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N Hannachi

Publications and source records attributed to N Hannachi.

18 recordsLinked to original sources
PubMed2005

[Multiclonality of methicilin-resistant Staphylococcus aureus in a university hospital].

OBJECTIVE: The methicillin resistance of Staphylococcus aureus MRSA is a major problem for human infections. The authors present a genotypic study of these bacteria to understand the spreading of these strains in a university hospital. PATIENTS AND METHODS: We collected 19 strains of MRSA (September 2003-March 2004) for which the presence of gene mecA had been confirmed by PCR. They were then genotyped in pulsed-field Gel electrophoresis (CHEF variety). RESULTS: Resistant strains accounted for 12.9% of all collected S. aureus strains. Most samples came from patients hospitalized or consulting in dermatology. Eleven different antibiotypes and four genotypic profiles were determined: type A (with 8 subtypes), type B (with 2 subtypes), type C, and D. CONCLUSION: MRSA strains have a multiclonal distribution in our hospital with a dominant endemic clone in the dermatological unit. Skin infections are the main hospital source for these strains.

Bacterial Proteins↗
PubMed2003

[Outbreak of nosocomial urinary tract infections due to a multidrug resistant Pseudomonas aeruginosa].

An outbreak of a multidrug resistant Pseudomonas aeruginosa including imipenem resistance occurred in the urology intensive care unit at Charles Nicolle Hospital (Tunis). All isolates presented the same antibiotic resistance pattern and were only susceptible to colistin. The epidemic strain was detected in different sites of this unit. Pulsed-field gel electrophoresis after enzymatic restriction using XbaI was performed in order to establish an epidemiologic link between these infections. Genotypic analysis showed two different patterns and the environmental source was identified in both cases. Although the same antibiotype was harbored by all the isolates, two outbreaks occurring in the same period were identified. The strengthening of hygiene measures allowed to stop the outbreak spreading. Since the hospital environment is the major source of Pseudomonas aeruginosa contamination, a continuous surveillance of the patients and the environmental sources is required for the implementation efficient control measures.

Colistin↗
PubMed2002

[Genotypic exploration of a hospital neonatal outbreak due to Klebsiella pneumoniae producing extended-spectrum-betalactamase].

BACKGROUND: The aim of the study was to explore nosocomial neonatal outbreak of Klebsiella pneumoniae producing extended-spectrum-betalactamase by macrorestriction genotyping. PATIENTS AND METHODS: Over a 25 days period, a hospital neonatal outbreak due to Klebsiella pneumoniae producing extended-spectrum-betalactamase affected 14 newborn infants admitted to a university hospital in Sousse (Tunisia). We collected 21 strains of Klebsiella pneumoniae producing extended-spectrum-betalactamase. Susceptibility testing to 17 antibiotics was determined. Macrorestriction genotyping of strains was determined by pulsed-field-electrophoresis. Neonatal intensive care unit survey was undertaken. RESULTS: A macrorestriction genotyping subdivided 21 strains into 3 clonally groups. Only cefoxitin, colistin, imipenem, amikacin and quinolons were active on the whole of strains. All infected babies died. The hygiene insufficiency and contamination of transfusion products at the time of their dividing in neonatal intensive care unit were incriminated. Handholding due to work overcharge was the main cause of bacterial diffusion. CONCLUSION: Multiclonal outbreak of Klebsiella pneumoniae producing extended-spectrum-betalactamase appeared following hygiene insufficiency related to work overcharge.

Cross Infection↗
PubMed1992

[Vascular complications in infectious endocarditis. Apropos of 86 cases].

During a 20 year period, 285 patients were hospitalised for infectious endocarditis (IE) in the Department of Cardiology of the Ernest-Conseil Hospital in Tunis and 86 of them, i.e. 30%, developed a vascular complication (VC). Among these 86 patients, there were a total of 108 lesions, including 52 neurological complications, 14 peripheral acute ischemic syndromes, 16 peripheral arterial aneurysms, 9 aortic aneurysms, 7 pulmonary embolisms, 6 splenic infarctions and 4 coronary lesions. The mortality in this patient group proved to be slightly greater than in the series as a whole, in particular concerning patients with multiple lesions and those with an artificial valve. No prognostic difference was seen between patients with a VC of aneurysmal type and of ischemic type, but the presentation and severity of lesions was very variable. The vascular complication was a presenting feature of IE in almost 40% of cases. The organism found most often was the streptococcus, above all in ischemic type IE as well as in the total patient group. Similarly, the preferential site was aortic, above all for aneurysmal type IE. Ultrasonography revealed a higher incidence of vegetations in this series of patients, above all in ischemic type VC, but anatomical studies have shown this to be an investigation of moderate sensitivity and poor specificity, poorly correlated from a prognostic standpoint with the risk of embolism. The conclusion of the study is above all the need to prevent such complications: embolic complications by early antibiotic treatment and valve replacement and aneurysmal complications by methodical routine angiographic evaluation and appropriate treatment.

