Characterization and molecular epidemiology of extended spectrum beta-lactamase producing Enterobacter cloacae isolated from a Tunisian hospital.

In 2009, out of the 66 nonrepetitive Enterobacter cloacae collected at Charles Nicolle hospital in Tunisia, 44 were extended spectrum ß-lactamase (ESBL) producers. The aim of the current study was to detect and characterize the genes encoding the ESBLs including blaTEM, blaSHV, and blaCTX-M groups by polymerase chain reaction and sequencing. Pulsed-field gel electrophoresis (PFGE) analysis was used to determine the genetic relatedness between isolates. All strains were susceptible to carbapenems. They were resistant to fluoroquinolones, gentamicin, tobramycin, and trimethoprim+sulfamethoxazole but variably resistant to netilmicin, amikacin, and tetracyclines. Sequence analysis of the polymerase chain reaction products revealed the presence of blaCTX-M-15 (39 strains), blaSHV-12 (6 strains), and blaSHV-27 (1 strain). The coexistence of two ESBLs was observed in two isolates harboring, respectively, SHV-12+CTX-M-15 and SHV-27+CTX-M-15. PFGE revealed 36 unrelated profiles. Diffusion of E. cloacae producing CTX-M-15 ESBL in our hospital is the consequence of dissemination of identical or related plasmids harboring the CTX-M-15 gene.

Carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-23 in Tunisia.

AIM: To analyze the mechanisms of resistance to carbapenems among imipenem resistant A. baumannii recovered from different wards at Charles Nicolle Hospital. METHODS: From January to December 2007, 50 carbapenem-resistant A. baumannii isolates were recovered from hospitalized patients. MICs were performed by agar dilution method and interpreted according to CLSI guidelines. Metallo-ß-lactamase production was evaluated using imipenem-EDTA disk synergy test. PCR and DNA sequencing targeting blaOXA genes were performed and pulsed field gel electrophoresis was used for epidemiologic study. RESULTS: Most of the isolates were obtained from patients hospitalized in surgery (62%) and Intensive Care Units (22%). All strains showed high level of resistance to ticarcillin (MIC50 > 2048µg/ml), ticarcillin-clavulanic acid (MIC50 >1024µg/ml), aztreonam (MIC50 = 512µg/ml), ceftazidim (MIC50 = 512µg/ml), imipenem (MIC50 = 512µg/ml), meropenem (MIC50 =128µg/ml) and cefepime (MIC50 = 256µg/ml). Metallo-ß-lactamase production was negative for all isolates. The co-existence of blaOXA-51-like/ blaOXA-23-like was detected in 82% (n= 41). The genes blaOXA- 24-like and blaOXA-58-like were not found in any isolate. All isolates harboured a blaOXA-51-like gene. Sequencing confirmed the presence of blaOXA-23 and blaOXA-69 genes. Eight distinct patterns were observed (A: 41 isolates, B: 1 isolate, C: 1 isolate, D: 1 isolate, E: 1 isolate, F: 2 isolates, G: 1 isolate, H: 2 isolates). CONCLUSION: Production of OXA-23 was the important mechanism of resistance to carbapenem among A. baumannii. Strengthening of prevention measures are required to control further spread of carbapenemases in Tunisia.

Molecular mechanisms of tetracycline and macrolide resistance and emm characterization of Streptococcus pyogenes isolates in Tunisia.

Streptococcus pyogenes or group A Streptococcus, a major human pathogen, remains susceptible to beta-lactams, but resistance to other antibiotics is becoming more common. The purpose of this study was to characterize both phenotypic and genotypic epidemiological markers of group A Streptococcus and to identify the mechanisms of resistance to macrolides and tetracyclines. A total of 103 strains, isolated at Charles Nicolle University Hospital of Tunis, were investigated. The rate of resistance to erythromycin was low (5%), whereas a high rate of tetracycline resistance was found (70%). All the macrolide-resistant isolates expressed the constitutive macrolide, lincosamide, and streptograminB phenotype and harbored the erm(B) gene. Resistance to tetracycline was mainly due to the tet(M) gene, which is commonly associated with the conjugative transposon Tn916. No significant association was found between erm(B) and tet(M) genes. The tetracycline-resistant strains belonged to 28 distinct emm types. Among them, emm118 was the most prevalent type, followed by emm42, std432, emm76, and emm18. However, emm1, emm4, emm6, emm28, and emm3 were the most frequent types among tetracycline susceptible isolates. Only emm118 and emm42 types (p ≤ 0.05) were significantly associated with resistance to tetracycline.

