Lahcen Belyamani

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

Introduction This study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat. Methods This is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014. Results During the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n = 6352) and 9.6% of Gram negative rods (n = 4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin. Conclusion This paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.

Myopathie hypokaliémique : complication rare des vomissements gravidiques

doi:10.1016/j.annfar.2009.05.008 Les vomissements gravidiques peuvent être à l’origine de complications graves responsables de séquelles importantes. La myopathie hypokaliémique reste une complication très rare. La seule description dans la littérature remonte à 1983 [1]. Nous rapportons le cas d’une femme âgée de 28 ans, sans antécédents pathologiques personnels ou familiaux, quatrième geste, troisième pare, enceinte à 16 SA. La patiente était admise pour paralysie des membres inférieurs et parésie des membres supérieurs survenues cinq jours auparavant. Elle présentait des vomissements gravidiques incoercibles et négligés depuis deux mois. À l’admission, la patiente était consciente mais grabataire, avec une pression artérielle à 100/60 mmHg, un rythme cardiaque régulier à 85 battements par minute, une fréquence respiratoire à 18 cycles par minute et une saturation artérielle en oxygène (SpO2) à 98 % à l’air ambiant. L’échographie obstétricale révélait une mort fœtale in utero. L’examen neurologique trouvait une tétraparésie flasque associée à des myalgies diffuses ; les réflexes ostéotendineux étaient présents mais diminués, sans signe de Babinski, ni troubles de la sensibilité, ni troubles sphinctériens. Le bilan biologique montrait une hypokaliémie à 2 mmol/l, avec augmentation des CPK, ASAT et LDH (à deux fois la normale), la kaliurèse était normale à 20 mmol/j, la créatininémie à 17 mg/l (150 mmol/l) et l’urée à 0,50 g/l (8,3 mmol/l). L’ECG réalisé à trois reprises ne montrait aucune anomalie. Le traitement a consisté en une recharge potassique après mise en place d’un cathéter fémoral, une réhydratation ainsi qu’un traitement antiémétique (métoclopramide). La symptomatologie neurologique s’amendait alors rapidement et la patiente récupérait une force musculaire normale avec la normalisation de la kaliémie au bout de 48 heures. Les vomissements gravidiques sont une affection grave qui intéresse 0,5 % des femmes enceintes. Ils représentent la première cause d’hospitalisation en début de grossesse. Leur étiologie reste inconnue, mais certains auteurs suggèrent un support génétique [2]. Ils peuvent être responsables de complications allant de la déshydratation extracellulaire avec troubles hydroélectrolytiques majeurs à l’encéphalopathie de Gayet Wernicke et la myélinolyse centropontine [3]. La gravité potentielle des vomissements gravidiques pour la parturiente et le fœtus impose un traitement bien codifié. Les hypokaliémies au cours des vomissements gravidiques sont fréquentes ; elles sont essentiellement responsables de signes à l’ECG à type de sous-décalage ST, d’onde T plate et d’onde U et dans les cas extrêmes de torsades de pointes, tachycardie supraventriculaire et fibrillation ventriculaire. En

Evolution of a fatal septic arthritis caused by a Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus strain

We report the observation of a septic arthritis of the knee complicated within first 36 hours by multiorgan failure including acute respiratory distress syndrome (ARDS), heart failure, acute renal failure and disseminated intravascular coagulation (DIC). A diagnosis of staphylococcal arthritis was suspected confirmed by direct examination, and culture showed a Staphylococcus aureus sensitive to methicillin. The sample sent to the National Reference Centre for Staphylococci (Lyon, France) for genetic analysis confirmed the isolate positive for the PVL gene expression. The fulminating evolution of a septic S. aureus arthritis in an otherwise healthy man should probably evoke the possibility of LPV strain. Anti-PLV antibiotics with anti-staphylococcal activity, such as clindamycin and linezolid should be started without waiting for typing of the S. aureus strain.

