mercredi 5 février 2020 

14h10 - 15h10


 
Espace Poster 2

Infections : bactéries multi-résistantes

MODÉRATEUR(S) :  David GRIMALDI (Bruxelles, BELGIQUE ), Laurent MARTIN-LEFEVRE (Nantes)  
  

Colonization with carbapenemase-producing Gram-negative bacilli in burn patients in Tunisia

Orateur(s) :   Lamia THABET (Ben Arous, TUNISIE) 

Auteur(s) :  Sonia BEN BEHI (Ben Arous, TUNISIE)   Sarra DHRAIEF (Ben Arous, TUNISIE)   Hana FREDJ (Ben Arous)   Lilya DEBBICHE (Ben Arous, TUNISIE)   Amenallah MESSAADI (Ben Arous)  

14h10 - 14h17
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Colonization with carbapenemase-producing Gram-negative bacilli in burn patients in Tunisia

Introduction / Rationale :
Burn patients are at risk of multidrug-resistant (MDR) bacterial infections with high mortality rate. Therefore, monitoring the emergence of MDR pathogens in these vulnerable patients is important. This study aimed to assess digestive colonization with carbapenemase-producing Gram-negative bacilli (CP-GNB) in patients admitted to the burn intensive care unit.

Méthodes / Patients and Methods :
Our study was prospective and conducted over a one-year period (January 2018 to December 2018). Every admitted patient was subjected to the screening. A double swab set was used to collect rectal swab specimens. One swab was used for MDR screening by disk diffusion method on selective media ; the other for multiplex real-time PCR (Cepheid’s GeneXpert®) allowing detection of the most common carbapenemase-encoding genes (CEG) (blaOXA-48, blaKPC, blaNDM, blaVIM and blaIMP).

Résultats / Results :
Among the 125 studied patients, 71 (56.8%) were detected positive at admission for CP-GNB by the GeneXpert® Carba-R assay. Eleven patients, initially not colonized, acquired positive faecal carriage subsequently during their hospital stay. Forty-two colonized patients (59.1%) developed CP-GNB infection during their hospitalization.
The CEG blaNDM quantitatively dominated by far with 54 detections; either alone (15 cases) or associated with other CEG (39 cases). The second most frequent gene was blaOXA-48. It was detected alone eight times and in association with other CEG 38 times. Forty-three patients carried blaVIM gene, usually in association with other CEG (93%). However, only one patient carried blaKPC gene.
The parallel screening by classical microbiology methods (disk diffusion on selective media) detected the presence of CP-GNB in all molecular positive samples.

Discussion / Discussion :


Conclusion / Conclusion :
Our study describes the characterization of carbapenemase in burn patients and highlights their alarming spread. This emphasizes the importance of an active surveillance program by early detection of CP-GNB carriers and an isolation policy to limit the MDR infections expansion.
 

EVALUATION OF ANTIFUNGAL THERAPY IN BURN ICU

Orateur(s) :   Selma ABID (Ben Arous, TUNISIE) 

Auteur(s) :  Hana FREDJ (Ben Arous, TUNISIE)   Amel MOKLINE (Ben Arous)   Bahija GASRI (Ben Arous, TUNISIE)   Manel BEN SAAD (Ben Arous)   Amenallah MESSAADI (Ben Arous)  

14h17 - 14h24
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
EVALUATION OF ANTIFUNGAL THERAPY IN BURN ICU

Introduction / Rationale :
Invasive fungal infections are increasingly observed in the ICUs especially in burn units. In the absence of simple and accessible techniques for early microbiological diagnosis, the use of antifungals is steadily increasing. Little is known on the extent of the problem of antifungal prescription in burn ICUs.
Objective : Evaluate the antifungal prescription in major burn patients.

Méthodes / Patients and Methods :
During the study period (2018-2019), all prescriptions of antifungals were analysed. Analysis concerned demo¬graphics, clinical circumstances, as well as the basis of antifungal prescribing (targeted vs. empiric).