[Bacteriological profile of urinary tract infections in women in Aziza Othmana Hospital: 495 cases]. / Profil bactériologique des infections urinaires chez la femme à l'Hôpital Aziza Othmana: étude à propos de 495 cas.

BACKGROUND: Urinary infection is a frequent pathology in the community as well as at the hospital. AIM: To analyze the profile of bacteria isolated from urinary tract infectious in women and their antimicrobial resistance. METHODS: During two year period (1 January 2005 to 31 December 2006), 4536 urinary specimens were analyzed at the Laboratory of Aziza Othmana Hospital. All bacteria isolated from urinary tract infection (UTI) at women were retrospectively reviewed. RESULTS: 495 cases of UTI were collected during this period. They were recovered from out patients (67%) or from hospitalized patients in Gynecology and obstetrics (23%). Enterobacteriacae were the most frequently identified strains (90.4%) including Escherichia coli (71%). The identified strains presented natural resistance and a high frequency of acquired resistance to betalactams(60.3% of E.coli, 72% of P.mirabilis were resistant to amoxicillin)and cotrimoxazole(30.4% of E.coli, 19,1 of K.pneumoniae, 21.4% of P.mirabilis). 5.7% of K.pneumoniae and 1.8% of E.coli were producing extended spectrum betalactamase(ESBL). Aminoglycosides remained active on enterobacteriacae(resistance to amikacin<14%,gentamicin<5%).Ofloxacin was highly active against enterobacteriacae (resistance<14%) CONCLUSION: Enterobacteriacae were the most frequent species in women urinary tract infection. Among these isolates, a high frequency of acquired resistance to betalactams and cotrimoxazole was shown. Aminoglysosides and fluoroquinolones remained the most active drugs. In every case antibiotherapy should have been prescribed after performing an antibiogram for each strain. These data were useful for the first line antibiotherapy, however the antimicrobial susceptibility testing is necessary for the rational use to limit the highly active drugs to multiresistant strains.

[Questionnaire evaluation of hand hygiene by the healthcare staff of Charles Nicolle Hospital of Tunis]. / Evaluation de l'hygiène des mains par auto-questionnaire chez le personnel de santé de l'hôpital Charles Nicolle de Tunis.

BACKGROUND: Known to be reservoir of bacteria, hands are implicated in bacteria cross-transmission which enhances nosocomial-acquired infection rates (NI) and outbreaks. Hand washing is then considered the first mean with authentic efficiency to prevent NI. AIM: To describe the situation of the hand hygiene at Charles Nicolle hospital of Tunis in order to identify problems that can oppose to the good execution of this practice. METHODS: A descriptive transverse study performed in October 2006 where 600 questionnaires were distributed to healthcare staff of the hospital. RESULTS: Only 434 questionnaires were responded (158 doctors and 276 nurses). Analysis of data obtained showed that hand washing was essentially practiced after each contact presumed to be contaminant for the healthcare person himself (80%) and was principally done with water and soap (82%). Hydro-alcoholic solutions were rarely mentioned (17.1%). The main reasons evoked for the non observance were unavailability of the necessary means (84.8%) and default of awareness (61.3%). CONCLUSIONS: So, these results show a poor perception of the healthcare staff on the importance of hand hygiene which they share the responsibility with healthcare managers. Thus, implication of all healthcare actors is necessary to ensure the good practice and mainly the observance of hand hygiene.

Corynebacterium propinquum isolated from a pus collection in a patient with an osteosynthesis of the elbow.