Intubation chez une adolescente souffrant du syndrome Rubinstein-Taybi en utilisant le vidéolaryngoscope

CAN J ANESTH 55: 1 www.cja-jca.org January, 2008 Usually operators introduce the blade of the GlideScope® into the patient’s mouth along the midline of the tongue, and either the blade or the handle is raised in a plane perpendicular to the patient’s mandible to expose the larynx. The styletted ETT is then introduced between the space made by the blade of the GlideScope® and the patient’s mouth. In a patient with a small mouth, the space created by the blade and the patient’s mouth may be narrow, rendering difficulties with ETT insertion (Figure A, B). If the blade of the GlideScope® is inserted nearer to the left corner of the mouth, the operator can attain a larger space for ETT insertion (Figure C) potentially avoiding oropharyngeal mucosal injury. Although the laryngeal inlet may be exposed in a slightly deviated position with this approach (Figure D), visualization of the ETT tip on the video screen will enable easy insertion of the ETT. We have found that this maneuver allows easy introduction of the ETT into the glottis, and have observed no evidence of palatopharyngeal trauma.

Evaluation des prescriptions antibiotiques au service des urgences de l’Hôpital Militaire d’Instruction Mohammed V (HMIMV)

The objectives of this study are to describe prescribing practices, to evaluate their appropriateness and their compliance with guidelines and to examine their influencing factors. We conducted a cross-sectional study of antibiotic prescriptions data of 105 patients in the medical and surgical Emergency Department of the Military Hospital of Instruction Mohammed V in Rabat over a period of one month. Data were collected by means of a questionnaire including demographic and anamnestic data, patients history, allergies, specific clinical examination data, paraclinical data, detailed antibiotic prescription. Collected data were then evaluated by a referring physician, who was responsible for detecting any treatment error. Among infections requiring the prescription of antibiotics, respiratory and urinary system diseases were at the forefront, the most commonly used antibiotic families were penicillins, quinolones and cephalosporins. 74 prescriptions (70.5%) were both pertinent and compliant versus 9 prescriptions (8.6%) justified but nonpertinent and 6 prescriptions (5.7%) which were considered unjustified by the referring physician due to absence of infection. The evaluation of the existing medical practice is rarely conducted in health facilities; with this in mind, our case study aims to improve appropriate antibiotic prescribing and to optimize its compliance with guidelines.

Does intranasal fentanyl provide efficient analgesia for renal colic in adults

Introduction Intranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics. Methods A prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patients presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded. Results 23 eligible patientswere enrolled; median age was 51,3years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 μg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded. Conclusion Intranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.

Renal vein thrombosis in the post-partum period: a case report

IntroductionPhysiological hypercoagulability is a known condition in pregnancy designed to limit the risk of bleeding; it may exceptionally be complicated by thrombosis of the renal vein. To the best of our knowledge, this is the third case of renal venous infarction reported in the literature.Case presentationWe report the case of a 43-year-old Caucasian woman, a mother of three sons who presented with left flank pain and hematuria. The clinical investigations did not find any other cause for her thrombophilia.ConclusionsClinical onset is not specific, so it is important to evoke the diagnosis in the context of pregnancy; computed tomography angiography is the investigation of choice to set the diagnosis. It is important to know that anticoagulation therapy must be initiated as soon as possible.

Dyspnoea caused by a Chilaiditi syndrome: contribution of the non-invasive ventilation

A 49-year-old man presented to the emergency department with respiratory distress and extreme abdominal distension, with a history of chronic constipation. His chest auscultation was normal and the patient experienced drowsiness and showed signs of respiratory fatigue. He experienced severe disturbances in blood gas tensions (pH 7.28, PaO2 65 mm Hg, PaCO2 76 mm Hg); …

[Intubation using a videolaryngoscope in an adolescent girl with Rubinstein-Taybi syndrome].

CAN J ANESTH 55: 1 www.cja-jca.org January, 2008 Usually operators introduce the blade of the GlideScope® into the patient’s mouth along the midline of the tongue, and either the blade or the handle is raised in a plane perpendicular to the patient’s mandible to expose the larynx. The styletted ETT is then introduced between the space made by the blade of the GlideScope® and the patient’s mouth. In a patient with a small mouth, the space created by the blade and the patient’s mouth may be narrow, rendering difficulties with ETT insertion (Figure A, B). If the blade of the GlideScope® is inserted nearer to the left corner of the mouth, the operator can attain a larger space for ETT insertion (Figure C) potentially avoiding oropharyngeal mucosal injury. Although the laryngeal inlet may be exposed in a slightly deviated position with this approach (Figure D), visualization of the ETT tip on the video screen will enable easy insertion of the ETT. We have found that this maneuver allows easy introduction of the ETT into the glottis, and have observed no evidence of palatopharyngeal trauma.

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

Spinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patients evolution was favorable after antibiotic therapy.