mercredi 5 février 2020 

14h10 - 15h10


 
Espace Poster 3

Infectiologie I : diagnostic et résistance

MODÉRATEUR(S) :  Anahita ROUZÉ (Lille), Jean-Ralph ZAHAR (Bobigny)  
  

SIRS is still useful in the sepsis-3 era

Orateur(s) :   Hadil MHADHBI (Tunis, TUNISIE) 

Auteur(s) :  Abderrahim ACHOURI (Tunis, TUNISIE)   Khedija ZAOUCHE (Tunis)   Hamida MAGHRAOUI (Tunis)   Radhia BOUBAKER (Tunis, TUNISIE)   Kamel MAJED (Tunis)  

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


Abstract : 
SIRS is still useful in the sepsis-3 era

Introduction / Rationale :
Sepsis is known for its important mortality in critically ill patients. The last guidelines has defined sepsis as life threatening organ dysfunction. It rejected the concept of systemic inflammatory response syndrome (SIRS)associated to suspected or confirmed infection, and considered the concept of dysregulated response to infection. Actual guidelines recommend the quick sequential organ failure assessment score (qSOFA) to identify patients with sepsis especially when outside intensive care unit. Thus, outcomes have mainly to judge the value of SIRS in the sepsis-3 era.
The purose of our study is to compare whereas qSOFA score or the SIRS criterion are superior to predict in-hospital mortality, shock and mechanical ventilation use in sepsis.

Méthodes / Patients and Methods :
Our study includes patients in whom the sepsis-3 definition is met. Therefore, this inclusion was retrospectively performed throughout emergency department (ED) admission cases for clinically suspected infection.

Résultats / Results :
We collected 93 patients admitted to ED for sepsis. Mean age was 65 years ± 14 with bornes of 24 and 92. Men were 57% of the patients. Death occurs in 29.6% of patients, sepstic shock in 25% and the use of mechanical ventilation in 5.6%.
qSOFA ≥ 2 has a significant association with in-hospital mortality (p=0.000) but not SIRS ≥ 2 (0.208). Neither qSOFA ≥ 2 nor SIRS ≥ 2 has association with the use of mechanical ventilation (p=0.104 vs p=1). Whereas, both have a significant association for prediction of septic shock.

Discussion / Discussion :
The absolute sensitivity and negative predictive value in our study can be explained by the small size of our sample. This needs confirmation with literature data about the fact that SIRS criterion are superior in term of sensitivity and NPV than qSOFA to predict septic shock. Despite the weak odds ratio (OR) of SIRS before that of qSOFA and the poor specificity and Positive predictive value (PPV), we can conclude that SIRS according to its sensitivity and NPV, seems to persist useful in the sepsis-3 era as a reliable prognostic tool in the ED. This may need more large studies to confirmation.

Conclusion / Conclusion :
Despite SIRS has no significant association with mortality in sepsis, it has largely higher sensitivity and superior NPV to predict septic shock than qSOFA in ED.
 

Predictors of mortality in septic schok in intensive care

Orateur(s) :   Mohamed LAZRAQ (Casablanca, MAROC) 

Auteur(s) :  Sabah BENHAMZA (Casablanca, MAROC)   Youssef MILOUDI (Casablanca)   Abdelhak BENSAID (Casablanca)   Najib ELHARRAR (Casablanca)  

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


Abstract : 
Predictors of mortality in septic schok in intensive care

Introduction / Rationale :
The mortality from septic shock in intensive care remains high despite the evolution of diagnostic and therapeutic techniques. Our study aims to determine the predictive factors of mortality in our patients.

Méthodes / Patients and Methods :
Retrospective study on 2 years in the intensive care unit of the hospital 20 August. All patients with septic shock were included. A percentage <0.05 was considered significant.

Résultats / Results :
81 patients were collected. The age ranged from 11 to 94 years old. The average duration of hospitalization in pre-intensive care was 5 days. The reasons for admission :( febrile respiratory distress: 31% of cases, polytrauma: 14% and 23% for sepsis), the most frequent infections: pulmonary (33%) and blood (32%). 38% received prior antibiotic therapy and 35% were immunocompromised. The overall mortality was 48%. The analytical study of the data shows that the age, the length of stay before admission in intensive care and that in intensive care, fever, hypothermia, slimming, hypotension, collapse, failures (respiratory, hematological, renal, hepatic and neurological) and the use of catecholamines are correlated with mortality, whereas sex, chest pain, tachycardia or bradycardia and mottling are not predictive of mortality.

Discussion / Discussion :


Conclusion / Conclusion :
Despite improved techniques for the diagnosis and treatment of patients with septic shock, mortality remains high, especially in the presence of certain risk factors, hence the value of prevention in immunocompromised patients and the reduction in their length of stay in a hospital setting.
 