Résultats / Results :
Among the 691 patients admitted in this period, 58 patients were treated with antifungals (sex ratio: 1.4; mean age: 38 ± 19 years, with low associated comorbidity).The TBSA was 34.25 % [19.5-53.25], UBS was 57 [32.75-91]. Most of the patients (87.9%) were transferred from another hospital structure within 62 ± 96 hours.
Antifungal treatment was started at the average of the seventh day post wound injury, more often on an empiric basis. Sofa score at the beginning of the treatment was 11 ± 3.9. Leucolymphopenia was present in 32% and thrombopenia was present in 41%. Index of colonisation was positif only in 4 cases. The average candida score was 2.72 ± 1.15. Microbiological results were tardily collected, within 3 weeks, in 27%. Fungal urine infections were found in 9 cases. Candidemia and catheter-related infections were considered only in 2cases.
The risk factors of fungal infection as described in literature were found in most of the patients, and that includes mechanical ventilation (84.4 %), length period of stay (16 days [8.75 – 29.5]), central venous line (100 %),severe sepsis or septic shock (100 %), large-spectrum antibiotherapy for more than 3 days (100 %).

Discussion / Discussion :


Conclusion / Conclusion :
The management of antifungal infections in major burn patients is still a challenge. Antifungal prescription is based on clinical presumption. The empirical prescription reflects the lack of efficient laboratory support and late microbiological results prompting physicians to rely on clinical informations. The management of fungal infections is based on the improvement of mycological investigations.
 

EPIDEMIOLOGY OF CANDIDEMIA IN A MEDICAL ICU: A 12-YEARS RETROSPECTIVE STUDY

Orateur(s) :   Ahlem TRIFI (Tunis, TUNISIE) 

Auteur(s) :  Salma KLAII (Tunis)   Aicha KALLEL (Tunis)   Foued DALY (Tunis)   Yosr TOUIL (Tunis)   Sami ABDELLATIF (Tunis, TUNISIE)   Kalthoum KALLEL (Tunis)   Salah BEN LAKHAL (Tunis)  

14h24 - 14h31
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
EPIDEMIOLOGY OF CANDIDEMIA IN A MEDICAL ICU: A 12-YEARS RETROSPECTIVE STUDY

Introduction / Rationale :
Invasive candidiasis is a widespread and alarming infection in intensive care units (ICU) patients. Its diagnosis is often difficult because of the lack of specificity of clinical signs and the low sensitivity of blood cultures. While the Candida albicans species remain the most common cause of bloodstream infections, non-albicans are emerging. These infections are serious, associated with high mortality rate and requiring early diagnosis and appropriate treatment. In Tunisia, few data are available. We aimed to determine the epidemiological profile of a series of candidemia in ICU, the risk factors associated with the occurrence of candidemia and to describe the modalities of the mycological diagnosis of candidemia and their etiological profile.

Méthodes / Patients and Methods :
A retrospective longitudinal descriptive study conducted in the Parasitology - Mycology laboratory with the collaboration of the medical ICU of la Rabta hospital -Tunis over a 12-year period from January 1, 2006 to December 31, 2017. All hospitalized ICU patients with at least one Candida-positive blood culture were included.

Résultats / Results :
Forty-three patients among 2585 hospitalized patients during the study period had at least one candidemia infection. The main risk factors for development of candidemia infection include invasive procedures, a prior use of antibiotics and receipt of parenteral nutrition. C. albicans was the most common species, detected in 41.9% of patients. Non-albicans Candida species were prominent (58.1%), represented by C parapsilosis, followed by C. tropicalis and C. Krusei then C. glabrata and finally C. lusitaniae. All the isolates tested were sensitive to the common antifungal agents. The mortality rate of our patients was high (76.7%), and the detection of the albicans species in blood cultures was the only prognostic factor identified (OR=9,38 [0,83-105,23], p= 0,06).

Discussion / Discussion :


Conclusion / Conclusion :
Candidemia in the medical ICU patients is common and is associated with high mortality rate. Despite the progress of biological tools, the diagnosis is not obvious and needs to take into account the risk factors of the patients and their predisposing pathologies as well as scores based on clinical and microbiological parameters to identify patients with risk of candidemia and to initiate an early empirical treatment for them.
 

Necrotizing soft-tissue infections in the intensive care unit: a retrospective hospital-based study.

Orateur(s) :   Kais REGAIEG (Montfermeil) 

Auteur(s) :  Sabrine NAKAA (Montfermeil)   Arnaud MAILLOUX (Montfermeil)   Madjid BOUKARI (Montfermeil)   Johana COHEN (Montfermeil)   Dany GOLDGRAN-TOLEDANO (Montfermeil)  

14h31 - 14h38
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Necrotizing soft-tissue infections in the intensive care unit: a retrospective hospital-based study.

Introduction / Rationale :
The objective of our study is to describe the epidemiological and clinical characteristics of Necrotizing soft-tissue infections (NSTI) and to improve therapeutic management.

