In Vitro Activity of Ceftazidime-Avibactam Against Enterobacteriaceae and P. aeruginosa Isolated at the Ibn Rochd University Hospital of Casablanca.

BACKGROUND: The aim of this study is to determine the in vitro activity of ceftazidime-avibactam (CZA) on Entero-bacteriaceae and P. aeruginosa strains isolated in the bacteriology-virology laboratory of the Ibn Rochd University of Casablanca. METHODS: This is a prospective descriptive longitudinal study conducted from May 28 through June 25, 2022, on Enterobacteriaceae and P. aeruginosa isolated from diagnostic samples received at the Bacteriology-Virology and Hospital Hygiene Laboratory of the Ibn Rochd University Hospital of Casablanca. The isolation and identification of the strains were carried out using standard bacteriological techniques. The study of sensitivity to ceftazidime-avibactam was done by diffusion susceptibility testing on agar medium according to EUCAST 2022 recommendations. RESULTS: During the study period, 271 strains of Enterobacteriaceae were isolated. The sensitivity rate to ceftazidime-avibactam was 91% vs. 74% for ceftazidime alone. R. terrigena was the most resistant strain to CZA with a rate of 69%, followed by E. cloacae (14%), then K. pneumoniae (6%), and finally E. coli (5%). Among the strains isolated, 24% (n = 66) produced ESBL, of which 29% (n = 19) were resistant to CZA, and 10.7% (n = 29) were re-sistant to imipenem, including 44, 8% (n = 13) that were resistant to imipenem and CZA. Regarding P. aeruginosa, 92 strains were isolated. The CZA resistance rate was 33.6% (n = 31). Among the strains isolated, 30.4% (n = 29) were resistant to imipenem, of which 82.7% (n = 24) were resistant to CZA. CONCLUSIONS: The in vitro evaluation of the ceftazidime-avibactam activity on the strains isolated, mainly: E. Coli, K. Pneumoniae, and E. Cloacae, showed a good inhibitory activity of this molecule which can constitute a therapeutic alternative for the treatment of infections due to these microorganisms.

Evaluation of Antibiograms Interpretation Training Needs of Medical Biology Residents at Ibn Rochd University Hospital.

BACKGROUND: In order to determine domains with the most difficulties and plan a relevant training, the aim of this study was to assess training needs of medical biology residents at the Ibn Rochd University Hospital of Casablanca, concerning antibiograms interpretation. METHODS: A descriptive and comparative study was carried out in February 2022, with two resident groups. The first one included all residents in training in the bacteriology-virology laboratory and having spent at least 2 months. The 2nd one included residents who had validated their course (9 months). Data were collected from collective interviews and a self-administered questionnaire with a qualitative and quantitative grid analysis. RESULTS: Residents expressed needs in the three learning domains (knowledge, know-how, interpersonal skills) but they were low to moderate (scores from 0.2/4 to 2.4/4). Priority topics for training were: interpretation of observed phenotypes (5.85/8), followed by interpretative reading according to EUCAST recommendations (5.05/8). The two groups' responses were similar, except for the know-how domain of natural resistance mechanisms where the needs were greater in G1 (p = 0.008). CONCLUSIONS: In the light of these results, additional training with relevant aims should be planned.

Nosocomial Bacterial Infections in Covid-19 ICU at Ibn Rochd University Hospital Casablanca Morocco.

BACKGROUND: The aim is to determine the prevalence of bacterial nosocomial infections (NI) and its associated factors in COVID-19 ICU. METHODS: A descriptive retrospective study, from April to August 2020, was carried on patients with respiratory distress following SARS-Cov-2 infection presenting a sign of bacterial infection. RESULTS: A total of 29 patients (33% of hospitalized patients) contracted a NI, their age was 65 years ± 13.90 and sex-ratio M/F was 2.62. All patients had an invasive device: central line (65%), bladder catheter (72%), and mechanical ventilation (76%). The time of NI occurring was 5 to 8 days. Charlson comorbidity index was 4 - 6 in 18 patients (62%). Of the 35 samples taken, 45 bacteria were isolated: multi drug resistant A. baumannii and P. aeruginosa accounted for 24.4%. Of all, 16 deaths were recorded (55, 17%). CONCLUSIONS: NI is common in COVID-19 ICU and can be predicted by risk factors that should be managed.