BACKGROUND: Although non- diphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, they rarely account for clinical infections. AIM: we report a case of infection due to non- diphtherial corynebacteria, Corynebacterium propinquum. CASE: A Tunisian male patient of 67 years old was admitted to orthopedic surgery and traumatology ward of Charles Nicolle university hospital of Tunis (Tunisia) for a left elbow trauma. He was treated by osteosynthesis and received an antibioprophylactic therapy with amoxicilline-clavulanate and gentamicin association. No postoperative incident was noted. When he was readmitted a month later for the osteosynthesis material removal, clinical examination found a pus collection in the operated elbow. Specimen analysis showed a Gram positive stained bacilli identified as C. propinquum. The organism was resistant only to penicillin G and sulfamethoxazole-trimethoprim association. The patient was treated with ofloxacin (2 g per day for 8 days) and gentamicin (160 mg per day for 5 days) with clinical improvement. CONCLUSION: According to literature, infections due to C. propinquum are rare, occurring especially in patients with medical device or immunocompromised. Thus, this pathogen should be taken in consideration in such situations.

Hospital acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a health care worker.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly important pathogen leading to hospital acquired infections. AIM: This study was done to confirm an outbreak of MRSA suspected at Charles Nicolle Hospital. METHODS: From 26 April to 11 June 2002, six patients hospitalized in the dermatologic ward at Charles Nicolle hospital of Tunisia have developed infections caused by MRSA. An investigation of the outbreak has been detected a nasal carriage nurse. This carrier received topical mupirocin treatment to decolonize the anterior nares and the outbreak was stopped without further incident. RESULTS: Typing of the MRSA strains by pulsed field gel electrophoresis demonstrated the same pulsotype shared by all isolates showing that MRSA isolates belonged to a single clonal type responsible of outbreak. Colonized nurse was the source of MRSA dissemination. CONCLUSION: This report illustrates the risk of nosocomial outbreak linked to cares delivered by the staff personnel. More sensibilisation and the respect of strict hygienic measures should be emphasized.

Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region.

BACKGROUND: This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions. METHODS: MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions. RESULTS: Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P=.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P=.002), combination penicillins (P=.018), and aminoglycosides (P=.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P=.005), but a negative association was evident for beta-lactamase-resistant penicillins (P=.010) and first-generation cephalosporins (P=.012). CONCLUSIONS: The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.

Molecular epidemiology and genetic environment of acquired bla ACC-1 in Salmonella enterica serotype Livingstone causing a large nosocomial outbreak in Tunisia.

Eighty-four isolates of Salmonella enterica serovar Livingstone were collected from patients hospitalized in a pediatric ward in Sfax Hospital (South Tunisia). These isolates were responsible for two nosocomial outbreaks in 2000 and 2002. Twenty-eight clinical isolates of S. enterica serovar Livingstone were also obtained in two other Tunisian hospitals in Monastir (Central Tunisia) and Tunis (North Tunisia), respectively, in 2002 and 2003. Pulsed-field gel electrophoresis yielded that these isolates were closely related. Antimicrobial susceptibility testing showed a particular beta-lactam resistance phenotype, suggestive of the presence of an AmpC-type enzyme in 111 of the 112 clinical isolates. bla(ACC-1) was characterized by polymerase chain reaction (PCR) and sequence analysis in the 111 isolates. TEM-1 was characterized in all strains and SHV-2a in only two strains. The genetic organization of bla(ACC-1) was determined by PCR mapping and sequencing. The plasmid-borne bla(ACC-1) gene mapped immediately downstream from ISEcp1. This ISEcp1 insertion sequence was itself disrupted by IS26 insertion sequences. A supplementary deletion of 13 bp was observed in ISEcp1 upstream IS26, in all isolates from Tunis, except one. PCR analysis and sequencing also revealed the presence of tnpR, bla(SCO-1), gdha, IS1353, and TniB Delta 1.

Health care worker perceptions of hand hygiene practices and obstacles in a developing region.

A structured self-assessment questionnaire was distributed to 8 southern and eastern Mediterranean hospitals to identify perceived obstacles to hand hygiene (HH). An insufficient number of sinks and alcohol handrub stations was rated by the vast majority of respondents as the most critical impediment, whereas improved availability of HH products was deemed the key intervention to increase compliance. The least importance and relevance were given to HH auditing and collegial reminders. While initiatives to improve HH compliance clearly must address infrastructural inadequacies, sociocultural issues also need to be considered when transposing initiatives found to be successful in Western countries to less-developed regions, to ensure that campaigns are not compromised by perceptual undercurrents.