Méthodes / Patients and Methods :
We conducted a retrospective observational study that included patients admitted in the intensive care unit (ICU) of general hospital between september 2014 and Aout 2019 with a primary or secondary diagnosis of NSTI. We collected Demographic and clinical data, cultured pathogens, lengths of stay, and intra-ICU mortality.

Résultats / Results :
During the study period, a total of 20 patients admitted to the ICU were diagnosed with NSTI(0,3% of the total number of patients). The mean of age was 69 years. The sex ratio (M/W) was 0,6. Ten patients (50%) were directly admitted to the ICU, others were transferred from medical or surgical wards. The mean of SAPS II was 61.6 (26.6). The main indication to admission in ICU was shock (50%).
The most common comorbidity was diabetes (50%). The other co-morbidities associated with NSTI were cardiovascular diseases (33%), obesity (25 %) and carelessness (25%). The sites most commonly affected were extremities in 15 patients (75%) and abdomen/ano-genital in 4 patients (20%). In ICU, a total of 17 patients (85%) were mechanically ventilated [(median duration : 4.70 days (8.63)], 15 patients (75%) were given vasopressors, and 4 patients (20%) underwent renal-remplacement. All patients underwent one or more chirurgical intervention. 17 patients (85%) underwent radical necrotectomy. In 3 cases, an amputation was necessary. Polymicrobian infection was seen in 10 patients (50%). In 8 patients (40%), we used vacuum assited closure therapy, which in 3 patients was followed by definitive reconstruction by split skin grafts. The mortality in ICU was 50%. The mean stay in ICU was 12 days (2-73). The mean duration of hospitalization of the patients who survived was 75 days (15-180).
On the basis of a univariate analysis, higher SAPS II score and lactate levels were associated with increased mortality(p<0.01).

Discussion / Discussion :


Conclusion / Conclusion :
NTSI is rare in ICU but it’s a life threatening and disabling disease with a high mortality requiring a multidisciplinary management. Early diagnosis and adequate treatment are necessary to improve clinical outcome and must be known by everyone. More studies are needed to estimate the interest and delay of new strategies such as negative pressure therapy.
 

Bacteriological profile and antimicrobial susceptibility of isolated bacteria in a burn intesive care unit in Tunisia

Orateur(s) :   Lamia THABET (Ben Arous, TUNISIE) 

Auteur(s) :  Karim MECHRI (Ben Arous, TUNISIE)   Sarra DHRAIEF (Ben Arous, TUNISIE)   Emna HAMMAMI (Ben Arous)   Amel MOKLINE (Ben Arous)   Kawther FALEH (Ben Arous)   Amenallah MESSAADI (Ben Arous)  

14h38 - 14h45
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Bacteriological profile and antimicrobial susceptibility of isolated bacteria in a burn intesive care unit in Tunisia

Introduction / Rationale :
Nosocomial infection remains a major cause of mortality and morbidity in burns. Providing information about the main causative bacterial agents and determination of their susceptibility to antibiotics may improve empiric therapy and early detection of emerging antimicrobial resistance. The aim of our study was to invetisgate the species distribution and antibiotic susceptibility of isolated strains from a burn intensive care unit (ICU).

Méthodes / Patients and Methods :
This study was performed retrospectively on all bacteriological samples taken from the burn ICU at the trauma and burn center in Tunisia during a seven year period (from January 2012 to December 2018). All isolated microorganisms were identified on the basis of standard microbiological techniques. Antibiotic susceptibility testing was carried out by the agar disk diffusion method, and susceptibility results were interpreted using clinical breakpoints according to CA-SFM guidelines. Minimum inhibitory concentration of colistin was determined using the E-Test® method (bioMérieux), then using the EUCAST broth micro-dilution method (UMIC, Biocentric®) since May 2017.