Adolescent↗
PubMed1991

[Neurologic manifestations of infectious endocarditis].

Thirty out of 287 patients (10.4%) admitted to hospital for infective endocarditis between December 1970 and January 1990 had neurological complications. Twenty-three patients had native valve infectious endocarditis and 7 had prosthetic valve endocarditis. The clinical features were characterized by the frequency of aortic valve involvement (23 out of 30) and other complications, especially cardiac failure (16 cases) and peripheral vascular manifestations (7 cases). The commonest organism was the staphylococcus (53% of identified organisms) but the number of negative blood cultures was high (50% of cases). The neurological complication was often the presenting symptom of the endocarditis (19 cases) but it occurred after bacteriological cure in 4 cases. The complications observed were cerebral ischemia (16 cases), cerebral haemorrhage (11 cases), coma (2 cases), and one peripheral neuropathy causing a Claude Bernard Horner syndrome. These complications presented with hemiplegia in 17 cases, a meningeal syndrome in 8 cases, a convulsion in 1 case, a Von Wallenberg syndrome in 1 case, and a Claude Bernard Horner syndrome in 1 case. Twelve patients had a transient or permanent neurological coma. Cerebral CT scan showed ischemic lesions in 7 cases and haemorrhagic lesions in 10 cases. Carotid angiography demonstrated mycotic aneurysms in 6 patients. Twelve patients died: the cause of death was neurological coma (7 cases), low cardiac output (4 cases) and haemorrhagic shock (1 case). Four patients underwent neurosurgery: 3 for clipping a mycotic aneurysm and 1 for drainage of an intracerebral haematoma. Poor prognostic factors were: coma, cardiac failure, cardiac valve prosthesis and, above all, the extent and multiplicity of the neurological lesions. The authors propose the following measures to improve the prognosis: early surgery in cases of large and/or mobile vegetations especially when the infecting organism is a staphylococcus and when a systemic embolism has occurred; routine CT scanning and/or digitised cerebral angiography in all patients with infective endocarditis to detect surgically accessible mycotic aneurysms.

Adolescent↗
PubMed1989

[Treatment of chronic refractory cardiac insufficiency with enalapril].

The objective is here to study the long and intermediate term clinical and haemodynamic effects of enalapril during chronic heart failure resistant to the classic digitalis-diuretics treatment. The study involves 16 patients (12 males and 4 females), with a mean age of 50 years. Before being given enalapril, 12 patients were at stage IV and 4 patients at stage II of the NYHA; the mean capillary pressure was quite elevated (30 +/- 6.3 mmHg), the cardiac index has collapsed (2.12 +/- 0.38 l.min.m2) and the stroke fraction (SF) is 0.28 +/- 0.08. At the 1st month control, there is a definite functional and haemodynamic improvement of the pre-charge as well as the post-charge. This improvement is still present at 6 months. The ventricular function is improved (SF = 0.38 +/- 0.13; p less than 0.001). The clinical tolerance of enalapril is excellent and the only adverse reaction is a transient deterioration of the renal function in a patient with diabetic glomerulopathy.

Adolescent↗
PubMed1988

[Auriculoventricular blocks in the acute phase of myocardial infarction. Course and prognosis. Apropos of 90 cases].

The objective is to study the clinical and electrocardiographic characteristics as well as the course of myocardial infarction complicated by atrio-ventricular block (AVB), and to propose a management to acute myocardial infarction with A-V block. This study concerns 90 patients (78 men and 12 women), with a mean age of 58 years. The overall frequency of AVB is 7.6 p. cent. The infarction is most of the time found posteriorly (51 p. cent of the cases). Syncopes are essentially seen in complete AVB (81 p. cent) and with deep antero-septal necrosis (73 p. cent). Heart failure is especially the complication of anterior (73 p. cent) and deep septal (78 p. cent) necrosis. The mortality of myocardial infarction complicated by A-V block (41 p. cent) is higher than that of uncomplicated necroses (15 p. cent). The prognosis is usually favorable in posteriorly located infarctions where the A-V block is usually regressive and benign while it is much more severe in other locations where the conduction disorders associated with severe myocardial lesions. Temporary and/or permanent electrosystolic stimulation must be well codified in its indications which should be broadened, especially in case of anterior or deep septal necrosis.

