Manel Mallouli

Carriage of multidrug-resistant bacteria among pediatric patients before and during their hospitalization in a tertiary pediatric unit in Tunisia

ABSTRACT The pandemic spread of multidrug-resistant (MDR) bacteria (i.e., methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLPE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii) pose a threat to healthcare Worldwide. We found limited data of MDR bacteria in pediatric patients hospitalized in Tunisian tertiary healthcare.The aim of the study is to evaluate the acquisition rate of MDR acquisition during hospitalization and to explore some of the associated risk factors for both carriage and acquisition at the pediatric department, Sahloul University Hospital. During September and October 2016, newly admitted patients were screened, at admission, during care and at discharge. Risk factors for colonization were explored by multivariate analysis. Of 112 newly admitted patients, 8.92% were colonized with at least one MDR. No risk factor was identified at admission. During hospitalization, five newly acquisition MDR (4.9%) were detected and eight (7.84%) at discharge. The specie most frequently detected on admission was Escherichia coli (50%), whereas, on discharge, Escherichia coli and K. pneumoniae were the species most frequently detected (52.7%). The pediatric intensive care unit (PICU) hospitalization, the length of hospital stay (more than 3days) and age under 2 years were identified as risk factor for acquisition of MDR during hospitalization. We identified several independent risk factors for contracting MDR bacteria during hospitalization in a tertiary pediatric department. The incidence of symptomatic MDR Infection among those colonized should be under close surveillance and long-term screening for those children is required. An institutional screening program for MDR especially in PICU might be discussed in regards to cost effectiveness.

Mobile Emergency Care Medical Records Audit: The Need for Tunisian Guidelines

Objective: This study was designed to assess the quality of the Gabès (Tunisia) mobile emergency care medical records and propose corrective actions.Materials and methods: A clinical audit was performed at the Gabès mobile emergency care unit (SMUR). Records of day, night and weekend primary and secondary interventions during the first half of 2014 were analysed according to a data collection grid comprising 56 criteria based on the SMUR guidelines and the 2013 French Society of Emergency Medicine evaluation guide. A non-conformance score was calculated for each section.Results: 415 medical records were analysed. The highest non-conformance rates (48.5%) concerned the “specificities of the emergency medical record” section. The lowest non-conformance rates concerned the surveillance data section (23.4%). The non-conformance score for the medical data audit was 24%.Conclusion: This audit identified minor dysfunctions that could be due to the absence of local guidelines concerning medical records in general and more specifically SMUR. Corrective measures were set up in the context of a short-term and intermediate-term action plan.

Prevalence et facteurs associes au tabagisme parmi les etudiants de la ville de Sousse (Tunisie)

Within the framework of the fight against tobacco among young people, we conducted a descriptive cross-sectional study in 2013 to estimate the prevalence of smoking and to identify associated factors among students in Sousse. A questionnaire was administered to a representative sample of 556 students in 5 academic institutions in Sousse randomly drawn. The age of the participants was between 17 and 35 years. The prevalence of tobacco consumption in the past 12 months was 22.1% and consumption during the past 3 months was 65.3%. The average age of starting smoking was 17 years. Smoking prevalence was significantly higher for males (P < 0.001) and those aged over 25 years (P = 0.002). Students from 2 of the institutions were using more tobacco than their colleagues in the other institutions (P = 0.027). The high prevalence of smoking found among the students means that prevention measures are essential; this requires increasing self-esteem and evaluating intervention programmes implemented before smoking the first cigarette. كلذب ةطبترلما لُماوعلاو سنوتب ةسوس ةنيدم في بلاطلا ينب ينخدتلا رُاشتنا يمجعلا ايرث ،يوايرطلما ليع ،وُّ لدرغلا ميرم ،ليحاسلا ناهيج ،ماملإا لانم ،ليوللما لانم ،خيشلا نب ءماسأ ،ينيديزلا بيكش نـب نـخدتلا راـشتنا لدـعم رـيدقتل 2013 ماـع في ةـيعطقم ةـيفصو ةـسارد اـنيرجأ بابـشلا نـب غـبتلا كلاهتـسا ةـحفاكم راـطإ في :ةـصلالخا ةـيميداكأ تاـسسؤم 5 في اًـبلاط 556 نـم ةـن َّ وكم ةـلِّ ثمم ةـنيعل نايبتـسا مادختـسا مـتف .كـلذب ةـطبترلما لـماوعلا دـيدتحو ةـسوس في بلاـطلا ةقباـسلا 12 ــلا رهـشلأا في غـبتلا كلاهتـسا راـشتنا ناكـف .اًـماع 35 و 17 نـب نكراـشلما رماـعأ تـناكو .ةيئاوـشع ةـقيرطب اويرـتخا ةـسوس في نـخدتلا راـشتنا ناكو .اًـماع 17 نـخدتلا في ءدـبلا رـمع طـسوتم ناكو .65.3% ةـيضالما رهـشأ 3 ــلا للاـخ كلاهتـسلاا ناكو ،22.1% ثـحبلل نتـسسؤم ذيملات ىدـل غـبتلا كلاهتـسا ناكو .)P = 0.002( اًـماع 25 ــلا مـهرماعأ تزواـتج نـمَ ىدـلو )P < 0.001( روـكذلا ىدـل يرـثكب ىـعأ يرـبادت ذاـتخا نأ يـنعي بلاـطلا ىدـل دـجوُ يذـلا نـخدتلا راـشتنا لدـعم عاـفترا نإ .)P = 0.027( ىرـخلأا تاـسسؤلما في مـنهارقأ نـم ىـعأ .لىولأا ةراجيـسلا نـخدت لـبق ذـ َّ فنت يـتلا لـخدتلا جـمارب مـييقتو ،تاذـلا مارـحا ةـيمنت بـلطتي اذـهو .يروضر رـمأ ةـيئاقو طسوتلما قشرل ةيحصلا ةلجلما نوشرعلا و نياثلا دلجلما لولأا ددعلا