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This study aimed to evaluate the relationship between antimicrobial resistance in Pseudomonas aeruginosa and annual antibiotic use in a burn unit.From 1 January 2000 to 31 December 2004, 203 non-repetitive strains of Ps. aeruginosa were recovered from various clinical specimens. Antimicrobial susceptibility testing was performed using the disc diffusion method, and susceptibility data were interpreted according to break points recommended by the French Society of Microbiology. The antibiotic consumption for imipenem, ceftazidime, cefotaxime, piperacillin-tazobactam, ofloxacin, ciprofloxacin, gentamicin and amikacin was calculated with antimicrobial density. The relationship between antibiotic use and the resistance of Ps. aeruginosa was analysed.The consumption of ceftazidime and amikacin showed no association with resistance. A statistically significant relationship was observed between increasing use of ciprofloxacin and the incidence of resistant Ps. aeruginosa to this antibiotic (rs = 0.89, p = 0.05), and a significant correlation between ciprofloxacin consumption and resistance to imipenem was noted (rs = 0.89, p = 0.043). Restricted use of ciprofloxacin during 2003 and 2004 was followed by a significant decrease of resistance in Ps. aeruginosa. Our report illustrates the major role of ciprofloxacin in the emergence of resistant Ps. aeruginosa. [ABSTRACT FROM AUTHOR]

Resistance to carpabenems in burns is rapidly spreading in many countries. Therefore identification of carbapenemase pathogen carriers is imperative in order to establish adequate infection control precautions and stop outbreaks of these multidrug-resistant bacteria. The aim of our study was to evaluate the distribution of carbapenemase producers in burn patients admitted to a burn center in Tunisia over 9 months. PCR for carbapenemase portage was performed in all patients within 48 hours of admission. Seventeen patients carried a single carbapenemase, 11 carried two, and 25 carried three. The enzymes detected were VIM (n=41), NDM (n=41) and OXA48 (n=32). Enzyme mapping revealed two main areas of carriage in central western Tunisia: Kairouan (NDM/OXA48) and Kasserine (NDM/VIM). Predictive factors for carriage of carbapenemase were: prior antibiotic therapy (n=24); mechanical ventilation (n=30); vascular catheterization (n=31) and a previous stay in intensive care (n=11)., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)

Electrical burn injuries (EBI) affect both adults and children and are responsible for a very high number of major limb amputations. Their management is still a major challenge. This retrospective review concerns 42 children, admitted to an intensive burn care department in Tunisia for high electrical burns, from January 2016 to September 2022. The average age of our patients was 12 years, with a male predominance (90.5%). Electrotrauma was accidental in the majority of cases (93%) and secondary to a domestic accident in 54.8% of cases. Total body surface area was 19%. Burns were second degree in 2/3 of cases and third degree in 1/3 of cases. The most affected areas were distal extremities in 2/3 of the cases. Rhabdomyolysis was observed in 93% of cases and troponins were elevated in half of the patients. Escharotomy was required in 38% of cases. Amputation was performed in 18 children (43%): one limb (n=10); 2 limbs (n=6) and 3 limbs (n=2). The outcome was favorable in 9 children (21.4%); functional and cosmetic sequelae with an impact on schooling and psychology were reported in 25 cases. Mortality was 16.7%., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)

The incidence of extubation failure varies between 2 and 25% depending on the studied population. Few studies have been conducted in burn victims. To determine the incidence, causes, risk factors and outcome of burned patients after a failed extubation, a retrospective single-center case-control study was conducted over a period of 3 years (January 2018-December 2021). All burned patients aged over 16, ventilated for at least 24 hours and having had at least one extubation attempt were included. Extubation failure was defined as the need for re-intubation within 48 hours. Eighty-eight patients had planned extubation. These patients were divided into 2 groups comparable in terms of age and sex. Failure group: including patients with failed extubation (N= 34) and a success group (N= 64) including patients who succeeded. The incidence of extubation failure was 36.6%. Hypophosphatemia, anemia <8g/dl, duration of mechanical ventilation of 8,5 days and abundant secretions during extubation were identified as risk factors for extubation failure (p<0.05). The main cause of failure was retention of secretion (50%). Extubation failure was associated with prolonged length of stay (34 vs. 19 days, P= 0.005), increased infectious complications (P=0.007) and mortality rate (79.4%, 1.5%, P<0.001)., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)

Burns in diabetics are quite frequent and serious in relation to diabetic neuropathy, which is common in this population, delaying healing and predisposing to the risk of infection. The objective of this study was to describe the characteristics of burns in diabetics hospitalized at the CTB of Tunis over 18 months. During the study period, 891 patients were hospitalized, including 43 diabetics (5%). The average age of our patients was 57 years old with a male predominance (65%). Type 2 diabetes was present in 86% of cases and type 1 diabetes in 14% of cases. Degenerative complications were reported in 10 cases (23%), such as diabetic retinopathy (n=6), diabetic nephropathy (n=4) and diabetic neuropathy (n=6). The circumstances of burns were related to a domestic accident in 2/3 of the cases (76.7%). Thermal burns were involved in 83.7% of cases. 86% of the patients had decompensated their diabetes during their hospitalization. Sepsis marked the evolution of the patients in 55.8% of cases. In our study, poor prognostic factors were: a glycosylated haemoglobin > 13%, an extent of burns greater than 20%, and a delay in consultation greater than 6 hours. The mortality rate was 18.6%., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)