Molecular characterization of carbapenemase-producing Enterbacteriaceae In trauma and burn center in Tunisia

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

Auteur(s) :  Mehdi GADDAS (Ben Arous)   Sarra DHRAIEF (Ben Arous, TUNISIE)   Karim MECHRI (Ben Arous, TUNISIE)   Imen JAMI (Ben Arous)   Amenallah MESSAADI (Ben Arous)  

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


Abstract : 
Molecular characterization of carbapenemase-producing Enterbacteriaceae In trauma and burn center in Tunisia

Introduction / Rationale :
The emergence of carbapenemase-producing Enterbacteriaceae (CPE) is an increasingly serious worldwide problem associated with high rate of therapeutic failure and mortality. Thus, early detection of CPE and rapid application of infection control measures is of a paramount importance. We conducted a prospective study to characterize the molecular mechanisms and to determine the antimicrobial susceptibility profiles of CPE isolated in trauma and burn center in Tunisia.

Méthodes / Patients and Methods :
We examinated 148 strains with reduced susceptibility to carbapenems among 978 Enterobacteriaceae clinical isolated collected between January 2018 and December 2018. Sixty-three strains were selected for the study (one strain per species and per patient). The susceptibility of each strain was determined for a range of antibiotics involved, according to CA-SFM guidelines. Minimum inhibitory concentration (MIC) of carbapenem were determined using the E-test® method (bioMérieux). Multiplex real-time PCR was performed with Cepheid’s GeneXpert®, allowing detection of the most prevalent carbapenemase gene families (blaVIM, blaNDM, blaIMP, blaOXA-48 and blaKPC).

Résultats / Results :
Of the 63 selected bacteria, Klebsiella pneumoniae was the main isolated one (74.6%) followed by Enterobacter cloacae (11.1%). Selected bacteria were mainly isolated from burn intensive care unit (74.6%). PCR was positive for 57 isolates (90.5%). Thirty-one bacteria (54.4%) expressed the blaNDM gene. The blaoxa-48 gene was found in 15 strains (26.3%) and 11 strains carried both genes.
Of the 57 CPE, 89.5% revealed ertapenem MIC> 1mg/l, whereas only 7% showed imipenem MIC> 2mg/l.
The antibiotics showing the highest resistant rates were cefotaxime (100%), piperacillin-tazobactam (94.7%), aztreonam (93.9%), ciprofloxacin (89.4%) and amikacin (52,6%).
The most active agents were colistin, tigecycline (excepting with Proteae) and fosfomycin with 94.7%, 61.4% and 91.2% of susceptibility, respectively.

Discussion / Discussion :


Conclusion / Conclusion :
The spread of CPE is an alarming problem in our center. Among carbapenemase encoding gene, the blaNDM was predominant. Detection of CPE by GeneXpert® carba-R was established in the center with a whole protocol of prevention.
 

Proteus mirabilis infections in intensive care unit

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

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

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


Abstract : 
Proteus mirabilis infections in intensive care unit

Introduction / Rationale :
P.mirabilis, a Gram-negative rod-shaped bacterium most noted for its swarming motility and urease activity, frequently causes nosocomial infections especially catheter-associated urinary tract infections. The aim of our study is to point out the incidence of P.mirabilis infection 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 out University Hospital who developed P.mirabilis infections from January 01, 2017 to June 30, 2019 were included

Résultats / Results :
During the study period, 36 patients were included. The mean age was 49.4±19.5 years. Sex ratio (M/F) was 3.5. Trauma was the major cause of hospitalization in 20 cases (55.6%). Length of hospital stay prior to ICU admission was 5 ± 9.4 days. SAPSII was 44.9 ± 13.3, mean SOFA was 10.4 ± 3.1 and mean APACHEII was 18.1 ± 5.4. All patients required invasive mechanical ventilation, had central venous catheter (CVC) and indwelling urinary catheter in place. Nine patients (25%) presented acute kidney failure and 6 (16.7%) needed dialysis. Before the isolation of P.mirabilis, 10 patients (27.8%) hadn’t any infections and 5 patients (13.9%) didn’t received any antibiotics. Concerning the other 31 patients, antibiotics prescript were: amoxicillin/clavulanic acid in 17 patients (47.2%), carbapenems in 17 patients (47.2%), aminosids in 13 patients (36.1%), glycopeptides in 10 patients (27.8%), colistin in 9 patients (25%), fluoroquinolones in 7 patients (19.4%), cephalosporins in 6 patients (16.6%), tigecycline in 4 patients (11.1%).The most common infection site of P.mirabilis was the urinary tract in 22 patients (61.1%).After P.mirabilis infection, 18 patients (50%) had septic shock. Antibiotics used to treat P.mirabilis infection were resumed in table 1. The mean length of ICU stay was 38.4 ± 18.4 days. Out of the 36 included patients, 9 patients died (The mortality rate was 25%). Death was not related to P. mirabilis infections.
.

