[Acquired bacterial meningitis in Monastir region, Tunisia (1999-2006): bacteriological aspects and susceptibility patterns]. / Lesméningites purulentes dans la région deMonastir, Tunisie (1999-2006): aspects bactériologiques et état de résistance aux antibiotiques.

The aim of this study was to analyze the distribution of bacteria responsible for purulent meningitis and the pattern of resistance of common species in the University Hospital of Monastir (Tunisia). All bacteriologically confirmed cases of bacterial meningitis were recorded between 1999 and 2006, and have been analyzed by classic bacterial methods advocate for meningitis. Two hundred fifty three strains have been isolated. The most frequent species were Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae, followed by Escherichia coli and Neisseria meningitides with 19.4, 13.8, 13.8, 7.1, and 6.3% of cases, respectively. Their distribution with regard to age was in accordance with literature data. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteriaceae and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. Influenzae was the predominant microorganism in children between three month and five years of age (36.3%), followed by S. Pneumoniae (28.8%). S. Pneumoniae was the predominant bacteria responsible for 47% of the cases over five years of age. 38.8% of S. Pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were 4.1%, respectively. Only one strain of N. meningitidis (6.2%) presented a decreased susceptibility to penicillin. 22.9% of H. Influenzae strains produced ß-lactamase. The resistance rates of Enterobacteriaceae to third generation cephalosporins were 25%. In our study, nosocomial meningitis have shown a rate of 24.4%. The most affected service was neurosurgery, pediatrics, and intensive care units. The increasing prevalence of pneumococci meningitis with reduced sensitivity to penicillin G strains isolated from meningitis makes adequate therapeutic management difficult.

[Susceptibility patterns of Pseudomonas aeruginosa strains isolated in the Monastir region, Tunisia]. / Profil de sensibilité aux antibiotiques des souches de Pseudomonas aeruginosa isolées dans la région de Monastir.

The aim of this study was to determine the susceptibility rates and patterns in P. aeruginosa strains isolated from 2002 to 2005 in a teaching Hospital of Tunisia. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. During this period, 1368 strains of P. aeruginosa were identified, they were isolated mainly from pus (52.9%), respiratory samples (19.5 %), urine (10.6%), and blood cultures (5%). The percentages of resistant isolates were as follows: ticarcilline: 26.2%; ceftazidime: 21.8%; imipenem: 19.6%; gentamicin: 39.3%; amikacin: 19.2%, and ciprofloxacin: 21.6%. Nosocomial infections in P. aeruginosa are responsible for important morbidity and mortality rates, the survey of resistance to antibiotics is necessary for an efficient treatment.

Mechanical efficiency and propulsion technique after 7 weeks of low-intensity wheelchair training.

BACKGROUND: To evaluate the effect of a 7-week low-intensity hand rim wheelchair training on the submaximal metabolic cost, mechanical efficiency and propulsion technique in able-bodied participants. METHODS: Participants were randomly divided over an experimental group (n=14) and a control group (n=7). The experimental group received 7 weeks wheelchair training (3 week(-1), 70 min) at a low intensity (30% of the heart rate reserve), whereas the control group did not receive training. During pre- and post-tests, submaximal exercise was performed on a stationary wheelchair ergometer at fixed levels of power output. Mechanical efficiency, oxygen uptake, heart rate, timing parameters and stroke angles were measured. Video recordings were made to determine the stroke pattern. FINDINGS: Mechanical efficiency increased and metabolic cost decreased significantly in the experimental group compared to the control group. Push time increased and cycle frequency decreased as a result of training. The stroke angle increased in the experimental group during the training period. The experimental group preferred double-looping over propulsion, while the control group mainly used single-looping over propulsion patterns during the post-test. INTERPRETATION: A low-intensity, 7-week training protocol has a beneficial effect on the mechanical efficiency and metabolic cost of wheelchair propulsion in able-bodied participants. The improved mechanical efficiency seems to be the result of changes in propulsion technique that were found.

Group A rotavirus strains circulating in the eastern center of Tunisia during a ten-year period (1995-2004).

An epidemiological survey investigating rotavirus infections in children was undertaken in the Eastern Center of Tunisia between January 1995 and December 2004. A total of 982 faecal specimens collected from children less than 5 years in age were screened by enzyme-linked immunosorbent assay (ELISA) or latex agglutination assay for the presence of group A rotavirus antigen. Rotavirus-positive samples were used for G and P typing by multiplex semi-nested reverse transcription-PCR. Rotaviruses were detected in 22% (n = 220) of stools. Of these, 164 were typed for VP7: G genotypes found were G1 (59%), G2 (2%), G3 (9%), G4 (10%), G8 (1%), and G9 (1%). Sixteen specimens (9%) showed mixed G profiles. A total of 119 specimens were typed for VP4. P genotypes detected were P[8] (32%), P[6] (15%), and P[4] (13%). Mixed P profiles were also detected (6%). Although the distribution of the detected genotypes appeared to change annually, G1P[8] rotavirus strains always predominated during the 10-year period of study. This is the first report of rotaviruses in Tunisia with unconventional VP7 serotypes such as G8 and G9, highlighting the need for continual surveillance of emerging strains in Northern Africa. Indeed, the new commercial vaccines only contain the VP7 genes that dictate G1 or G1 to G4 specificities. These vaccines may protect less well against unusual strains circulating in countries planning to implement a rotavirus vaccine strategy.

[Antimicrobial susceptibility of Streptococcus agalactiae strains in Monastir]. / Sensibilité aux antibiotiques des souches de Streptococcus agalactiae à Monastir.

OBJECTIVE: The aim of this study was to determine the antimicrobial susceptibility of Streptococcus agalactiae strains in Monastir (Tunisia). METHOD: This retrospective study included 300 strains of S. agalactiae from several pathological samples collected at the Monastir Fattouma Borguiba Hospital. The identification was based on conventional bacteriological features. Serogrouping was performed using agglutination tests. The susceptibility to antibiotics was studied according to the Antibiogram Committee of the French Society of Microbiology recommendations. RESULTS: S. agalactiae was mainly isolated from patients with vaginal infections (31.3%) and urinary tract infections (24.7%). All strains were susceptible to penicillin G. Resistance was mostly observed to erythromycin (38.5%) and lincomycin (36.6%). 6.5% were highly resistant to kanamycin and 0.6% to gentamicin. CONCLUSION: Penicillin remains the most effective antibiotic, but resistance to other antibiotics is emerging. This justifies the routine studying of antimicrobial susceptibility in S. agalactiae stains.