Self-immolation is a violent way of committing suicide. Few studies have focused on this phenomenon in children. The aim of this study was to determine the epidemiological profile of children who committed suicide by fire. A retrospective descriptive study was conducted in an intensive burn care department in Tunis, over a period of 10 years (2011-2020). Of a total 3077 patients, 761 were admitted for burns by suicide attempt, among them 62 children and adolescents (8%). The number was on average six per year. The highest annual prevalence was noted in 2011 (27% of cases). The mean age was 16 and a half years old. The majority of cases were adolescents aged 15 or older. There is a male predominance (sex ratio:3). Total burn surface area (TBSA) was on average 44%. The act of self-immolation occurred in public places in 58% of cases. Socio-economic environment was unfavorable in 60% of cases. The suicidal act of self-immolation was due to a family conflict in 34% of cases (n=21). Seven patients (11%) had a history of mental illness. Forty-three patients (70%) required mechanical ventilation. The length of hospital stay was on average 30 days. The mortality rate was 56.5%. In conclusion, self-immolation is frequent in the pediatric population; it induces severe burns associated with a poor prognosis., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)

The goal of this study was to assess plasma procalcitonin (PCT) concentrations during infectious events of burns in the ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 120 septic patients admitted to the Burn ICU were included in our study. Sepsis was assumed according to the French Burn Association criteria for the presence of infection. Serum PCT was measured over the entire septic episode every 48 hours until resolution of infection, based on clinical signs and decrease of PCT of about 80% compared to its initial value. Patients were assigned to two groups depending on clinical course and outcome: Group A = patients with favourable evolution; Group B = patients with unfavourable evolution. Monitoring of kinetics of PCT allowed us to judge the effectiveness of the initial antibiotic therapy, with a threshold of 43.5% decrease at day 3 of treatment, with a better sensitivity and specificity of 79.6% and 87.7% respectively. In addition, PCT monitoring allowed a reduction in the duration of antibiotic therapy of 5±2.8 days versus 8 to 10 days before the use of PCT., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)

Drug-induced acute pancreatitis (AP) associated with tigecycline (TGC) is considered a rare complication (incidence between 1‰ and 1%). In this paper, we report five cases of AP occurring after the administration of TGC in septic patients hospitalized in intensive burn care in Tunisia over 9 years. The diagnosis of AP was based on clinical and/or biological signs. Among 303 cases treated with TGC, AP occurred with an incidence of 1.65%. The mean age was 28±6 years. Only one patient had a history of chronic alcoholism. The prescribed dose was 200 mg as a loading dose, followed by 100 mg twice a day. The time to onset of symptoms after initiation of TGC was 5.4 days [2-7]. PA was suspected due to abdominal pain associated with nausea and vomiting (n=2), occlusive syndrome (n=1) and fortuitously increased pancreatic enzymes in 2 patients under mechanical ventilation. The mean lipase level at diagnosis was 447 IU ± 135 IU (4.5 to 10 times the normal). All the aetiologies of AP were ruled out, including gallstones, hypercalcemia, hypertriglyceridemia, trauma and infections. The mean time to symptom resolution after stopping TGC was 4±2 days [5-7] and to the normalization of pancreatic enzymes it was 9 days [2-20 days]. In conclusion, clinical and biological monitoring was necessary in patients treated with TGC in order to avoid severe forms, especially in at-risk patients., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)

The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals is a major global public health concern. The current study sought to characterize 25 MRSA clinical isolates collected in a Tunisian hospital from December 2015 to September 2016, with the genetic lineages, virulence factors, and antibiotic resistance mechanisms determined for these isolates. Three spa-types were detected: t037 (23 isolates), t932, and t2235 (one isolate each). Isolates were ascribed to agr I (n = 20), agr II (n = 1), with four nontypeable isolates. Depending on sequence type (ST), the 25 MRSA isolates were assigned to two clonal complexes (CC8 and CC5), with a predominance of the lineage ST239-CC8 (n = 24; 96%). All isolates belonging to CC8 had the SCCmec type III, while the unique CC5 isolate had SCCmec type IV. Antimicrobial susceptibility testing revealed high levels of resistance to aminoglycosides, tetracycline, ciprofloxacin and rifampicin for the majority of isolates belonging to the ST239-CC8 lineage. The ST149-CC5 isolate was susceptible to non-β-lactam antibiotics. One isolate harbored the tsst-1 gene (4%); however, lukS/LukF-PV, eta and etb genes were not detected. The MDR ST239-CC8 clone would seem to be widespread in this hospital. Therefore, a rigorous hygienic control system is urgently required., (© The Author(s) 2022. Published by Oxford University Press on behalf of Applied Microbiology International.)

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen causing health care-infections in the world, especially in burns. The aim of this study was to assess the extent of dissemination of MRSA isolated from burn patients in Burn Intensive Care Unit in Tunisia and to evaluate the frequency of virulence and antibiotics resistance genes. Among the 72 S. aureus isolates analyzed in the study, 54% were MRSA. The majority of MRSA (94.8%) were multidrug resistant and they had a high resistance rates to kanamycin (94.8%), tobramycin (90%), tetracycline (94.8%) and ciprofloxacin and rifampicin (87%, each). The gene aac(6')-Ie-aph(2″)-Ia conferring resistance to kanamycine and tobtamycin were detected in all isolates and the aph(3')-Ia gene conferring resistance to gentamicin were detected in 2.8% of resistant isolates. Tetracycline resistance genes tet(M), tet(K) and tet(L) were detected in 100%, 10.8% and 2.8% of the isolates, respectively. The SCCmec type III and the agr type I were the most predominant (69.2% and 90%, respectively). The 27 SCCmecIII-agrI isolates were clustered into two PFGE types A and B. The two representative isolates of PFGE clusters A and B belonged to ST239-t037 and ST241-t037 respectively. As conclusion, our results showed a high prevalence of MRSA in trauma burn intensive care unit belonging to two multidrug resistant clones ST239/ST241-agrI-t037-SCCmecIII MRSA. We also demonstrated that MRSA was disseminated between burn patients.

