Évolution de la sensibilité et épidémiologie de la résistance des entérobactéries de ville au cours des enquêtes Vigil'Roc

Trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in the community: the Vigil'Roc multicenter studies.ObjectiveThis study was performed in order to describe the trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in the community.Materiel and methodsIn 1993, 1997 and 2000, 9290 strains of Enterobacteriaceae were isolated in community lab settings and their susceptibility to antibiotics evaluated by the disk method according to the French recommendations (CA-SFM). Epidemiological data concerning medical history of patients were simultaneously collected.ResultsSamples are essentially provided from urinary tract (88.7 %) and from women (79.5 %). 88.2%of the strains are Escherichia coli and Proteus mirabilis. Over the three studies, we observe an increasing resistance to penicillins, coamoxiclav and cotrimoxazole for E. coli, to coamoxiclav for P. mirabilis and to penicillins for Salmonella sp. Ceftriaxone, gentamicin and ciprofloxacin retain a very good activity. Producers of extendedspectrum â-lactamase are detected for a rising number of species, but strains remain rare (0.5%). Analysing, by logistic regression, the risk factors for adults to be infected by a resistant strain of E. coli, lead to observe a narrow association of antimicrobial resistance with prior antibiotherapy and a relative specificity between the family of prior antibiotics and the compound affected by bacterial resistance. Prior hospitalisation is preferentially linked to multiresistance and age > 60 years is associated with cefixime and quinolone resistance and with multiresistance. Resistance of E. coli to penicillins is more elevated in children than in adults, and is also linked to a prior antibiotic use by children. Some comparable results are provided in univariate analysis for P. mirabilis and Salmonella sp.     

Facteurs associés au gain pondéral insuffisant au cours de la grossesse

ObjectivesStudy weight gain in pregnant women according to the recommendations of the American Institute of Medicine (IOM 2009) and identify the associated factors with inadequate weight gain in pregnant women in Constantine (Algeria).Materials and methodsA prospective and longitudinal study of a cohort of 217 pregnant women aged 19 to 43 years was carried out during the entire period of pregnancy at antenatal consultation and monitoring centers in Constantine (Algeria) from December 2013 to July 2016. Their weight was measured in the first, second and third trimester. Gestational weight gain was classified as lower or meeting the IOM recommendations. Factors associated with gestational weight gain (GWG), such as pre-gestational body mass index, women's knowledge of GWG, sympathetic signs, eating habits and consumption, and maternal stress were studied. Statistics were performed using Statview? and SPSS software.ResultsThe majority of women (65.4 %) had inadequate total GWG and only 34.6 % of them had GWG consistent with IOM recommendations. Inadequate weight gain was more frequent in women obese before pregnancy (p < 0.0001), women who reported not knowing the ideal GWG (p = 0.01), had sympathetic signs (p = 0.01), food aversions (p = 0.0086), and insufficient vitamin, and mineral intakes (p < 0.01). Inadequate GWG was also common among women with insufficient duration of sleep and living in a stressful environment.ConclusionGWG is associated with a number of factors and variable relationships for each trimester of pregnancy.     

Épidémiologie de la flore nasopharyngée au cours des otites moyennes aiguës de l'enfant de décembre 2000 à mars 2001

Method. – A French multicentric survey was made between December 2000 and March 2001 on 734 children (6 months–6 years) presenting with acute otitis media (AOM).Results. – A total of 1133 bacterial strains were isolated from nasopharyngeal secretions, the 3 main pathogens were S. pneumoniae (409 isolates, 36%), H. influenzae (328 isolates, 29%) and M. catarrhalis (275 isolates, 24%). The overall NP carriage rate for S. pneumoniae reached 56%. Among the 409 pneumococcal strains, 63% showed reduced susceptibility to penicillin (PRSP). Thirty two percent of PRSP isolates belonged to serotype 19, the other predominant resistant serotypes were 23, 6, 14 and 9. The analysis of PRSP strain distribution showed that resistance concerned all of France and was homogeneous, with an incidence superior to 50% in all regions, except for Alsace. H. influenzae was isolated from nasopharyngeal flora in 45% of children. 43% of H. influenzae isolates produced a β-lactamase with large variations in regional distribution (13–64 % of isolates). The overall NP carriage rate for H. influenzae was 19%. Less than 1% of H. influenzae isolates were ampicillin-resistant without producing β-lactamase. Nasopharyngeal carriage rate for M. catarrhalis was 37%, with 97% of isolates producing β-lactamase.Conclusion. – Evidence of geographical variation in the incidence of PRSP and β-lactamase-producing H. influenzae stresses the need of therapeutic policies adapted to regional epidemiology. The introduction of the heptavalent pneumococcal conjugate vaccine and the diversification of first-line antibiotherapy can only have beneficial effects in terms of cost and bacterial epidemiology.     

Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb

ObjectiveTo objectively assess the quality of “crisis communication” media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco).MethodsA compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid.ResultsA total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46–58]), without major variability between countries. The most appreciated dimension was “maintaining the confidence of the population”, with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was “strengthening community participation”, with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases).ConclusionThe quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.