[Current antibiotic resistance profile of uropathogenic Escherichia coli strains and therapeutic consequences]. / Profil actuel de résistance aux antibiotiques des souches d'Escherichia coli uropathogènes et conséquences thérapeutiques.

UNLABELLED: Urinary tract infections (UTI) are a very common reason for consultation and prescription in current practice. Excessive or inappropriate use of antibiotics in treating urinary tract infections is responsible for the emergence and spread of multiresistant uropathogenic bacteria. AIM OF THE STUDY: To evaluate the isolation frequency and antibiotic resistance of uropathogenic Escherichia coli strains isolated at the Marrakech region. MATERIAL AND METHODS: We conducted a retrospective study over a period of three years (from 1st January 2010 to 31 December 2012). It included all non-redundant uropathogenic E. coli strains isolated in the microbiology laboratory of the Avicenne hospital of Marrakech, Morocco. RESULTS: During this study, 1472 uropathogenic enterobacteriaceae were isolated including 924 non-repetitive E. coli strains, an overall isolation frequency of 63%. Antibiotic resistance of isolated E. coli strains showed resistance rates to amoxicillin (65%), sulfamethoxazole-triméthropime (55%), amoxicillin-clavulanic acid (43%), ciprofloxacin (22%), gentamicin (14%), nitrofurans (11%), amikacin (8%) and fosfomycin (7%). The number of E. coli strains resistant to C3G by ESBL production was 67, an average frequency of 4.5% of all isolated uropathogenic enterobacteria. The associated antibiotic resistance in the case of ESBL-producing E. coli were 82% for ciprofloxacin, 76% for sulfamethozole trimethoprim, 66% for gentamicin and 56% for amikacin. No resistance to imipenem was recorded for the isolated E. coli strains, which represents an imipenem sensitivity of 100%. CONCLUSION: Antibiotic resistance of uropathogenic E. coli strains limits treatment options and therefore constitutes a real public health problem. The regular updating of antibiotic susceptibility statistics of E. coli strains allows a better adaptation of the probabilistic antibiotic therapy to local epidemiological data.

[Recent evolution of the epidemiological profile of extended-spectrum ß-lactamase producing uropathogenic enterobacteria in Marrakech, Morocco]. / Évolution récente du profil épidémiologique des entérobactéries uropathogènes productrices de ß-lactamases à spectre élargi à Marrakech, Maroc.

INTRODUCTION: Urinary tract infection by extended-spectrum ß-lactamase producing enterobacteriaceae (ESBL-E) is a growing infection risk and may even lead in many cases to therapeutic impasses because of their multidrug resistance. AIM OF THE STUDY: Follow, over a 5-year period, the evolution of the epidemiological profile of uropathogenic ESBL-E and describe their current level of antibiotic resistance. MATERIALS AND METHODS: A retrospective work was made over a period of 5 years (from 1st January 2008 to 31st December 2012). It focused on all the ESBL-E strains isolated from all the urinary samples at the microbiology laboratory of Avicenne hospital, Marrakech (Morocco). RESULTS: We noticed in 5 years, an important increase in the prevalence of ESBL-E. The higher prevalence of ESBL-E (51%) was recorded in the urology department. The study of the antibiotic resistance of the ESBL-E had shown antibiotic co-resistances to the ciprofloxacin (82%), to sulfamethoxazole-trimethropim (85%), to gentamicin (74%), to amikacine (51%). Our results also showed, for the first time in our region, an emergence in the resistance of enterobacteria producing ESBL to imipenem (10%). CONCLUSION: The significant increase in the prevalence of ESBL-E has become a concern at the hospitals and in community medicine as well. The study of the resistance of ESBL-E strains antibiotics showed high rates of co-resistance to antibiotics, including the usual urology molecules. LEVEL OF PROOF: 5.

[Study of nasopharyngeal colonization by Streptococcus pneumoniae and its antibiotics resistance in healthy children less than 2 years of age in the Marrakech region (Morocco)]. / Étude du portage rhinopharyngé de Streptococcus pneumoniae et de sa sensibilité aux antibiotiques chez les enfants en bonne santé âgés de moins de 2 ans dans la région de Marrakech (Maroc).

UNLABELLED: The healthy carrier of Streptococcus pneumoniae (S. pneumoniae) has been studied very little at the national level. With the emergence of antibiotic-resistant strains worldwide, and the emergence of new serotypes, an epidemiological survey is needed before the vaccine can be introduced in Morocco. OBJECTIVES: This study's objective was to determine the prevalence and risk factors of pneumococcal nasopharyngeal carriage in children less than 2 years of age in the Marrakech region and to assess the antibiotic susceptibility of the isolates and the serotypes present prior to the introduction of the conjugate pneumococcal vaccine. PATIENTS AND METHODS: From 2008 to 2009, 660 nasopharyngeal samples were collected on children under 2 years of age during scheduled visits to dispensaries for routine immunization in the Marrakech region. RESULTS: S. pneumoniae carriage was found in 45.8% of children. Of the 660 samples, 302 strains were isolated. The percentage of pneumococcal strains with reduced susceptibility to penicillin (PRSP) was 34.7%. Among these strains, 87.1% showed low-level resistance and 12.9% high-level resistance. Resistance to amoxicillin was found in 3.3% of the strains and no strains were resistant to cefotaxime. Several risk factors for pneumococcal carriage were identified, the main ones being breastfeeding less than 2 months, the presence of more than one sibling, passive smoking, and low socioeconomic level. The most frequent serotypes were 19F, 6, 14, 23, 18, and 9. The study of the vaccine serotype distribution showed that the theoretical vaccine coverage of the 7 valent vaccines was at 57% for all the isolates. CONCLUSION: These data show the frequency and the risk factors on nasopharyngeal carriage, and report the status of penicillin resistance of strains carrying children less than 2 years of age in the Marrakech region. The fluctuation of circulating serotypes at the national level underscores the importance of epidemiological surveillance carried out before the introduction of the heptavalent vaccine in Morocco.

[Serratia rubidaea bacteremia]. / Bactériémie à Serratia rubidaea.

Serratia rubidaea is an opportunist pathogenic bacterium, it is rarely identified in man, and when so, generally found in the respiratory tract, wounds, feces, bile, but also in blood. S. rubidaea can be responsible for infection, particularly in debilitated patients, receiving broad spectrum antibiotics or after undergoing extensive surgery, or invasive procedures. We report the case of a 54-year-old, nicotinic patient, with no previous medical history, admitted for complete arrhythmia due to auricular fibrillation. The patient had been carrying an arterial catheter for two weeks. Two hemocultures were positive in the first 48 hours with identification of Serratia rubidaea. S. rubidaea features inductible chromosomal betalactamase of the cephalosporinase type, resistant to ampicilline and cefalotin. The treatment combined gentamycin 160 mg/d and ciprofloxacin 400 mg/d for 10 days. The evolution was favourable.