Résultats / Results :
During the study period, the most frequent identified species were Pseudomonas aeruginosa (15.7%), Staphylococcus aureus (15%), Klebsiella pneumoniae (12.6%) and Acinetobacter baumannii (12%). These strains have been mainly isolated from blood cultures (37%) and skin samples (26.6%). Pseudomonas aeruginosa resistance to ceftazidime increased from 9.2% in 2012 to 53.5% in 2018. Its resistance to imipenem and ciprofloxacin was 63.3% and 42.9%, respectively. Four strains were resistant to colistin. The rate of methicillin resistant Staphylococcus aureus (MRSA) decreased from 65.3% in 2012 to 41.6% in 2018. Resistance rate to gentamicin and ciprofloxacin was 52% and 50.8%, respectively. All strains were susceptible to glycopeptides, tigecyline and linezolid. Most of A. baumannii strains were multidrug resistant with 81.8% of resistance to ceftazidime, 88.9% to amikacin, 90.5% to ciprofloxacin and 94.5% to imipenem. Sixteen strains were resistant to colistin. Concerning K. pneumoniae, 77.5% of the strains were resistant to cefotaxime and 5.2% to imipenem. Two strains were resistant to colistin. Vancomycin resistance in Enterococcus faecium increased from 33.4% in 2012 to 72.2% in 2018.

Discussion / Discussion :


Conclusion / Conclusion :
Multidrug resistance in burn patients imposes an epidemiological surveillance of microbial ecology and better application of hygienic measures.
 

Prognostic factors of community-acquired peritonitis

Orateur(s) :   Khalid KHALEQ (Casablanca, MAROC) 

Auteur(s) :  Amine ZERHOUNI (Casablanca)   Driss ELHAMMOUDI (Casablanca)   Rachid EL HARRAR (Casablanca)  

14h45 - 14h52
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Prognostic factors of community-acquired peritonitis

Introduction / Rationale :
Community-acquired peritonitis is a heterogeneous group of situations whose only common point is the inflammation of the peritoneum, a response to an aggression whose origin is mainly infectious. The aim of our study is to describe the epidemiological, clinical, bacteriological, etiological, therapeutic and evolutionary data of community peritonitis, and to evaluate the prognostic factors.

Méthodes / Patients and Methods :
This is a retrospective descriptive and analytical study spanning three years (between January 2015 and December 2017) involving 114 cases of community peritonitis, hospitalized in the surgical emergency resuscitation department P33 Ibn Rochd Casablanca University Hospital. Our study included adult patients with community-acquired peritonitis who underwent medical and surgical management. The studied parameters are the demographic data, the clinical and para-clinical signs, the care taken and the evolution of the patients.

Résultats / Results :
The study showed that the mean age was 54.25 ± 17.208 years, with a sex ratio of 2.17. The antecedents were dominated by tobacco (31,60%), the extra-abdominal signs [hemodynamic insufficiency (45%), renal insufficiency (39,50%), hematological disorders (80,70%) and respiratory disorders (38.60%) ...]. Therapeutic management was based on perioperative resuscitation, treatment of organ failure, probabilistic antibiotic therapy and median laparotomy surgery. The main etiologies of community peritonitis were: digestive perforations (76.3%), purulent effusion (50%), intestinal necrosis (16.70%), cholecystitis (3.50%). Intraoperative bacteriological specimens yielded the following bacteriological profile: predominance of BGN (85.93%) dominated by E. coli (46.81%) followed by Klebsiella pneumoniae and Enterobacter cloacae (28.25%) The mean hospital stay was 5.42 ± 5.48 days. The mortality rate was 55.30%.

Discussion / Discussion :


Conclusion / Conclusion :
Improvement in the prognosis of community-acquired peritonitis can only be achieved by constant assessment of very early diagnosis and initiation of appropriate resuscitation and antibiotic therapy associated with a complete surgery carefully codified according to the standards.
 

Bloodstream infections caused by KPC-producing bacteria

Orateur(s) :   Sabrine BRADAI (Sfax, TUNISIE) 

Auteur(s) :  kamilia CHTARA (Sfax, TUNISIE)   Basma MNIF (Sfax)   Karama BOUCHAALA (Sfax, TUNISIE)   Mabrouk BAHLOUL (Sfax, TUNISIE)   Mounir BOUAZIZ (Sfax, TUNISIE)  

14h52 - 14h59
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Bloodstream infections caused by KPC-producing bacteria

Introduction / Rationale :
Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are a group of emerging
highly drug-resistant Gram-negative bacilli causing infections associated with significant
morbidity and mortality. The aim of our study is to point out the incidence of bloodstream
infections (BSI) caused by KPC in ICU patients, its clinical presentation and course.

Méthodes / Patients and Methods :
We conducted a retrospective descriptive study. All patients hospitalized in the ICU of our hospital who developed BSI caused by KPC from January 01, 2016 to December 31, 2017 were included.