Clonal spread of carbapenem resistant Pseudomonas aeruginosa in an university hospital.

AIM: We examined 14 Pseudomonas aeruginosa clinical isolates collected in 2000 from patients hospitalised in different wards at Charle Nicolle hospital from Tunisia. METHODS: Analysis includes serotyping, antimicrobial susceptibility profile, beta-lactamase detection, randomly amplified polymorphic DNA and pulsed field gel electrophoresis. All Pseudomonas aeruginosa strains belonged to serotype O12 and they demonstrated a high level of resistance to all antibiotioc tested. RESULTS: Beta-lactamase detection revealed that 9 of these strains had ceftazidime activity restored by cloxacillin and none of the 14 strains were metallo-beta-lactamase producing. Randomly amplified polymorphic DNA analysis and pulsed field gel electrophoresis were able to discriminate isolates and gave concordant results which showed epidemiologically related strains. CONCLUSION: These results confirm a clonal spread of multiresistant Pseudomonas aeruginosa O12 throughout the hospital.

[Methicillin resistant Staphylococcus aureus: phenotypic and genotypic studies]. / Staphylococcus aureus résistants à la méticilline: etude phénotypique et génotypique.

BACKGROUND: Staphylococcus aureus is a human opportunistic pathogen. Its important pathogenicity and the increasingly rate of resistance to methicillin are the main causes of morbidity and mortality. AIM: In order to evaluate the epidemiologic situation of Methicillin Resistant S. aureus (MRSA) at Charles Nicolle hospital. METHODS: A four years retrospective study (January 1999-December 2002) was conducted. RESULTS: 65 non redundant MRSA isolates were collected. Identification was based on morphology, culture and biochemical characters. Antibiotic susceptibility was determined by disk diffusion method. Resistance to methicillin was confirmed by mec A PCR. Molecular typing was performed by Random Amplified Polymorphic DNA using ERIC-IR. Despite a perfect biotypic similarity between strains, ERIC-IR PCR revealed 7 genotypes. CONCLUSION: The combination of phenotypic methods and RAPD fingerprinting were easy to perform routinely for MRSA typing. However, phylogenetic relationship between strains needs more investigations.

[Community-acquired pneumonia due to Panton-Valentine producing Staphylococcus aureus: first description in Tunisia]. / Pneumonie communautaire à Staphylococcus aureus producteur de la toxine de Panton-Valentine: première description en Tunisie.

BACKGROUND: Community-acquired pneumonia due to Panton-Valentine producing S.aureus is a serious infection recently described. Many cases have been reported worldwide. AIM: We report here the first case in Tunisia. OBSERVATION: Our patient is a previously healthy fourteen-year-old girl hospitalized for bilateral hypoxemic pneumonia. The clinical course had violently deteriorated two hours later, marked by massive hemoptysis that lead to rapid degradation of her hemodynamic state and death. Toxicologic research and bloodcultures were negatives. A post-mortem pleural specimen culture yielded a meticillin-resistant Staphylococcus aureus strain that carried the Panton-Valentine leucocidin genes. CONCLUSION: Community-acquired pneumonia due to Panton-Valentine producing Staphylococcus aureus is a serious affection unrecognized in our country. Thus, this pathogen must imperatively be included in the spectrum of those responsibles for pulmonary infections in children and young adults

Spread of multidrug resistant Acinetobacter baumannii in a teaching hospital.

BACKGROUND: A. baumannii is an important opportunistic pathogen widely distributed in the hospital environment and responsible for a variety of nosocomial infections especially in patients from intensive care units. AIM: We describe an outbreak of Acinetobacter baumannii (16 stains) in 3 intensive care units (I, II, III) at Charles Nicolle hospital of Tunis over a 5 month period (March to July 2005). METHODS: The antimicrobial susceptibility was determined by disc diffusion test and the genetic relatedness of isolates was done by Random Amplified Polymorphic DNA (RAPD) analysis. Two strains not related to the outbreak were used for the discrimination of the technique. RESULTS: Samples were collected from blood (44%), materials (31%), pus (6.5%), urines (6.5%) and respiratory tract (12.5%). Antibiotic resistance pattern showed 2 different profiles. However, molecular typing of isolates revealed 3 distinct profiles (A, B, C) represented respectively by 8, 7 and one isolates. The major profile was the profile A found in 5 patients and in materials. It was appeared firstly in intensive care unit I, then in the 2 other units (II and III). The profile B was observed also in the 3 units. However, the profile C was found in one patient in unit I. CONCLUSION: These data emphasize the need for active surveillance for multidrug-resistant Acinetobacter baumannii, and the value of molecular typing of strains in hospital settings to investigate spread of infection.

