Comparative study of multidrug-resistant bacterial infections in hospitals and community settings in the region of Monastir - Tunisia.

INTRODUCTION AND AIM: Multidrug resistance in bacteria has become a widespread scourge. The objective of this study is to investigate the epidemiology of multidrug-resistant bacteria (MDR) at Fattouma Bourguiba University Hospital of Monastir - Tunisia compared to the community and to define their antibiotic resistance profiles. METHODS: It was a retrospective and descriptive study over a period of 5 years (2016-2020) conducted at the microbiology department of Fattouma-Bourguiba University Hospital of Monastir - Tunisia. All MDR strains isolated from diagnostic microbiological samples collected from patients hospitalized in high-risk infectious departments and from outpatients were included in our study. RESULTS: A total of 4324 MDR among 16353 bacteria were isolated during the study period, i.e. a resistance rate of 26.4% with a predominance of hospital strains (80.3% versus 19.7% in the city). Third generation cephalosporin-resistant Enterobacteriaceae were the most prevalent and were mainly represented by extended-spectrum beta- lactamases (67.1% versus 83.4% in the community). Escherichia coli was the most frequent species (40.9%). It was frequently associated with resistance to fluoroquinolones (in more than 73% of cases). Imipenem-resistant Acinetobacter baumannii was mostly responsible for hospital acquired infections (77%). Co- resistances concerned most of the antibiotics but spared colistin. Methicillin-resistant Staphylococcus aureus infections were more frequent in the city (20.5% versus 19.3% in hospitals). Resistance associated was mainly to fusidic acid (49.6%). Glycopeptides have maintained their activity and only 2% were of decreased sensitivity to vancomycin. CONCLUSION: The emergence of MDR always represents a public health challenge. Thus, hygiene measures associated with an optimization of antibiotic therapy are necessary for a better control of their diffusion.

Phenotypic and Genotypic Characterization with MALDI-TOF-MS Based Identification of Staphylococcus spp. Isolated from Mobile Phones with their Antibiotic Susceptibility, Biofilm Formation, and Adhesion Properties.

Cell phones, smartphones, and tablets are extensively used in social and professional life, so they are frequently exposed to bacteria. The main goal of the present work was to isolate and characterize Staphylococci strains from students' cell phone mobiles. Subsequently, 24 Staphylococci strains were tested against a wide range of antibiotics, for the distribution of some virulence-related genes and their ability to form biofilm. Staphylococcus spp. were cultured from all studied devices on chromogenic medium and identified using the matrix-assisted laser desorption/ionization (MALDI), time-of-flight (TOF) mass spectrometry (MS) technique (MALDI-TOF-MS). The results obtained showed that S.aureus was the dominant species (19 strains, 79.1%), followed by S.warneri (3 strains, 12.5%), and S.haemolyticus (2 strains, 8.3%). Isolated strains showed high percentages of hydrolytic enzymes production, resistance to many tested antibiotics, and 37.5% expressed the mecA gene. The tested strains were highly adhesive to polystyrene and glass and expressed implicated icaA (62.5%) and icaD (66.6%) genes. All Staphylococcus spp. strains tested were found to possess proteases and the α-hemolysin gene. Our results highlighted the importance of mobile phones as a great source of Staphylococcus spp., and these species were found to be resistant to many antibiotics with multiple antibiotic resistance (MAR) index ranging from (0.444) to (0.812). Most of the studied strains are able to form biofilm and expressed many virulence genes. Phylogenetic analysis based on the phenotypic and genetic characters highlighted the phenotypic and genetic heterogeneity of the S.aureus population studied. Further analyses are needed to elucidate the human health risks associated with the identified Staphylococci strains.

Ruscus hypophyllum L. extracts: chemical composition, antioxidant, anticoagulant, and antimicrobial activity against a wide range of sensitive and multi-resistant bacteria.

The aim of this study is to evaluate the polyphenolic and flavonoid contents in the leaves extracts of Ruscus hypophyllum. Antioxidant activity was estimated by α,α-diphenyl-ß-picrylhydrazyl (DPPH) and 2,2'-azino-bis-3-ethylbenzthiazoline-6-sulfonic acid (ABTS) assays. The anticoagulant activity of Ruscus extracts was evaluated in vitro, using the prothrombin time (PT) and a PTT-activated partial thromboplastin time tests. The antibacterial activity was tested against large number of important medically and resistant bacteria by the broth dilution method. In this study, ethyl acetate and chloroform extracts displayed the highest total phenols contents (74.76 mg EAG/g and 73.89 mg EAG/g, respectively) and flavonoid content 40 and 32.43 mg EC/g, respectively. The GC-MS analysis of ethyl acetate extract confirmed the presence of oxygenated sesquiterpenes and hydrocarbon diterpenes with percentages of 16.41% and 10.72%, respectively, but chloroform extract was rich with, oxygenated monoterpenes, and oxygenated diterpenes, with percentages of 6.19 and 3.27%, respectively. Among tested extracts, ethyl acetate exhibited the best antioxidant and anticoagulant activities. Furthermore, ethyl acetate and chloroform extracts showed important antibacterial activity against resistant bacteria methicillin-resistant Staphylococcus aureus (SARM), Acinetobacter imipenem-resistant (IMP/R), P. aeruginosa imipenem-resistant (IMP/R) and extended-spectrum beta-lactamase producing E. cloacae (BLSE) with minimal inhibitory concentration (MIC) values varying between 0.125 and 0.5 mg/mL.