Ocular lesions in burns are common and diagnosis is often late, leading to functional impairment including loss of vision to these individuals. A retrospective study was conducted to assess ocular lesions in burns during ICU stay (01/01/2013 to 30/09/2020) in a 20-bed burn ICU in Tunis. Twenty-six cases combining burns and ocular lesions were reviewed. The average age was 26, with a sex-ratio 3.3/1. TBSA was 22±13%. Face was affected in 23 patients, and mechanical ventilation was required in 10 cases. Diagnosis of ocular lesion was noted at 4.5 H (1-33 H) after burn injury. Main clinical signs were: eye redness (n=5) and purulent eye discharge (n=5). Lesions were mainly corneal abscess and corneal ulcer. Treatment combined local antibiotics (n=16) associated to systemic antibiotics in 10 cases. Surgery was required in 2 cases. Loss of vision was noted in 2 patients. Risk factors of corneal abscess were: facial burn (p=0,01); burn depth (p=0,02) and mechanical ventilation (p=0,04)., (Copyright © 2022 Euro-Mediterranean Council for Burns and Fire Disasters.)

Acinetobacter baumannii is a feared pathogen in the burn center due to its opportunistic nature and its multidrug resistance. Our purpose was to study the incidence density of Acinetobacter baumannii colonization and infection and to determine the antibiotic susceptibility of the strains isolated in patients hospitalized in the Trauma and Burn Center Burn Unit in Tunisia. Our retrospective study included 1517 non-repetitive strains of Acinetobacter baumannii, between January 2012 and September 2020, with an average rate of 12.2% of the service's bacterial ecology. The incidence density of Acinetobacter baumannii colonization and infection was 13.7‰ days of in-patient stay and 14.1‰ days of in-patient stay, respectively. A positive and statistically significant correlation between Acinetobacter baumannii colonization and infection (rs=0,7; p=0.005) was noted in our study. The colonization strains were mainly isolated from central catheters (71.2%) and skin swab samples (22.9%). Infections were dominated by bacteremia (47.6%) and respiratory tract infections (25.4%). Bacteremia was microbiologically documented in 53% of cases. The most common source of bacteremia was central catheters (60.8%), skin (22.2%) and respiratory tract (15.5%). The rates of resistance inAcinetobacter baumannii to the antimicrobial agents tested were high: ceftazidime (85.2%), pipéracillin-tazobactam (95.6%), imipenem (95.3%), amikacine (91.1%), ciprofloxacin (93.5%), rifampicin (36.4%) and cotrimoxazole (88.1%). The resistance of colistin was noted in 1.8% of cases., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)

Antibiotics are one of the greatest advances in modern medicine. Antibiotic resistance is one of the most serious threats to global health, aggravating the prognosis of immunocompromised patients, especially burn patients. Our objective was to study the consumption of antibiotics of critical importance according to the WHO and the correlation between antibiotic resistance in Pseudomonas æruginosa and the consumption of these antibiotics. Our study took place in the Medical Laboratory in collaboration with the Trauma and Burn Center's Burn Unit in Tunisia. In our retrospective study, 1384 non-repetitive strains of Pseudomonas æruginosa responsible for colonization or infection were included, between January 2012 and December 2019. Pseudomonas æruginosa was the most isolated bacterial strain in the service, with an average rate of 15.9% of the service's bacterial ecology. The antibiotic resistance rates tested were high: 77.1% to piperacillin-tazobactam, 56% to ceftazidime, 74.9% to imipenem, 78.8% to amikacin, 54.7% to ciprofloxacin and 32.8% to fosfomycin. Among our strains, 81.8% were multi drug-resistant strains. The analysis of the correlation between the level of consumption of antibiotics and the antibiotic resistance levels in Pseudomonas æruginosa showed that the increased consumption of piperacillin-tazobactam increased resistance not only to piperacillin-tazobactam but also to imipenem and amikacin as well as multi drug resistance. Similarly, the increase in the consumption of fosfomycin correlates with resistance to piperacillin-tazobactam and imipenem., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)

Hypernatremia is associated with poor outcomes in critically ill patients. Hypernatremia risk factors in burned patients are not well studied. We aimed to identify hypernatremia risk factors and to evaluate outcomes in burned patients admitted to our burns intensive care unit. A case control study was conducted in adult burned patients hospitalized between January 1st 2017 and December 31st 2019. Cases who developed hypernatremia (>145 meq/L) during hospitalization were matched 1:1 with controls based on age and total burn surface area. There were 57 cases and 57 controls with a mean age of 41 ± 18 years. The majority of patients had major burns (n=99, 86.8%). The time onset of hypernatremia was seven days post burn. Compared to controls, the case group mostly consisted of transferred patients with longer time from injury to intensive care unit admission. Inhalation injury, mechanical ventilation, intravenous fosfomycin and colistin were associated with hypernatremia. Admission to the intensive care unit after six hours post-burn was the independent risk factor (OR=4.5). Hypernatremia was associated with longer length of stay and with higher mortality. We conclude that delayed management, inhalation injury, mechanical ventilation, fosfomycin and colistin administration are the main hypernatremia risk factors in burned patients., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)

Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019)., (Copyright © 2021 Euro-Mediterranean Council for Burns and Fire Disasters.)