COVID-19: Patient care after discharge from the Intensive Care Unit.

INTRODUCTION: The Ibn Rochd CHU is a tertiary care structure that provides care for the most severe cases of COVID-19 requiring hospitalisation in intensive care. The objective of study is to describe the complementary medical and psychological care of patients with COVID-19 in the endocrinology department after a stay in intensive care. PATIENTS AND METHODS: This is a descriptive observational study of patients transferred from the intensive care unit to the endocrinology service following a COVID-19 infection during the period from 17 April 2020 to May 26, 2020. Clinical characteristics of the patients and complications related to COVID-19 infection were studied; a nutritional assessment using the MNA nutritional status assessment questionnaire; psychological assessment using quality-of-life questionnaires (Hamilton depression and anxiety, HAD, SF36, PCLS); a treatment satisfaction questionnaire (TQCMII) and an assessment of patient autonomy by the ADL score. RESULT: Our study included 41 patients with an average age of 55 years (19-85 years), a sex ratio M/F of 1.05, 43.9% were diabetic, 34.1% hypertensive, 4.9% asthmatic and 5% obese, and 51.2% were severe and critical cases. The average ICU stay is 8.42 days, requiring intubation in 12.2% of cases. All patients were treated with the Hydroxychloroquine, Azithromycin, vitamin C, zinc and corticosteroid protocol, 14.6% had undernutrition and 65.9% had a risk of undernutrition. The average BMI was 25.34 kg/m2 (17-42), 61% had experienced weight loss, which was greater than 8 kg in 26.1% of cases, 12.2% of patients were not autonomous, 12.2% had moderate depression, 2.4% severe depression, 14.6% mild to moderate anxiety, 12.2% severe anxiety and 29.3% suffered acute post-traumatic stress disorder. CONCLUSION: Patients with COVID-19 are, in addition to the complications from coronavirus infection, vulnerable to undernutrition, psychological and motor complications. Additional care before discharge is essential for better integration of patients into their families.

Concomitant visceral and localized cutaneous leishmaniasis in two Moroccan infants.

BACKGROUND: Leishmaniases are vector-borne diseases caused by the protozoa of the Leishmania genus. The clinical spectrum of these diseases extends from benign dermal lesions to visceral forms. In the Mediterranean region, zoonotic visceral leishmaniasis (ZVL) is caused by L. infantum. If untreated within two years, the disease usually leads to death. In Morocco, ZVL is endemic in the north, with a hundred cases notified each year, mostly in children aged below five years. Here, we report on two clinical observations in infants presenting unusual concomitant VL and cutaneous leishmaniasis (CL) in Morocco. CASE PRESENTATION: In this case study, we report on two infants aged nine and 12 months old. They both have a history of febrile splenomegaly, anemia, and pallor of mucous membranes. Visceral leishmaniasis was confirmed by parasitological diagnosis (positive bone marrow smear and screening of anti-L. infantum antibodies). However, the clinical examination also showed cutaneous lesions that suggested the presence of CL. This was reinforced by the patients having a history of living or traveling to endemic foci. Thus, direct examination, culture, and PCR-RFLP (ITS1-Hae 3) were carried out on the patients' dermal exudates. In one of the infants, CL was associated with L. infantum, while in the other it was associated with L. tropica. The infants were treated as according to the recommendations of the Ministry of Health. Both patients were cured in two months; defervescence, reduction of splenomegaly, and healing of cutaneous lesions were all observed. CONCLUSIONS: These singular patients illustrate the clinical polymorphism of CL and the necessity of updating the differential diagnosis of leukemia-like syndromes, including VL, in children living in or travelling to known endemic areas. These observations suggest a change in the Mediterranean VL phenotype that may be associated with CL.