before storage were insufficient. Strict adherence to reprocessing procedures ended the outbreak. Conclusions The endoscopes used for ERCP can act as a reservoir for the emerging ESBL-producing K. PNEUMONIAE. Regular audits to ensure rigorous application of cleaning, high-level disinfection, and drying steps are crucial to avoid contamination.

L’effet des pesticides utilises en culture cotonniere sur l’activite microbienne globale des sols a ete etudie sur un sol ferrugineux tropical en zone ouest du Burkina Faso. Des echantillons de sol ont ete preleves a 30, 73, et 119 jours apres semis du cotonnier. Les analyses de respirometrie, de determination de la biomasse microbienne et de l’ammonification ont ete realisees. Les resultats indiquent que les doses de pesticides apportees sont insuffisantes pour affecter les bacteries ammonifiantes. En revanche, ces doses perturbent la vie du sol en affectant l’efficience des microorganismes a utiliser la matiere organique, en activant tantot la respiration et la biomasse microbiennes et tantot en les inhibant. Mots Cles : Pesticide – Sol – Activite Respiratoire – Biomasse Microbienne – Bacterie Ammonifiante The effect of pesticides used in cotton cultivation on soil global microbial activity was studied on a tropical ferruginous soil in the west zone of Burkina Faso. The soil samples were took at 30, 73 and 119 days after the cotton seeds. The analyses of respirometry, of microbial biomas determination and of the ammonification were realized. The results indicate that the doses of pesticides that put aren’t enough to affect ammonificate bacteriums. In return, these doses disrupt soil life by affecting microorganism’s efficiency in using organic matter, by stimulating sometimes microbial’s respiration and biomas, and sometimes inhibiting it. Key words: Pesticide – Soil – Respiratory activity – Microbial biomas – Ammonificate bacterium

Crop production in the Sahel is limited by nutrients availability. The study aimed to estimate the contribution of avifauna, crop rotation and trees to soil fertility and crop production improvement. Pot experiment was carried out with soils sampled in Faidherbia albida parklands in cotton production zone of West Burkina Faso. The treatments consisted of two levels of sampling sites (outside and under the crown of Faidherbia albida), three types of previous crop (fallow, maize and sorghum) and two levels of fertilization (normal rain drop and raindrop washes). Results showed that cotton plants height were affected by sampling site and previous crop between 30 and 80 days after sowing. Rain drop washes contained nutrients that can help to improve soil fertility although their nutrients level in the soil is too small to have an impact significant on cotton plant development. No significant difference was observed between factors for the number of nodes and generative branches except for sampling site. Nutrients content in cotton plants was affected by the soil sampling site, the previous crop and the fertilization.

Crop production in the Sahel is limited by both nutrients and water availability. This study evaluated the possible use of three invading plants (Azolla pinnata, Ceratophyllum demersum and Typha australis) forcrop production. For that, two pots experiments and a single on-farm experiment were carried in Farako-Bâ research center in Burkina Faso in 2005 and 2006. The treatments compared the effect of raw and composted substrates application on the fonio (Digitaria exilis, CVF 477) and the maize (Zea mays, FBH-34 SR) production. Both raw and composted substrates were analyzed for their nutrient content before beingincorporated in the soil. The results showed that both substrates (composted and not) have higher phosphorus and nitrogen content for C. demersum compared to T. australis and A. pinnata. T. australis is a lignified substrate with a C/N ratio of 55 and 26, respectively for not and composted substrates. The composting process increased substrates pH of about a unit for A. pinnata and C. demersum and 4 units for T. australis. The fonio and the maize biomass production were not significantly different for substrates. The maize yield benefit was highest for C. demersum. The three aquatic invading plants represent a high potential for crop production in the Sahel. However, the long term effects of substrates are to be assessed.

International audience; The aim of this study was to assess the presence and seasonal frequency of various enteric viruses in wastewater treatment. The detection of astrovirus, norovirus, enterovirus, hepatitis A virus (HAV) and rotavirus was carried out by molecular analyses in concentrated water samples collected over 18 months at the entrance and exit of an activated sludge sewage treatment plant. The reverse transcriptase-polymerase chain reaction (RT-PCR) results were confirmed by sequencing, and comparative phylogenetic analysis was performed on the isolated strains. Genomes of human astrovirus and human rotavirus were identified in 26/29 and 11/29 samples of raw sewage, respectively, and in 12/29 and 13/29 treated effluent samples, respectively. Some rotavirus sequences detected in environmental samples were very close to those of clinical strains. Noroviruses, enteroviruses and HAV were not detected during the study period. This could be related to the small sample volume, to the sensitivity of the detection methods or to local epidemiological situations. Frequent detection of viral RNA, whether infectious or not, in the exit effluent of sewage treatment indicates wide dispersion of enteric viruses in the environment. Consequently, viral contamination resulting from the use of these treated waters is a risk that needs to be addressed.

Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.

OBJECTIVES: To describe HIV-1 variants circulating in Mali and to estimate the rate of transmission of HIV-1 drug resistance in 2006. PATIENTS AND METHODS: Viral reverse transcriptase (RT) and protease (PR) genes from 198 antiretroviral (ARV)-naive patients diagnosed HIV-1 positive in May 2006 in Bamako and Segou were sequenced. RESULTS: Although CRF02_AG was always the predominant HIV-1 subtype observed (72%) a higher genetic diversity than that in 2005 was observed. The overall prevalence of primary resistance is 11.5% in Mali in 2006 according to the 2007 IAS-USA list of mutations [nucleoside RT inhibitor (NRTI): 1.5% non-NRTI (NNRTI): 9% and PI: 1%] and 2.5% (NRTI: 1% NNRTI: 1.5% and PI: 0%) according to the Stanford list of mutations. There was no significant difference between 2005 and 2006 in the overall primary resistance prevalence or in the prevalence of mutations in the different ARV classes. Resistance mutations found in RT and PR genes are in agreement with the highly active antiretroviral therapy regimen available in Mali except for V90I V106I and A98G mutations which are associated with etravirine resistance but polymorphic in non-B subtypes. CONCLUSIONS: HIV-1 genetic diversity seems increased in Mali but the overall HIV-1 primary resistance prevalence remains low. This is consistent with the findings from other West African countries where prevalence rates are lower than 5%. However considering the large scaling up of ARV use in this country it is necessary to regularly monitor the development of primary resistance in Mali.