[Surveillance of multidrug resistant bacteria in a Tunisian hospital]. / Surveillance des bactéries multirésistantes dans un hôpital Tunisien.

BACKGROUND: Controlling antibiotic resistance of bacteria is a priority for public healthcare. AIM: This study concerned the frequency of multidrug resistant bacteria (MDRB) in a Tunisian Hospital with the aim of establishing guidelines for MDRB prevention. METHODS: The study was conducted during two years (1 January 2005-31 December 2006). Samples collected for the clinical diagnostic were included. The MDRB concerned were: methicillin resistant Staphylococcus aureus(MRSA), Enterobacteriacae resistant to of third generation cephalosporin (ER3GC), Acinetobacter baumannii resistant to both imipenem and ceftazidime, Pseudomonas aeruginosa resistant to both imipenem and ceftazidime. RESULTS: During the study period, 2475 bacteria were tested by disk diffusion. 597 MDRB were collected, the rate of MBR was 24.1%. These MDRB were mainly recovered in burn unit (82.6%). ER3GC (47%) and MRSA (29,2%) were the most frequent MDRB. A. baumannii and P. aeruginosa multiresistant concerned 14,8% and 9% of MDRB. MDRB were isolated mainly from blood cultures (45%). The rate of MRSA was 46.4% among 375 strains of S. aureus. ER3GC represented 25,6% among 1096 isolates. Concerning A. baumannii and P. aeruginosa, 51.7% and 20.5% were resistant to both imipenem and ceftazidime among 170 and 264 isolates. Antibiotic resistance evolution showed a decrease of resistance in 2006 versus 2005. This decrease should be explained by the improvement of hygiene measure especially hand washing with the introduction of hydro- alcoholic solutions, a better targeted antibiotherapy promoted by a close cooperation between microbiologists and clinicians. CONCLUSION: The MDRB were frequent in our hospital. They were mainly isolated from the burn department. The measures of prevention already implemented are effective and must be strengthened with the continuous surveillance of MDRB.

[Bacteriological profile and antibiotic resistance of bacteria isolates in a burn department]. / Profil bactériologique et résistance aux antibiotiques des bactéries isolées dans un service de réanimation des brûlés durant deux ans.

BACKGROUND: Nosocomial infections remain the main cause of morbidity and mortality in burn patients. Ongoing surveillance of infections in burned patients is essential to detect changes in epidemiology and to guide better empirical antibiotherapy and infection control policies. The aim of this study is to analyze the bacterial flora and the antibiotic resistance of isolates in a burn department during a two year period METHODS: From 1 January 2005 to 31 December 2006, 1268 strains were isolated from different specimens. Antimicrobial susceptibility testing has been carried out by disk diffusion method as referred to the French Society of Microbiology. All data were stored in a laboratory data base using whonet 5.3 software. Duplicate isolates defined as the same bacterial species for the same patient with the same antimicrobial susceptibility profile were excluded. RESULTS: The most frequently identified species were Staphylococcus aureus (19.8%), Pseudomonas aeruginosa (15.8%), Acinetobacter baumannii (11.8%), Providencia stuarttii. The rate of meticillin resistant S. aureus was 68.1%, all isolates were fully susceptibles to glycopeptide. P. aeruginosa resistance was 35.6% and 35.4% respectively for ceftazidime and imipenem. Concerning A. baumannii, 98.7% of strains were resistant to ceftazidime, 59.5% to imipenem and 87.5% to ciprofloxacin. 77.3% of P. stuarttii isolates were resistant to ceftazidime and were producing extended spectrum, lactamase (ESBL). The frequencies of resistance to ceftazidime, of loxacin and amikacin of K. pneumoniae were respectively 60.9%, 25.4% and 47.1%. CONCLUSION: Comparatively to the previous years, S. aureus still be the commonest pathogen in the burn department. The incidence of antimicrobial resistance has decreased during 2006 after a peak of multiresistance during 2005. Our results should be helpful in providing useful information regarding antimicrobial resistance among the burn isolates and this will help in formulation of effective guideline for therapy.

