Can ventral TAPP achieve favorable outcomes in minimally invasive ventral hernia repair? A systematic review and meta-analysis.

PURPOSE: The concept of the transabdominal preperitoneal (TAPP) was transferred from the inguinal hernia repair to be adopted in minimally invasive ventral hernia repair (VHR) and since then it has been gaining popularity. However, there are minimal data supporting the ventral TAPP (vTAPP) technique which may lead to reticence in the adoption of this approach. The aim of this meta-analysis was to evaluate the outcomes of patients who received minimally invasive vTAPP for VHR. STUDY DESIGN: A systematic search was performed of PubMed, Science Direct, Google Scholar and Cochrane Library until July 2022. We selected studies that compared the vTAPP technique with any of other minimally invasive techniques. A meta-analysis was done for the outcomes of perioperative characteristics and postoperative parameters. RESULTS: A total of 9 studies (1429 patients) were identified. vTAPP was associated with considerable benefit when compared to IPOM. vTAPP was less painful (MD = - 1.01; 95% CI [- 1.39, - 0.64], p < 0.00001), of reduced average cost (MD = - 457.10; 95% CI [- 457.27, - 456.92], p < 0.00001) and decreased SSI (OR = 0.29; 95% [0.09, 0.96], p = 0.04). On the other hand, the vTAPP approach consumed less operative time (MD: - 31.01, 95% CI [- 33.50, - 28.51]), p < 0.00001) and shorter hospital stay than the e-TEP approach. CONCLUSION: vTAPP appears to be safe and effective procedure for VHR, superior or similar to other minimally invasive techniques for perioperative characteristics and short-term outcomes.

First characterisation of plasmid-mediated quinolone resistance-qnrS1 co-expressed bla CTX-M-15 and bla DHA-1 genes in clinical strain of Morganella morganii recovered from a Tunisian Intensive Care Unit.

PURPOSE: Aim of this study was to show the emergence of the qnr genes among fluoroquinolone-resistant, AMPC and ESBL (extended-spectrum-beta-lactamase) co-producing Morganella morganii isolate. MATERIALS AND METHODS: A multi resistant Morganella morganii SM12012 isolate was recovered from pus from a patient hospitalized in the intensive care unit at the Military hospital, Tunisia. Antibiotic susceptibility was tested with the agar disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. ESBLs were detected using a standard double-disk synergy test. The characterization of beta-lactamases and associated resistance genes were performed by isoelectric focusing, polymerase chain reaction and nucleotide sequencing. RESULTS: The antimicrobial susceptibility testing showed the high resistance to penicillins, cephalosporins (MICs: 64-512 µg/ml) and fluoroquinolones (MICs: 32-512 µg/ml). But M. morganii SM12012 isolate remained susceptible to carbapenems (MICs: 4-<0.25 µg/ml). The double-disk synergy test confirmed the phenotype of extended-spectrum ß-lactamases (ESBLs). Three identical ß-lactamases with pI values of 6.5, 7.8 and superior to 8.6 were detected after isoelectric focusing analysis. These ß-lactamases genes can be successfully transferred by the conjugative plasmid. Molecular analysis demonstrated the co-production of bla (DHA-1), bla (CTX-M-15) and qnrS1 genes on the same plasmid. The detection of an associated chromosomal quinolone resistance revealed the presence of a parC mutation at codon 80 (Ser80-lle80). CONCLUSION: This is the first report in Tunisia of nosocomial infection due to the production of CTX-M-15 and DHA-1 ß-lactamases in M. morganii isolate with the association of quinolone plasmid resistance. The incidence of these strains invites continuous monitoring of such multidrug-resistant strains and the further study of their epidemiologic evolution.

Carbapenem-hydrolyzing class D ß-lactamase OXA-48 in Klebsiella pneumoniae isolates from Tunisia.

Two carbapenem-resistant Klebsiella pneumoniae isolates producing the plasmid-encoded carbapenem-hydrolyzing OXA-48 were identified. These isolates, recovered from two patients hospitalized in two different hospitals in Tunisia in December 2010, were not clonally related. Molecular investigations showed that both isolates co-produced the narrow-spectrum ß-lactamases TEM-1 and SHV-1, together with the extended-spectrum ß-lactamase CTX--15.

First detection of TEM-116 extended-spectrum ß-lactamase in a Providencia stuartii isolate from a Tunisian hospital.

PURPOSE: To study the resistance to third-generation cephalosporins in Providencia stuartii strain isolated from hospitalized patient in Tunisia and to identify the responsible genes MATERIALS AND METHODS: This strain was analysed by PCR and sequencing to identify the genes responsible for the ß-lactamase resistance phenotypes. The transferability of the phenotypes was tested by conjugation to Escherichia coli J53. The isoelectric point was determinate by isoelectrofocalisation. RESULTS: This resistance was carried by a 60 kb plasmid that encoded a ß-lactamase with a pI of 5.4. This ß-lactamase revealed identity with the blaTEM-1 gene encoding the TEM-1 ß-lactamase, except for a replacement of the Val residue at position 84 by Ile, and the Ala residue at position 184 by Val. These two mutations were encountered in TEM-116 ß-lactamase. CONCLUSION: This study demonstrates the first description of TEM-116 in the P. stuartii species in the world and the first one in a Tunisian hospital.

Nosocomial dissemination of extended-spectrum ß-lactamase VEB-1a-producing Providencia stuartii isolates in a Tunisian hospital.

A collection of 20 multidrug-resistant Providencia stuartii isolates recovered from 2005 to 2009 at the Military Hospital of Tunis, Tunisia, was analysed. They all expressed the extended-spectrum ß-lactamase (ESBL) VEB-1a. The bla (VEB-1a) gene was plasmid-located and it was associated with complex genetic structures, including Re elements. Pulsed-field gel electrophoresis (PFGE) revealed a clonal relationship between all of these isolates. This study identified a nosocomial dissemination of an ESBL-producing P. stuartii clone in a Tunisian hospital over a long period of time.