Résultats / Results :
During the study period, 20 patients were included. The mean age was 45.7±22.5 years with extremes of 8 and 91 years. Sex ratio (M/F) was 3.
Trauma was the major cause of hospitalization in 12 cases (60%).
The most common past medical diseases were arterial hypertension in 7 patients (35%).
Length of hospital stay prior to ICU admission was 4±7.2 days
At infection onset, mean SAPSII was 49±13.2, mean SOFA was 10.4±4.8 and mean APACHEII was 19.8±6.7.
During ICU hospitalization, all patients required invasive mechanical ventilation during 27.2± 13.2 days, had central venous catheter (CVC) and indwelling urinary catheter in place, 15 patients (63.9%) had tracheotomy, 12 (60%) underwent surgery, 9 (45%) presented acute kidney failure and 4 (20%) needed dialysis.
Before the isolation of KPC, all patients presented infections. Antibiotics prescript were: colistin in 14 patients (70%), carbapenems in 12 patients (60%), amoxicillin/clavulanic acid in 11 patients (55%), cephalosporins in 9 patients (45%), fluoroquinolones in 6 patients (30%), tigecycline in 5 patients (25%), aminosids in 4 patients (20%), rifampicin in 4 patients (20%), fosfomycin in 3 patients (15%), glycopeptides in 2 patients (10%).
The delay for KPC-BSI onset was 17.7±7.5 days.
The most common infection sources responsible of KPC-BSI were : CVC in 6 patients (30%) and pneumonia in 5 patients (25%).
KPC infection was responsible of septic shock in 18 patients (50%).
Resistance rates were: gentamycin (65%), amikacin (20%), colistin (15%), fosfomycin (10%) and tigecycline (10%).
Antibiotics used to treat KPC bloodstream infection were resumed in table 1.
The mean length of ICU stay was 36.1 ± 16.8 days. Out of the 20 included patients, 7 patients died (The mortality rate was 35%). Death was related to KPC infection in 5 patients.

Discussion / Discussion :


Conclusion / Conclusion :
The high prevalence of KPC-BSI in ICU patients dictates the importance of implementation of infection control measures and strict antibiotic policies.
 

Incidence of healthcare-associated infections in a Tunisian intensive care unit

Orateur(s) :   Mariem DLELA (Sfax, TUNISIE) 

Auteur(s) :  Rania AMMAR ZAYANI (Sfax, TUNISIE)   Farah ZOUARI (Sfax, TUNISIE)   Yousfi MOUNIR (Sfax)   Chokri Ben Hamida (Sfax, TUNISIE)   Mounir BOUAZIZ (Sfax, TUNISIE)  

14h59 - 15h06
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Incidence of healthcare-associated infections in a Tunisian intensive care unit

Introduction / Rationale :
Healthcare-associated infections are the most frequent adverse event in healthcare delivery worldwide .It causes significant increase in morbidity, mortality and financial burden on the healthcare system
Objective: to determine the incidence and clinical aspect of healthcare-associated infections

Méthodes / Patients and Methods :
A longitudinal study of incidence including patients who had exceeded 48 hours in the intensive care unit at Habib Bourguiba teaching hospital ,Sfax Tunisia over a period of 3 month (01/02/2019 to 31 / 05/2019).

Résultats / Results :
We included 136 patients whose mean age was 48.37 ± 20 years (4 - 90). Sex ratio was 2.31. The average score of SAPSII at admission was 33.5 points ± 16.22. The average score of S0FA at admission was 6.89 ± 3.98 points. The median of ICU stay was 9 days (2-80). We identified 103 episodes of nosocomial infections in 56 patients, representing a cumulative incidence rate of 41.17 per 100 exposed patients. The incidence density was 30.43 infections per 1000 days of hospitalization.
The prevalence of pneumonia was 38.83%, followed by urinary tract infections 21.35%, central venous catheterization infections 15.53%, bacteriemia16.3%, meningitis 6.7% and surgical site infections 1.9%. The incidence rate of intubation-related pneumonia was 24.47 / 1000 day of exposure. The incidence rate of bladder-related urinary tract infection was 9.7 / 1000 day of exposure. The incidence rate of positive culture of the central venous catheter was 7.05 / 1000 day of exposure. The incidence rate of bacteremia related to stay was 9.2 / 1000 day of exposure. The mortality rate was 26.5% with a significant difference between infected and uninfected patients (p = 0.041). Microorganisms were gram negative bacteria in 80% of cases.

Discussion / Discussion :


Conclusion / Conclusion :
Epidemiological surveillance of healthcare-associated infections was needed to establish prevention plan.