Pseudomonas æruginosa (PA) is among the major agents of infection in burns. Multidrug-resistant strains are commonly isolated, which hampers the management of these patients. Our purpose was to study the incidence density of PA colonization and PA infection and to investigate the antibiotic susceptibility of strains isolated in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia. It is a retrospective study including 1649 non-repetitive strains of PA during an 8-year period (2012- 2019). PA was the most common organism in TBC-BU bacterial ecology (15%). The incidence density of PA colonization and PA infection was 16.1‰ days of in-patient stay (DH) and 16.5‰ DH, respectively. A positive and statistically significant correlation was found between PA colonization and PA infection (rs=1; p=0,004). The colonization strains were mainly isolated from skin (25.1%) and central catheters (22.3%). Bacteremia was the most common infection (19.5%). The skin was the most common source of bacteremia (22.1%) followed by central catheters (18.3%). The highest rates of antibiotic resistance were found with piperacillin-tazobactam (72.4%), ceftazidime (49.4%), meropenem (74%), imipenem (70.5%), amikacin (74.6%), ciprofloxacin (56.5%) and fosfomycin (35.3%). We did not identify any colistin-resistant strain. The multidrug resistance rate was 78%. The metallo-carbapenemase-producing strains rate was 14.4%., (Copyright © 2020 Euro-Mediterranean Council for Burns and Fire Disasters.)

Patients with epilepsy are a high-risk population for severe burns. A retrospective study was conducted to assess burns during epileptic seizure in epileptic patients. The study was conducted in a 20- bed burn ICU in Tunis over the period 01/01/2011 to 30/06/2019. Fifty cases combining burns and epilepsy were reviewed. Twenty patients (11 women and 9 men, sex-ratio 0.6) suffering a burn following an epileptic seizure were included. The average age was 46. Epileptic disease was uncontrolled in 75% of our patients and 35% were not receiving any antiepileptic treatment. Burns were related to domestic accident in 95% of cases, 2/3 of which were related to a fall on a brazier. Lesions were deep in 70% of cases, requiring excision of necrotic tissue. Only two patients benefited from a dermal-epidermal graft. Amputation was necessary in 5 patients. Mortality was 25%, related to refractory septic shock., (Copyright © 2020 Euro-Mediterranean Council for Burns and Fire Disasters.)

Extensively drug resistant Acinetobacter baumannii (XDR-Ab), has emerged as an important pathogen in several outbreaks. The aim of our study was to investigate the eventual genetic relatedness of XDR-Ab strains recovered from burn patients and environment sites in the largest Tunisian Burn Intensive Care Unit (BICU) and to characterize β-lactamase encoding genes in these strains. Between March 04th, 2019 and April 22nd, 2019 an outbreak of XDR-Ab was suspected. Environmental screening was done. All isolates were screened by simplex PCR for β-lactamase genes. Genetic relatedness was determined by pulsed field gel electrophoresis (PFGE) of ApaI-digested total DNA. During the study period, 21 strains of A. baumannii were isolated in burn patients, mainly in blood culture (n = 7) and central vascular catheter (n = 6). All strains were susceptible to colistin but resistant to imipenem (n = 23), ciprofloxacin (n = 23), amikacin (n = 22), tigecyclin (n = 5) and rifampicin (n = 4). The blaOXA-51-like, blaOXA23, and blaADC genes were present in all strains. These resistance determinants were associated with blaPER-1 in 10 strains. The ISAba1 was inserted upstream of blaOXA-23 in all isolates. PFGE revealed two major clusters A (n = 11) and B (n = 5). This is the first description in Tunisia of clonally related PER-1 producing XDR-Ab in burn patients with probable environmental origin.

Background: Carbapenemase-producing Enterobacterales (CPE) present a threat to public health worldwide., Aim: To study their prevalence at the Trauma and Burn Center's Burn Unit and investigate their molecular characteristics and their associated antibiotics resistance patterns., Methods: This is a retrospective study conducted at the Trauma and Burn Center's laboratory between july 2017 and december 2018. It included all patients hospitalized in the Trauma and Burn Center's Burn Unit infected with Enterobacterales resistant to carbapenems. The search of the carbapenemases genes was performed by PCR amplification GeneXpert® IV (Cepheid, Sunnyvale, CA, USA) by Xpert® Carba-R kit., Results: During the study period, among 574 Enterobacterales, 64 strains (11.1%) were resistant to carbapenems, 58 strains (90.6%) of which were CPE. K. pneumoniae was the most predominant bacteria (n=50) fllowed by E. cloacae (n=7), P. mirabilis (n=3), E. aerogenes (n=2), E. coli (n=1) and P. rettgeri (n=1). The most common carbapenemase gene was blaNDM gene (58.6%) followed by blaOXA48 (24.1%). The co-existence of these two genes was identified in ten strains (17.3%). For the 58 CPE, resistance to ertapenem, imipenem and meropenem was 100%, 18.4% and 36.2%, respectively. The highest resistance rates were found to third-generation-cephalosporins (100%), ciprofloxacin (95%) and gentamicin (89.7%). Fosfomycin and colistin had the best susceptibility in vitro with only 5.2% and 4.8% of resistance, respectively., Conclusion: The high prevalence of CPE in our center requires continued screening and reinforcement of hygiene measures.

Chemical burns are rare but have specific diagnosis and treatment characteristics. We present a retrospective study among the 123 patients treated in the Tunis Burns Unit during the year 2018. They were young (36.4 years), active men (69%). Most (51%) burns were work-related. Only fiftyseven patients had their burn immediately washed, and time to the first specialized examination was 3.7 days. Burned surface was low, frequently involving the hands. The majority of patients (121/123) did not need surgery and the treatment length was 20 days, resulting in aesthetic or functional disability in 46.3% of the cases. It seems that information and prevention measures are lacking, despite the fact they are the best means to reduce the incidence of chemical burns, which have high individual and collective costs. If a chemical burn occurs, it should be copiously washed, and the victim should be urgently examined by a burn specialist., (Copyright © 2020 Euro-Mediterranean Council for Burns and Fire Disasters.)