Adult↗
PubMed1987

Prosthetic valve endocarditis. A survey.

Fifty eight patients (aged 8-59 years, mean 27) treated for prosthetic valve endocarditis from January 1966 to January 1985 were studied retrospectively by review of case notes. There were 12 cases of early and 46 cases of late prosthetic valve endocarditis. These developed in 28 patients with an isolated aortic valve, in 26 with an isolated mitral valve, and in four with both aortic and mitral prosthetic valves. Streptococci were the most commonly isolated microorganisms, followed by staphylococci, Gram negative bacteria, and fungi. A surgical (34 cases) or a necropsy specimen (10 cases) from 44 cases was examined. Eighty two per cent of the patients had congestive heart failure. Twenty four of the 58 patients were medically treated and 17 died (70% mortality). Combined medical and surgical treatment was used in 34 patients; the main indication for surgery was congestive heart failure. Fourteen patients on combined treatment died (40% mortality). Persistent sepsis and prosthetic valve dehiscence were the most common early and late operative complications. The most important influences on outcome were congestive heart failure, the type of micro-organism, the severity and extent of anatomical lesions, the time of onset of prosthetic valve endocarditis, and the type of treatment. This survey indicates that only patients without congestive heart failure or embolic complications and with sensitive micro-organism should be treated medically. In view of the poor prognosis patients with prosthetic valve endocarditis associated with congestive heart failure, persistent sepsis, and repeat arterial emboli should be treated by early surgical intervention.

Adolescent↗
PubMed1986

[Infectious endocarditis surgically-treated in the active phase. Apropos of 46 cases].

The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase. Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis. The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30). The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases). The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases). The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases). Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases). The commonest surgical indication was haemodynamic deterioration (30 cases). The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series. The surgical procedure was technically complex in 6 cases. Operative mortality was high (18 cases, 39%). The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

[Early and late hospital mortality in myocardial infarction. Causes and prognostic factors. Apropos of 140 cases].

The purpose of this work is to study the causes of early and late in-hospital mortality of myocardial infarction, to define elements of prognosis and to attempt to prevent the fatal outcome of the coronary disease. This study concerns 107 men and 33 women, between the ages of 30 and 83 years (mean age 62.8 years). The total mortality is 12% (early: 6.5%, late: 5.5%. 66% of the patients are over 60 and 45% present 3 or more coronary risks factors. The clinical picture is characterized by frequent initial complications (84% of the cases), dominated by hemodynamic failure. The infarction is most of the time located anteriorly (56.6% of the cases). Primary cardiogenic shock represents the main cause of early mortality (55.3%). A recurrent infarction represents 75% of the causes of late deaths. Tri-vessels involvement and alteration of the ventricular function are noted in 9 out of 14 coronary arteriograms. Prognosis factors are proposed to differentiate high risk patients requiring an early coronary arteriogram in view of a specific medical and/or surgical treatment. The best signs of a poor prognosis are: tri-vessels involvement and alteration of the ventricular function.

Adult↗
PubMed1984

[Long-term clinical and hemodynamic results of the treatment of refractory cardiac failure with molsidomine].

Molsidomine, one of the sydnonimine group of drugs; the object of this study was to evaluate its efforts in refractory cardiac failure. In the first part of the study, the haemodynamic effects of a single oral dose of 2 or 4 mg of molsidomine were compared with placebo controls in 23 patients. This showed molsidomine to be an active venous vasodilator reducing pulmonary artery and right atrial pressures without changing cardiac index or systemic pressures. The peak effect was observed after 1 to 1,5 hours. In the second phase, molsidomine was used in 9 patients aged 32 to 71 years (mean 47 +/- 12 years) over an average period of 19 months (3,5 to 42 months). The maintenance dose varied from 8 to 24 mg/24 hours. These patients had refractory cardiac failure secondary to primary cardiomyopathy with dilatation (6 cases) or ischemic heart disease (3 cases). The 9 patients were in functional classes IV (5 cases) or III (4 cases). Four patients were theoretically good indications for transplantation. Haemodynamic control was performed 1,8 +/- 5 months after a washout period of 8 hours, and after initial right heart catheterisation, the measurements were repeated 1 hour after oral administration of a 4 mg dose of molsidomine. Two patients did not respond initially to molsidomine; one died, the other remained in functional Class III. Another patient who responded initially was improved for over two years but died in cardiac failure after 42 months' treatment. The other six patients have been significantly improved and were in functional Class II at their last control.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