[Perceptions of a healthcare-associated infections reporting system in a Tunisian university hospital]. / Perceptions d'un système de signalement des infections associées aux soins dans un hôpital universitaire tunisien.

Objective: The implementation of a healthcare-associated infections reporting system is a principal component of infection control and quality improvement policies in healthcare institutions. This study was designed to determine the perceptions of health professionals concerning implementation of a healthcare-associated infections reporting system and to analyse factors influencing these perceptions.Methods: A descriptive cross-sectional study conducted in 2012 using a predefined, pre-tested and self-administered questionnaire in 380 health professionals working in 16 different departments of Farhat Hached University Hospital, Tunisia.Results: The majority of respondents (71.8%) reported that no healthcare-associated infections surveillance procedure had been implemented in their departments. However, most respondents (93%) recognised the value of implementation of a healthcare-associated infections reporting system in order to provide them with corrective actions (77%), to support the investigation of epidemic and emerging phenomena (49%) and to share experiences about the prevalence of healthcare-associated infections and their risk factors (44%).Conclusion: Staff training and development of a regulatory framework are essential to implementation and correct functioning of a healthcare-associated infections reporting system.

Microsatellite Typing of Aspergillus flavus Strains in a Tunisian Onco-hematology Unit.

Aspergillus flavus is the most common species associated with invasive aspergillosis in Tunisia. The molecular epidemiology of the species is poorly documented. We used five highly discriminative microsatellite markers for the genotyping of clinical and hospital environmental A. flavus strains to assess whether IA could be hospital-acquired in the onco-hematology unit of the Farhat Hached teaching hospital of Sousse, Tunisia. The genotyping of 18 clinical isolates, collected from sputa of 17 acute leukemia patients, and 81 isolates, collected in these patients' hospital environment and food, identified 57 isolates that were grouped in 10 clones, each of them including 2-17 isolates. The remaining 42 isolates showed a unique genotype. Two main transmission scenarios were observed: (1) the same clone was isolated from different patients; (2) the same clone was isolated from a patient, its hospital environment and/or food. These findings strongly suggest the occurrence of hospital-acquired A. flavus infection/colonization in the investigated onco-hematology unit.

Hospital environment fungal contamination and aspergillosis risk in acute leukaemia patients in Sousse (Tunisia).

Hospital environment is considered the main source of invasive aspergillosis (IA) in leukemic patients. This study aimed to describe Aspergillus colonisation in leukemic patients and their hospital environment and to test whether Aspergillus environmental contamination was associated with IA. For a 2-year period including 14-month renovation work, 91 acute leukaemia inpatients at the hematology department of University hospital in Sousse (Tunisia) were prospectively included. The incidence of probable IA (EORTC/MSG criteria) was 9.9%. Fifty-six Aspergillus were isolated from 53 (6.5%) of 811 sputa collected from 35 (38.5%) patients. Aspergillus spp. were isolated in 59.7% of 494 air samples and in 52.8% of 1579 surface samples taken in the patients' room. Aspergillus section Nigri (72.7%) was the most frequent. Aspergillus contamination peaked in autumn and winter on surface and in summer and autumn in air samples and was higher (P = 0.03) during the renovation work period. Multivariate analysis showed that for each Aspergillus section Nigri CFU airborne contamination IA risk increased by 1.05 (P = 0.04). In Tunisia, Aspergillus section Nigri and Flavi, but not Fumigati, are chiefly involved in IA. Our findings support swift implementation of airborne fungal contamination control measures in areas where immunocompromised patient are hospitalised.

[Incidence of device-associated infections in a Tunisian intensive care unit]. / Incidence des infections associées aux dispositifs médicaux dans un service de réanimation tunisien.

INTRODUCTION: Healthcare-associated infections represent a real public health problem. They are particularly frequent and severe in intensive care units due to the serious diseases presented by patients and the almost systematic use ofvarious medical devices. A study of the incidence of device-associated infections was conducted in the ICU of CHU Farhat Hached Sousse (Tunisia) to estimate the incidence and to identify risk factorsfor DAI METHODS: This prospective incidence study was conducted during the first quarter of 2012, with anonymous and standardized data collection for all patients hospitalized for at least 48 hours. RESULTS: Out of a total of 105 patients hospitalizedfor more than 48 hours during the study period, 17 cases of DAI were identified. The incidence density was 16.9 infected patients / 1,000 days of hospitalization. The infections most frequently identified were central and peripheral venous catheter-associated infections. Independent riskfactorsfor DAI in the ICUwere length of ICU stays which increased the risk of DAI by 1.10 per day (95% CI [1.03 - 1.17]; p=0.002), and the use of CVC, which increased the risk by 3.29 (95% CI [1.36 - 7.95]; p=0.031). CONCLUSION: The implementation of continuous surveillance of healthcare-associated infection in the intensive care unit should be encouraged in order to guide the actions of prevention and control of nosocomial infection risk.

Characteristics of invasive aspergillosis in neutropenic haematology patients (Sousse, Tunisia).