Comparative study of virulence factors among methicillin resistant Staphylococcus aureus clinical isolates.

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) is recognized worldwide as a leading cause of hospital and community infections. Biofilm formation by MRSA is an extremely important virulence factor to be understood. Our aim was to establish phenotypic and genotypic characterization of virulence factors among 43 MRSA clinical isolates in a Tunisian hospital. METHODS: We investigated enzymatic profiles, biofilm production and prevalences of genes encoding intracellular adhesion molecules (icaA and icaD), Microbial Surface Components Recognizing Adhesive Matrix Molecules genes (fnbA, fnbB and cna) and exoenzymes genes (geh, sspA and sspB). RESULTS: Our findings revealed that caseinase, gelatinase, lipase and lecithinase activities were detected in 100%, 100%, 76.6% and 93.3% of cases respectively. This study showed that 23 strains (76.7%) were slime producers on Congo red medium. Furthermore, 46.5% and 53.5% of isolates were respectively highly and moderately biofilm-forming on polystyrene. Significant association was found between both biofilm tests. PCR detection showed that 74.4%, 18.6%, 69.8%, 65.1% and 74.4% of isolates harbored fnbA, fnbB, icaA, icaD and cna genes respectively. In addition, 34.9%, 18.6% and 30.2% of MRSA strains were found positive for sspA, sspB and geh genes respectively. Further, statistical data showed that the presence of the fnbA and fnbB genes was significantly associated with a high biofilm production on polystyrene. However, no statistical association was observed for the icaA, icaD and cna genes. CONCLUSIONS: This study indicates that the detection of fnbA and fnbB contributing to the first step of biofilm formation has been predictable of high biofilm production. As studied factors contribute to MRSA virulence, this research could be of value in orienting towards the development of new preventive and therapeutic measures.

Chromobacterium violaceum and Pseudomonas aeruginosa PAO1: Models for Evaluating Anti-Quorum Sensing Activity of Melaleuca alternifolia Essential Oil and Its Main Component Terpinen-4-ol.

The problem of antibiotic resistance among pathogens encourages searching for novel active molecules. The aim of the research was to assay the anti-quorum sensing (anti-QS) and antibiofilm potential of Melaleuca alternifolia essential oil and its main constituent, terpinen-4-ol, to prevent the infections due to methicillin-resistant Staphylococcus aureus strains as an alternate to antibiotics. The tea tree oil (TTO) was evaluated for its potential in inhibiting QS-dependent phenomena such as violacein production in Chromobacterium violaceum, swarming motility of Pseudomonas aeruginosa PAO1, and biofilm formation in MRSA strains on glass. The results showed that terpinen-4-ol was able to inhibit MRSA strain biofilm formation on the glass strips by 73.70%. TTO inhibited the violacein production at a mean inhibitory concentration (MIC) value of 0.048 mg/mL by 69.3%. At 100 µg/mL TTO and terpinen-4-ol exhibited inhibition in swarming motility of PAO1 by 33.33% and 25%, respectively. TTO revealed anti-QS and anti-biofilm activities at very low concentrations, but it could be further investigated for new molecules useful for the treatment of MRSA infections.

Lessons about Causes and Management of an Ebola Outbreak.

Ebola virus disease (EVD) is one of the deadliest viral diseases. It is characterized by a high mortality rate due to the lack of effective and safe treatments or vaccines and its ability to spread at an unstoppable pace. The West Africa outbreak ended but the disease may strike again at any time. The latest epidemic was, by far, the deadliest to date. The most concern was why this outbreak was so different from the previous ones. We proposed in this review firstly to summarize the principal causes of its unprecedented spread and secondly to identify the steps for an effective management approach of a future Ebola outbreak. Attributes of the affected populations and insufficient control efforts were the main reasons of its amplification. This was complicated by a delayed international response. The health crisis was ignored for months until it got out of control. The management of Ebola presents a multitude of challenges in terms of preparedness and capacity to face an outbreak. In addition to the need for adequate health care facilities, ongoing surveillance tools, appropriate training of health workers and raising population awareness, readiness requires a large scale and coordinated international intervention to support affected and at-risk nations, to intensify their response activities and to strengthen their capacities. Constant interventions after the outbreak are still needed to ensure that vital health and related service institutions in these countries are fully prepared to respond to an eminent epidemic.

Systemic lupus erythematosus in the elderly.

Onset of the disease above the age of 65 years is unusual. This study was undertaken to determine retrospectively the clinical and laboratory features in SLE patients aged over 65 years. It is a retrospective study about 18 elderly patients with SLE out of 342 diagnosed between 1994 and 2009 in the center of Tunisia. All patients had at least 4 of 11 revised ACR criteria of SLE. The frequency of SLE in the elderly was 5.3%. The median age was 70 years (range 66 and 78 years). The sex ratio F/M was 5. The most frequent clinical signs were anemia (83.3%), arthralgia (55.5%), arthritis (38.9%), and malar rash (33.3%). The proteinuria and the neuropsychiatric troubles were present in 27.8% of cases. The pericarditis was present in 16.7% of cases. Antibodies to double stranded DNA (anti-dsDNA) were detected in 66.7%, anti-nucleosome in 50%, anti-SSA and anti-RNP in 27.8%, anti-Sm in 22%, and anti-SSB in 11%. Elderly patients with SLE exhibit distinct clinical and biological manifestations from the classic form. Thus, greater attention should be given for this particular subgroup of SLE patients to avoid delays in diagnosis or misdiagnosis.