Determining the source of nosocomial transmission in hemodialysis units in Tunisia by sequencing NS5B and E2 sequences of HCV.

Hepatitis C virus infection is a significant problem in hemodialysis units. HCV is very variable genetically with six genotypes. Clinical and epidemiological investigation of a new infection requires the determination of both the genotype and the strain of the HCV involved. A prospective, epidemiologic study of 395 dialysis patients in Tunisia was conducted from November 2001 to November 2003 to identify the source of nosocomial transmission using phylogenetic analysis of NS5b and E2 sequences. Hepatitis C infection was diagnosed by screening for anti-HCV antibodies and HCV RNA in sera using third generation ELISA and a qualitative RT-PCR assay. HCV strains were genotyped by sequencing the NS5b region. The genetic relatedness of the HCV strains was studied by sequencing the NS5b and the HVR-1 regions of the HCV genome. Two de novo cases of HCV infection were detected during the follow-up. One of them has been described previously. The case described in this study occurred in a center in which 12 patients were already infected with HCV strains belonging to genotypes 1b (n = 8) and 1a (n = 4). Phylogenetic analysis of the NS5b region from the HCV strains circulating in this center disclosed four clusters, confirmed by analysis of the HVR-1 region, providing strong evidence for nosocomial infection. Epidemiological data showed that these patients were dialyzed during the same shift and in the same area. Phylogenetic analysis of NS5b sequences is useful for determining the HCV genotype and providing evidence of nosocomial transmission.

[Evolution of antibiotic consumption in an intensive care burn department]. / Evolution de la consommation des antibiotiques dans un service de réanimation de brûlés.

BACKGROUND: The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units. AIM: Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measures. METHODS: The study was conducted during a 5 year period (1 January 2000 to 31 December 2004). The average number of admissions was 204/year and the mean number of hospitalisation was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics: imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density (AD) witch takes into account the quantity of antibiotics in Grams converted to daily defined dose (DDD) and number of hospitalization days. The daily defined dose (DDD) was proposed by WHO. The calculation of the AD for each molecule was carried out according to the following formula: [AD = Quantity consumed in grams for the particular antimicrobial X 1000]/[DDD for that antimicrobial X number of days hospitalizations]. RESULTS: There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae (rs=0.93; p=0.02). The use of ceftazidime was not significantly associated with resistance to this molecule in P. aeruginosa (rs=0.76 ; p=0.13). Concerning the fluoroquinolones, there was statistically significant relation ship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P. aeruginosa (rs=0.89,P=0.043). Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P. aeruginosa (rs=0.87, p=0.05 ). However, the consumption of imipenem was not significantly correlated to resistance of this drug in P. aeruginosa (rs=0.45; P=0,4). CONCLUSION: The monitoring of both antibiotic consumption andantibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics.

[Detection of DNA human cytomegalovirus of a molecular methods: hybrid capture DNA CMV by immunocompromised]. / Detection de l'adn du cytomegalovirus humain par hybridation moleculaire chez les immunodéprimés.

Human cytomegalovirus (HCMV), a member of the beta-virus herpes family, is a ubiquitous human pathogen. After a primary infection, HCMV establishes life latency. HCMV rarely causes symptomatic disease in an immunocompetent host, however, it is a major cause of infectious morbidity and mortality in immunocompromised individuals and developing fetuses. The HCMV genome consists of 240 kbp of double stranded DNA. Early diagnosis molecular of CMV infection is important. The objective of this study was to develop a molecular methods: Quantitative Hybrid capture for the detection of DNA CMV. We present results for 200 immunocompromised collected from 1999 to 2003 (122 men and 78 women, whom mean age was 35 years). Our results showed that 25% of women and 36% of men were positif for hybrid capture DNA CMV. This simple test (cold probe) provide quantitative and fast results. Also the efficacity of anti-CMV therapy can be followed. More over, in contrary with pp65-antigenemia assay and CMV PCR, this test can be managed on biopsy sample.