Although scarce, available data suggest that the epidemiology of invasive aspergillosis (IA) in North Africa differs from northern countries, where more than 80 % is caused by Aspergillus fumigatus. This study aimed at describing the epidemiology of IA in the region of Sousse, Tunisia, and at assessing the usefulness of the available diagnostic tools. For 2 years, clinical and mycological data were prospectively collected from 175 neutropenia episodes of 91 patients hospitalised in the haematology department at the Farhat Hached hospital in Sousse (Tunisia). Screening for galactomannan antigen was positive in 40 % of neutropenia episodes; Aspergillus PCR was positive in 42 % of the tested sera. Nine patients were classified as probable and two as possible IA according to the EORTC/MSG criteria. Twelve patients who prematurely died, had no CT scan and could not be classified. Fifty-six Aspergillus spp. were isolated in 53 (6.5 %) sputa collected from 35 (20 %) patients. The following species were identified with MALDI-TOF mass spectrometry and DNA sequencing: A. niger, 35 %; A. flavus, 38 %; A. tubingensis, 19 %; A. fumigatus, 4 %; A. westerdijkiae, 2 % and A. ochraceus, 2 %. Our findings highlight the epidemiological features of IA in Tunisia, which is characterised by the predominance of Aspergillus spp. from sections Nigri and Flavi.

Hesitation of the Tunisian population to COVID-19 vaccination, and its associated factors.

BACKGROUND: Many people are reluctant to be vaccinated against COVID-19. AIM: To determine the intention to accept COVID19 vaccine and its associated factors among Tunisians. METHODS: We conducted a cross-sectional study among Tunisians from December 2020 to January 2021 using an online questionnaire. Factors associated with intention to accept coronavirus vaccine were analysed using multinomial logistic regression. RESULTS: In total, 169 Tunisians participated in our study. The majority were female (85.2%). The mean age was 48.3 ± 11.8 years. Only 33.1% intended to accept to be vaccinated when COVID-19 vaccine will be available in Tunisia and 22.5% were still hesitant. In multinomial logistic regression, participants having high or very high perceived personal risk of COVID-19 infection (aOR: 3.257, 95% CI : 1.204 - 8.815) were more prone to hesitate to accept COVID-19 vaccine rather than those being willing to accept it. Respondents undergoing seasonal influenza vaccination (aOR: 0.091, 95% CI : 0.019 - 0.433) were less prone to refuse COVID-19 vaccine rather than those being willing to accept it. Young ones aged less than 40 years (aOR: 4.324, 95% CI: 1.180 - 15.843) were more prone to refuse COVID-19 vaccine rather than those being willing to accept it. CONCLUSION: The acceptance rate of coronavirus vaccination was moderate. Therefore, a good communication and health education at a community level are needed.

Burden of Healthcare-associated infections in a Tunisian University Hospital in 2019.

BACKGROUND: Healthcare-associated infections (HAI) represent a real threat to patient safety and their prevention should be a priority for any Health system. Prevalence surveys constitute one of the most common methods of HAI epidemiological surveillance to determine the burden of this problem. AIM: The aim of this study is to determine the prevalence of HAI and its associated risk factors. METHODS: It is a cross-sectional survey, carried out at Farhat Hached University Hospital in 2019, over a period of nine days including all patients who had been hospitalized for at least 48 hours, in 21 clinical departments of our hospital. A single passage has been carried out by department. RESULTS: Of 373 patients included, a total of 66 patients experienced HAI, with a mean prevalence of 17.7%. In addition, four patients suffered from two types of HAIs. The overall prevalence of HAI in Farhat Hached University Hospital was 19%. Peripheral venous catheter associated infection (41.5%) was the most common type of infections recorded in this survey. Patients admitted to a surgical ward were 4.6 times more likely to acquire HAIs. Patients admitted for more than 7 days were 4.57 times more at risk of developing HAIs. Exposure to peripheral venous catheter, to central venous catheter and to mechanical ventilation were among significant risk factors responsible for HAI with adjusted OR of 4.90, 10.65 and11.99, respectively. CONCLUSION: Prevalence of HAI is high at our center. National strategy to address HAI should be implemented for better control of HAIs.

In vitro susceptibility to amphotericin B, itraconazole, voriconazole, posaconazole and caspofungin of Aspergillus spp. isolated from patients with haematological malignancies in Tunisia.

The resistance of Aspergillus species to antifungal is increasingly reported and the knowledge of the local epidemiology and antifungal susceptibility pattern is pivotal to define adequate treatment policies. Our study aimed to: 1) describe the in vitro antifungal susceptibility profile of the Aspergillus species isolated from patients with haematological malignancies in Tunisia; 2) compare the E-test and Sensititre Yeast-One assays for the detection of paradoxical growth and trailing effect, both phenotypes commonly exhibited by Aspergillus spp. upon exposure to caspofungin and 3) to evaluate the mortality rate in patients according to the causative Aspergillus species and the antifungal treatment. We tested amphotericin B, itraconazole, voriconazole, posaconazole and caspofungin against 48 Aspergillus isolates (17, A. niger; 18, A. flavus; 9, A. tubingensis; 1, A. westerdijkiae; and 1, A. ochraceus) with the E-test. Minimal inhibition concentrations were above the epidemiological cut-off values for amphotericin B in 67% of A. flavus strains; for caspofungin in 22% of A. flavus strains; and for itraconazole in 22% of A. tubingensis strains, voriconazole and posaconazole MICs were below the epidemiological cut-off values for all strains. When exposed to caspofungin, 42% of the strains exhibited trailing effect and 38% paradoxical growth. Trailing effect occurred in 61% of A. flavus strains and paradoxical growth in 62% of Aspergillus section Nigri strains. E-test and Sensititre Yeast-One assays were only fairly concordant for the detection of these phenotypes. Repeatability of both assays was high for trailing effect but poor for paradoxical growth. The relatively high frequency of amphotericin B resistant strains makes voriconazole best adapted as a first-line treatment of invasive aspergillosis from amphotericin B to voriconazole in this hospital.