Discussion / Discussion :


Conclusion / Conclusion :
P.mirabilis is among the leading bacteria responsible for nosocomial infections in ICU. They are emerging highly drug resistant pathogens whose incidence is rapidly increasing in ICU. So that, it early identification with in vitro testing is of paramount importance to the success of infection control efforts
 

Eosinopenia in sepsis

Orateur(s) :   Kaoutar EL FAKHR (Casablanca, MAROC) 

Auteur(s) :  Habibou hassane MAHAMANE RABIOU (Casablanca)   Abdeljabbar MARHFOUR (Casablanca, MAROC)   Boubaker CHARRA (Casablanca)  

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


Abstract : 
Eosinopenia in sepsis

Introduction / Rationale :
Eosinopenia is a reliable marker of sepsis.
The aim of this study was to test the value of Eosinopenia in the diagnosis of sepsis.

Méthodes / Patients and Methods :
This prospective study was including 30 patients with sepsis documented on a bacteriological specimen on admission or during hospitalization in the medical resuscitation department of Ibn Rochd Casablanca University Hospital, from January 2018 to April 2019.

Résultats / Results :
Comparison between infected and non-infected studied patients was statistically significant as regard variables of SOFA score, APACHE II score at admission, and Eosinophil count at admission.
Multivariate regression analysis showed statistically significant differences and was independent predictors for infection as follow: total leucocytic count, eosinophil count at admission and SOFA score. The AUC for eosinophil count to predict was 95% with optimal cut off value was 50 cells/mm3 with for admission diagnoses.
Eight patients (26.7%) were in renal impairment, with Whiteblood cell count > 10,000 / mm3, Eosinophils counts was under 50 cells / mm3 ,CRP> 40mg / L,PCT> 100 ng / ml.
22 patients (73.3%) had correct renal function, 6 patients (20%) had Whiteblood cell count > 10,000 / mm3 Eosinophils counts was under 50 cells / mm3 CRP> 40 mg / L PCT> 0.5 ng /ml.

Discussion / Discussion :


Conclusion / Conclusion :
The result of the present study revealed that eosinophil counts ˂50 cells/mm3 at admission time was apredictor for diagnosis of sepsis in critically ill patients. However,eosinophil counts at admission time were not a specific indicator of mortality.
 

Impact of multiplex PCR on antibiotic prescription in ICU patients with community acquired-pneumonia

Orateur(s) :   Marion GIRY (Rouen) 

Auteur(s) :  Déborah BOYER (Rouen)   Manuel ETIENNE (Rouen)   Dorothée CARPENTIER (Rouen)   Steven GRANGÉ (Rouen)   Christophe GIRAULT (Rouen)   Fabienne TAMION (Rouen)   Gaetan BEDUNEAU (Rouen)  

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


Abstract : 
Impact of multiplex PCR on antibiotic prescription in ICU patients with community acquired-pneumonia

Introduction / Rationale :
Pneumonia is the most frequent community-acquired infection responsible for ICU admission. Multiplex PCR enables early diagnosis of viral infection in daily practice. Few series have been described the impact of this technique on the antibiotic duration in ICU. Our principal objective was to evaluate the impact of multiplex PCR on the duration of antibiotic in ICU patients with community-acquired pneumonia (CAP). Our secondary objectives were to evaluate the practices and the respect of French recommendations in the prescription of antibiotics for ICU patient with CAP and to evaluate the potential undesirable effects of overprescribing antibiotics.

Méthodes / Patients and Methods :
Retrospective analysis of the consecutive viral multiplex PCR (Eplex™, Genmark) between November 2016 and October 2017 in a French 21 bed medical ICU admitting around 1,000 patients per year. Patients’ nasopharynx was sampled within 72 hours following their ICU admission. We identified patient with a viral CAP (group 1) and patient with other microbiological finding (bacterial, mixed, no finding) CAP (group 2). Comparisons were made with non-parametric Welch t-test and Fischer’s exact tests.

Résultats / Results :
223 patients were sampled, of whom 75 had CAP, 27 aspiration or opportunistic pneumonia, 25 non-pulmonary infections, 21 exacerbations of chronic lung disease, 16 pulmonary edema, 10 bronchitis, 6 pleural empyema and 43 other diagnoses.
Patients with CAP had the following characteristics: age 60 ± 17 years, male sex 52%, SAPS 2 score 41 ± 19, ICU length of stay 9,1 ± 8.7 days, mortality 15 %. There were 16 patients (21%) in the group 1 and 59 patients (79%) in the group 2. The main bacteria were S. pneumonia (40,4%) and H. influenza (9.3%). The main viruses were Influenzae A (26,5%), Rhinovirus (23,5%) and Parainfluenzae (17,6%).
The antibiotic duration was shorter in group 1 than in group 2 (4,1 days vs 6,4 days p= 0,007) for the ICU stay. No statistical difference was found on the antibiotic duration for the whole hospitalization (8,1 days vs 11,1 days, p=0,07).
French recommendations (duration of antibiotic treatment, choice of initial therapy, de-escalation at 48-72h) were followed in 36% cases. 48% of patients had an antibiotic treatment for more than 7 days. Adverse events were found in 5% of patients.

Discussion / Discussion :


Conclusion / Conclusion :
In our study, respiratory viruses were present in 45 % of CAP. Their diagnosis with multiplex PCR allows shorter ICU antibiotic treatment duration, no statistical difference was found for the whole hospitalization. A multicentric prospective study needs to validate these results.