This study was retrospective, conducted over seven years at the Trauma and Burn Centre. Its purpose was to establish the bacteriological profile and antibiotic resistance of isolated bacteria in patients admitted to the Burn Intensive Care Unit. Identification was carried out according to the conventional methods and antibiotic susceptibility was analyzed according to the standards of the Antibiogram Committee of the French Society of Microbiology. Pseudomonas aeruginosa was the main isolated bacterium, followed by Staphylococcus aureus, Klebsiella pneumoniae and Acinetobacter baumannii. These strains were isolated mainly from haemocultures (37%). The resistance of Pseudomonas aeruginosa to ceftazidime increased from 9.2% in 2012 to 53.5% in 2018. The resistance to imipenem and ciprofloxacin was 63.3% and 42.9%, respectively. Four strains were resistant to colistin. The resistance of S. aureus to meticillin decreased from 65.3% in 2012 to 41.6% in 2018. All strains were susceptible to glycopeptides, tigecycline and linezolid. A. baumannii was multi-resistant to antibiotics with 81.8% resistance to ceftazidime, 88.9% to amikacin, 90.5% to ciprofloxacin and 94.5% to imipenem. Sixteen strains were resistant to colistin. Concerning K. pneumoniae, 77.5% of strains were resistant to cefotaxime and 5.2% to imipenem. Two strains were resistant to colistin. Vancomycin resistance in Enterococcus faecium increased from 33.4% in 2012 to 72.2% in 2018. Multidrug resistance in burn patients calls for an epidemiological surveillance of bacterial ecology and the application of hygiene measures., (Copyright © 2019 Euro-Mediterranean Council for Burns and Fire Disasters.)

Carbapenemase-producing Enterobacteriaceae (CPE) pose an emerging threat worldwide. The purpose of our work was to determine their prevalence among patients hospitalized in the Trauma and Burn Centre's Burn Unit, and to study their microbiological and molecular characteristics. Our study was longitudinal, conducted at the Trauma and Burn Centre's laboratory between January and June 2017. It focused on 42 CPE strains isolated from 34 patients. These strains were made up of K. pneumoniae (24), P. mirabilis (13), K. oxytoca (2), P. stuartii (1), E. coli (1), and E. cloacae (1). The overall prevalence of CPE among Enterobacteriaceae was 14.43% with a monthly decline. The blaNMD gene (59%) predominated on blaOXA-48 (33%) and 7% of strains co-expressed these two genes. We describe the first case of P. stuartii carrying blaNDM in Tunisia. Resistance to ertapenem, imipenem and meropenem was 83%, 57%, and 10% respectively. The antibiotics showing the highest resistant rates were third-generation cephalosporins (97%), gentamicin (98%) and norfloxacin (90%). Colistin and fosfomycin had the best-preserved activity in vitro with 4% and 33% resistance, respectively. The prevalence of EPCs is high among burns. Screening efforts, hygiene measures and the preservation of the few molecules still active are a vital issue., (Copyright © 2019 Euro-Mediterranean Council for Burns and Fire Disasters.)

Tracheal stenosis remains frequent, especially in intensive care patients requiring prolonged intubation or tracheotomy. There is little data in the literature regarding this complication in burn patients. The aim of our study was to determine incidence, characteristics and risk factors of tracheal stenosis in burn patients. A retrospective study was conducted in a 20-bed burn ICU in Tunis over 7 years. It included all patients who presented tracheal stenosis confirmed by endoscopic and/or radiological exploration. Tracheal stenosis was confirmed in 15 patients with an overall incidence of 0.8% and an incidence of 3.5% in intubated patients. The mean age was 24 years, with TBSA of 28±15%. The burn was thermal in all patients. Facial burn was noted in all patients. Inhalation syndrome was observed in 12 patients. Duration of intubation was 16±12 days. Dyspnea, stridor and dysphonia were the most common symptoms. The onset of clinical signs was 30 days on average after extubation. All patients underwent bronchoscopy and/or cervico-thoracic scan for diagnosis. The average distance between the stenosis and vocal cords was 27 mm and the average degree of stenosis was 68%. The average length was 20 mm. Therapeutic management was based on: dilation in 3 cases, Montgomery tracheal T-tube insertion in 2 cases, and endoscopic laser therapy in 3 cases. Tracheal resection-anastomosis was performed in 5 patients. The evolution was favorable in 8 patients. Restenosis was observed in 2 patients. Five patients died. Inhalation injury, facial burn and prolonged intubation were recognized as risk factors that increase the likelihood of this complication.

This study was longitudinal, conducted at the Trauma and Burn Centre between January and June 2017. Its purpose was to determine the prevalence of CPE infection among patients admitted to the Burn Intensive Care Unit, and to study their clinical and biological characteristics. Molecular typing of carbapenemases was performed with PCR type GeneXpert. Thirteen patients were infected with 7 episodes of bacteremia, 2 had ventilator acquired pneumonia and 4 catheter infections, with a prevalence of 7% of admissions. The average length of stay in the intensive care unit prior to infection was 12 days. Antibiotic exposure involved 12 of the 13 patients: 9 patients were transferred from other intensive care units. Thirteen and ten patients were respectively exposed to central catheterization and mechanical ventilation. The predominant carbapenemase among the infecting carbapenemase-producing enterobacteriacae strains was NDM carbapenemase (9/15), with a first description of P. stuartii carrying blaNDM strain in Tunisia. One patient died before adapting antibiotic therapy. For the others, 13 adapted bi-antibiotherapies were prescribed. There were five patient deaths from infection, four of whom had received appropriate antibiotic therapy. Imipenem was used each time the MIC was ≤4mg/l, in combination with another antibiotic: amikacin (3/8), colimycin (4/8), or tigecycline (1/8). Three of these prescriptions resulted in death. The prevalence of carbapenemase-producing enterobacterial infections is high among burn patients with a predominance of NDM-type carbapenemase.

Burns induce complex physiological changes such as modification of distribution volume, increased clearance of elements and decrease of protein binding. The pharmacokinetics of many antibiotics may then be modified, which requires dose adjustment. We attempted to evaluate the pharmacokinetics of linezolid in burn patients at a standard dose of 600 mg intravenously thrice a day. A prospective study was conducted in a 20-bed adult burn ICU at a university-affiliated teaching hospital in Tunis. Thirteen adult burned patients with documented and/or suspected multi drug resistant (MDR) gram-positive bacterium-related infections were enrolled in the study. Our study suggests that linezolid dosing at 600mg thrice a day leads to adequate pharmacodynamic/pharmacokinetic exposure to linezolid with a Cmin > 2mg/l in 84.6% of cases, T > MIC in about 87.5% and AUC/MIC > 100 in 61.5% of cases. However, a high variability in linezolid serum concentrations with a substantial percentage of sub-therapeutic levels was observed in a few patients, 15% of cases. Therefore, therapeutic drug monitoring of linezolid might be helpful for adequate dosing of linezolid in burned patients, to avoid the risk of treatment failure or of dose-dependent toxicity.

Plasma lactate (PL) has been used as a marker of cellular hypoxia and shock. The correlation between PL and clinical outcome has been well accepted in hemorrhagic and septic shock. In contrast to the existing evidence, there are no or almost no data dealing with lactate and burn-related outcome. We attempted to assess whether early plasma lactate (PL) is a useful parameter to predict outcome in burned patients. A prospective study was conducted in a 20-bed adult burn ICU at a university-affiliated teaching hospital in Tunis. Patients admitted within the first 24h post burn with greater than 10% total body surface area (TBSA) burned were enrolled in the study. There were 60 males and 20 females. Mean age was 40.7 ± 19.5 years old, and average TBSA was 32 ± 21%. At admission, 86.7% patients had an initial lactate value of more than 2 mmol/L. In our study, an initial lactate value of 4 mmol/L provided the best sensitivity and specificity: 88% and 79% respectively for predicting sepsis, with an area under the ROC curve of 0,82. Furthermore, plasma lactate cut-off value for mortality prediction was 4.46 mmol/l with a good sensitivity (86%) and specificity (92%). Mortality rate was 36.25%. Plasma lactate appears to be a powerful predictor biomarker of sepsis and mortality in burn patients.

Toxic epidermal necrolysis (TEN) or Lyell's syndrome is a potentially life-threatening dermatological disorder, with clinical and histological features characterized by the destruction and detachment of the skin epithelium and mucous membranes. Intensive symptomatic management is crucial: analgesia, daily dressing changes, prevention of infections and symptomatic intensive care measures (hydration, nutrition and oxygen therapy). The aim of our study is to determine epidemiological, clinical and therapeutic characteristics of patients admitted to the intensive burn care unit of Tunis over 9 years, from July 2001 to July 2009.

The goal of this study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 121 patients admitted to the Burn ICU were included in our study. Serum PCT was measured over the entire course of stay in patients with predictive signs of sepsis according to the Americain Burn Association Criteria for the presence of infection. Patients were assigned to two groups depending on the clinical course and outcome: Group A = non septic patients; Group B = septic patients. A PCT cutoff value of 0,69 ng/ml for sepsis prediction was associated with the optimal combination of sensitivity (89%), specificity (85%), positive predictive value (82%) and negative predictive value (88%). Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injuries as well as in monitoring the response to antimicrobial therapy.

Background: Continuous monitoring of the bacterial flora and antibiotic resistance of the main bacteria involved in nosocomial infections helps improve treatment and prevention strategies., Aim: To compare the bacteriological profile and antibiotic susceptibility of the main bacterial isolates within the burned patients over two periods of 3 years and in two hospitals., Methods: During two three-year periods: period 1 (P1): 1/7/2005-30/6/2008 and period 2 (P2): 1/7/2008-30/6/2011) and in two hospitals: Hospital Aziza Othmana (HAO) and the traumatology and burn center (CTGB), 2153 and 3719 non-repetitive strains were isolated from burn patients from different samples. The transfer of the intensive care unit was made on 01/07/2008 from the Hospital Aziza Othmana to CTGB. The study of antibiotic sensitivity was performed according to CA-SFM., Results: During the period P1, Pseudomonas aeruginosa was the main bacteria isolated (18%) followed by Staphylococcus aureus (14%) and Acinetobacter baumannii (12%). After the transfer of intensive care burn unit to the traumatology center, ecology bacterial varied with S. aureus (20%) in the first place followed by P. aeruginosa (15%) and Proteus mirabilis (11%). The study of the evolution of antibiotic susceptibility showed an overall downward trend of resistance in the second half of 2008, immediately after the transfer of service in the new hospital structure. The rate of ceftazidim resistant Klebsilella pneumoniae decreased from 80.4% to 50%, Similarly the resistance of P. aeruginosa to ceftazidime and imipenem decreased respectively from 61% to 39.4% and from 63.3% to 37.1%. Nevertheless, the reduction of resistance was followed by a rapid increasing during the year 2009 to reach overall rates of resistance previously observed in the hospital Aziza Othmana. Concerning S. aureus, the rate of MRSA (methicillin-resistant S. aureus) showed no significant variation throughout the study period: 60% versus 56.3% at HAO and CTGB. A. baumannii brings up the problem of mutirésistance: 92.7% of strains were resistant to ceftazidime and 63.9% to imipenem during P1 with an emphasis on resistance to imipenem during P2 increased to 89.3%., Conclusion: Resistance is a problem in the intensive care burn unit. Preventive measures have to be taken.

Background: Pseudomonas aeruginosa is a known opportunistic pathogen frequently causing serious infections in burned patients., Aim: To analyze the epidemiological profile of Pseudomonas aeruginosa isolated in a Tunisian burn unit., Methods: During a 3-year period (from 01 July 2008 to 30 June 2011), 544 non repetitive strains of P. aeruginosa were isolated from burn patients. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. Serotypes were identified by slide agglutination test using P.aeruginosa O antisera (Biorad). Producing carbapenemase was analyzed for 202 imipenem resistant isolates by EDTAtest. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software., Results: The most frequent sites of isolation were cutaneous infections and blood cultures (83.4%). The percentages of resistant isolates were as follows: ceftazidime: 34%; imipenem: 37.1%, ciprofloxacin: 27.1% and amikacin: 29.6%. The most prevalent serotypes were: 011(51%), 06(17%), 03 (8%), 04(12%), 012(5%). Among the 202 imipenem resistant strains, 58% expressed a metallocarbapenemase. All theses strains were resistant to all tested antibiotics except colistin and belonged to the serotype O11., Conclusion: The dissemination of carbapenemases strains must be contained by implementation of timely identification, strict isolation methods and better hygienic procedures.

Background: Pseudomonas aeruginosa is a known opportunistic pathogen frequently causing serious infections in burned patients., Aim: To analyze the epidemiological profile of Pseudomonas aeruginosa isolated in a Tunisian burn unit., Methods: During a 3-year period (from 01 July 2008 to 30 June 2011), 544 non repetitive strains of P. aeruginosa were isolated from burn patients. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. Serotypes were identified by slide agglutination test using P.aeruginosa O antisera (Biorad). Producing carbapenemase was analyzed for 202 imipenem resistant isolates by EDTA test. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software., Results: The most frequent sites of isolation were cutaneous infections and blood cultures (83.4%). The percentages of resistant isolates were as follows: ceftazidime: 34%; imipenem: 37.1%, ciprofloxacin: 27.1% and amikacin: 29.6%. The most prevalent serotypes were: 011(51%), 06(17%), 03 (8%), 04(12%), 012(5%). Among the 202 imipenem resistant strains, 58% expressed a metallocarbapenemase. All theses strains were resistant to all tested antibiotics except colistin and belonged to the serotype O11., Conclusion: The dissemination of carbapenemases strains must be contained by implementation of timely identification, strict isolation methods and better hygienic procedures.

During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmid-mediated CMY-16 β-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6')-Ib' enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C(2) of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C(2), unusual antibiotic resistance genes (e.g., aphA-6), and their genetic environments. Further investigation suggested that deletions, acquisition of the ISCR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C(2) plasmid which underwent a remarkable evolution during the epidemic period.

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.

Background: Fluoroquinolones (FQ) use has been identified as a risk factor for colonization and infection to methicillin resistant Staphylococcus aureus(MRSA), Pseudomonas aeruginosae multiresistant(PMR), Acinetobacter multiresistant (AMR) and multidrug resistant bacteria(MDRB)., Aim: Our study proposes to measure the annual antibiotic use of FQ and antimicrobial resistance in P. aeruginosa, S. aureus, Klebsiella pneumoniae and A. baumannii in an intensive care burn unit., Methods: The study was conducted during a 4 year period (1 January 2000 to 31 December 2003). Antimicrobial susceptibility testing was performed using the disk diffusion method as recommended by the French Society of Microbiology. The consumption of the following antibiotics: ofloxacin, ciprofloxacin was expressed as the antimicrobial use density (AD) taking into account the quantity of antibiotics in Grams converted to defined daily doses (DDD) and the number of day hospitalization. Statistical significance was defined as p value < 0. 0 5 for the corresponding correlation coefficient., Results: There were statistically significant relationship between use of ciprofloxacin and resistance in P. aeruginosa to this drug (rs=0. 95, p<0. 05). Moreover, the ciprofloxacin consumption was correlated with resistance to imipenem (rs=0. 95, p<0. 05) and ceftazidime (rs=0. 95, p<0. 05) in P. aeruginosa . A restriction use of ciprofloxacin has been taken during 2003, it is followed by a significant decrease of resistance to imipenem, ceftazidime and ciprofloxacin in P. aeruginosa (p<0, 05 ). The use of fluoroquinolones was correlated significantly with MRSA (rs=0. 96, P<0. 05) . The restriction use of FQ was significantly associated with a decrease of MRSA. The consumption of ciprofloxacin was also correlated (P<0. 05) with resistance of ceftazidime in K. pneumoniae. However, there is not a correlation (P> 0. 05) between fluoroquinolones use and resistance in A. baumannii as well in ciprofloxacin, imipenem and ceftazidime., Conclusion: Our study illustrates the pressure of selection of fluoroquinolones use in the development of MDRB. The use and or the duration of treatment with theses antibiotics should be rationalised as part of efforts to control the emergence of multidrug resistant bacteria.

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.

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.

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 earned Out according to the following formula: AD = (Quality consumed in for the particular antimicrobial x 1000) / (DDD for that antimicrobial x number of days of hospitalizations)., Results: There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae (rs = 0.93; p = 0.O2) The use of ceftazidime was not significantly associated with resistance to this molecule in P. aeruginosa (rs = 0.76 p = 0.13). Conceerning 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 and antibiotic 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.

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.

Methicillin resistant Staphylococcus aureus (MRSA) constitutes one of the main causes of nosocomial infections in badly burnt patients. The purpose of our study was to determine the frequency and evolution of Methicillin resistant Staphylococcus strains in the department of resuscitation of badly burnt patients of Hopital AZIZA OTHMANA. From January 1, 2000 to December 31, 2003, tests for Staphylococcus aureus proved positive in 139 patients on at least, one occasion. Mean age of patients was 34 years and their sex ratio 1.7. 59.7% of the accidents were house hold accidents, and 70% of them were of thermal native. The average burnt cutaneous surface area was 44%. Sepsis occurred 7 days on average after admission to hospital. Hospital stay for this group varied between 3 and 140 days, outcome was fatal in 13 cases. MRSA occurred in 69% of cases. As for the other families of antibiotics, the frequencies of resistance remained elevated for tetracyclines, cotrimoxazole, gentamicine, erythromycine.

In mechanically ventilated patients, disconnection from the ventilator and endotracheal suctioning can induce major arterial oxygen desaturation resulting from apnea, changes in inspired oxygen fraction, and decrease in lung volume. The aim of this study was to test the efficacy of a simple method of delivering oxygen and maintaining lung volume during this process. Our study was conducted in two parts. In the first part, constant-flow insufflation of oxygen (CFI) was used in seven patients ventilated for acute respiratory failure (PaO2/FlO2 = 347 +/- 33 mm Hg) as a means of maintaining arterial oxygenation during apnea and disconnection from the ventilator. CFI was administered via a modified endotracheal tube in which small capillaries allowed delivery of a high-velocity jet flow near the tracheal end of the tube during disconnection from the ventilator. In comparison to apnea alone, CFI prevented a fall in arterial oxygen tension (16 +/- 7 mm Hg during CFI versus 117 +/- 27 during apnea, after 90 s of disconnection in the two situations, p less than 0.001), whereas it did not reduce the development of hypercapnia. The efficacy of CFI resulted both from the injection of oxygen into the trachea and from the maintenance of positive alveolar pressure induced by air entrainment (mean 10.4 +/- 1.1 cm H2O), preventing a fall in lung volume usually occurring after disconnection (+338 +/- 88 ml during CFI versus -344 +/- 64 ml during apnea, p less than 0.01). In the second part of the study CFI was used to prevent arterial oxygen desaturation induced by endotracheal suctioning.(ABSTRACT TRUNCATED AT 250 WORDS)

In a case of acute intoxication with high-dose methotrexate, a kinetic study of plasma methotrexate concentrations enabled the authors to begin treatment with high-permeability membrane haemodialysis combined with intensive folic acid loading before the clinical signs of iatrogenic toxicities developed, and to continue with haemodialysis rather than using other depurative methods. In this case, the post-depuration course was favourable: dermatological signs and febrile pancytopenia regressed within 4 days, and these was no sign of hepatic toxicity.

Background: Patients with acute exacerbations of chronic obstructive pulmonary disease may require endotracheal intubation with mechanical ventilation. We designed, and here report on the efficacy of, a noninvasive ventilatory-assistance apparatus to provide inspiratory-pressure support by means of a face mask., Methods: We assessed the short-term (45-minute) physiologic effects of the apparatus in 11 patients with acute exacerbations of chronic obstructive pulmonary disease and evaluated its therapeutic efficacy in 13 such patients (including 3 of the 11 in the physiologic study) who were treated for several days and compared with 13 matched historical-control patients., Results: In the physiologic study, after 45 minutes of inspiratory positive airway pressure by face mask, the mean (+/- SD) arterial pH rose from 7.31 +/- 0.08 to 7.38 +/- 0.07 (P less than 0.01), the partial pressure of carbon dioxide fell from 68 +/- 17 mm Hg to 55 +/- 15 mm Hg (P less than 0.01), and the partial pressure of oxygen rose from 52 +/- 12 mm Hg to 69 +/- 16 mm Hg (P less than 0.05). These changes were accompanied by marked reductions in respiratory rate (from 31 +/- 7 to 21 +/- 9 breaths per minute, P less than 0.01). Only 1 of the 13 patients treated with inspiratory positive airway pressure needed tracheal intubation and mechanical ventilation, as compared with 11 of the 13 historical controls (P less than 0.001). Two patients in each group died. As compared with the controls, the treated patients had a more transient need for ventilatory assistance (3 +/- 1 vs. 12 +/- 11 days, P less than 0.01) and a shorter stay in the intensive care unit (7 +/- 3 vs. 19 +/- 13 days, P less than 0.01)., Conclusions: Inspiratory positive airway pressure delivered by a face mask can obviate the need for conventional mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease.

Two out of nine patients in which inferior vena cava interruption was performed with a Günther filter developed a recurrent pulmonary embolism. In both cases, the filter had moved down and the anchoring legs had perforated the wall of the vena cava. The source of the pulmonary embolism was a clotted basket filter. Anticoagulation was given for two weeks in one patient and six months in the other after insertion of the filter, but it had been stopped before the thrombotic event leading to the recurrent pulmonary embolism. The formation of the thrombi had probably been caused by the migration of the filter and the subsequent perforation, which may have been facilitated by the cessation of the anticoagulation.