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Loghmari MH, Aissaoui F, Guediche A, Bouhlel W, Zakhama M, Chaabene NB, Rehaiem A, Ben Abdeljalil N, Njima M, Zakhama A, Kadri Y, Mastouri M, Safer L. Treatment of Helicobacter pylori infection 14-day concomitant quadruple therapy versus triple therapy: A parallel double-blind randomized controlled trial. Health Sci Rep 2023; 6:e1593. [PMID: 37808931 PMCID: PMC10551283 DOI: 10.1002/hsr2.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/14/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background and Aims Successful Helicobacter pylori (Hp) eradication with the traditional 7-day course of proton pump inhibitor triple therapy is declining. Prolonging therapy to 14 days is associated with better eradication rates. Most learned societies recommend concomitant quadruple therapy (QC) as a first-line alternative therapy for this bacterial infection. The aim of this study is to compare the efficacy and safety of triple therapy (TT) and QC for the eradication of Hp infection. Methods A parallel double-blind randomized controlled trial was conducted. The diagnosis of Hp infection was made by pathological examination of gastric biopsies. Patients were randomly assigned to two treatment groups: either QC (esomeprazole 80 mg, amoxicillin 2000 mg, clarithromycin 1000 mg, and metronidazole 1000 mg daily) or triple therapy (esomeprazole 80 mg, amoxicillin 2000 mg, and clarithromycin 1000 mg daily in divided doses) for 14 days. The efficacy of the treatment is defined by Hp eradication attested by a negative breath test performed 6 weeks after the completion of treatment. Treatment outcomes were compared using the chi-square test, while binary logistic regression identified predictors of treatment failure. Results Ninety-two patients were included. Forty-two patients belonged to the QC group and 50 to the TT group. No significant difference was noted between the two groups concerning the rate of Hp eradication either by intention to treat (81% vs. 72% respectively, p = 0.31) or per protocol (81.6% vs. 76.1% respectively, p = 0.54). Likewise, there was no difference between the two groups in terms of tolerance to treatment (59.5% for QC vs. 58% for TT, p = 0.88). No factor has been associated with treatment failure. Conclusion There was no significant difference in the rate of HP eradication between the QC and the 14-day triple therapy. Neither regimen should be used topically because of their low eradication rates.
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Affiliation(s)
| | - Firas Aissaoui
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
| | - Arwa Guediche
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
| | - Wided Bouhlel
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
| | - Mejda Zakhama
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
| | - Nabil B. Chaabene
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
| | - Amel Rehaiem
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
| | - Nouha Ben Abdeljalil
- Department of Pathological AnatomyFattouma Bourguiba University HospitalMonastirTunisia
| | - Manel Njima
- Department of Pathological AnatomyFattouma Bourguiba University HospitalMonastirTunisia
| | - Abdelfetteh Zakhama
- Department of Pathological AnatomyFattouma Bourguiba University HospitalMonastirTunisia
| | - Yosr Kadri
- Microbiology LaboratoryFattouma Bourguiba University HospitalMonastirTunisia
| | - Maha Mastouri
- Microbiology LaboratoryFattouma Bourguiba University HospitalMonastirTunisia
| | - Leila Safer
- Department of Hepato‐GastroenterologyFattouma Bourguiba University HospitalMonastirTunisia
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Rhim H, Ben Trad R, Haddad O, Kadri Y, Mastouri M. Comparative study of multidrug-resistant bacterial infections in hospitals and community settings in the region of Monastir - Tunisia. Tunis Med 2022; 100:390-395. [PMID: 36206088 PMCID: PMC9552238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIM Multidrug resistance in bacteria has become a widespread scourge. The objective of this study is to investigate the epidemiology of multidrug-resistant bacteria (MDR) at Fattouma Bourguiba University Hospital of Monastir - Tunisia compared to the community and to define their antibiotic resistance profiles. METHODS It was a retrospective and descriptive study over a period of 5 years (2016-2020) conducted at the microbiology department of Fattouma-Bourguiba University Hospital of Monastir - Tunisia. All MDR strains isolated from diagnostic microbiological samples collected from patients hospitalized in high-risk infectious departments and from outpatients were included in our study. RESULTS A total of 4324 MDR among 16353 bacteria were isolated during the study period, i.e. a resistance rate of 26.4% with a predominance of hospital strains (80.3% versus 19.7% in the city). Third generation cephalosporin-resistant Enterobacteriaceae were the most prevalent and were mainly represented by extended-spectrum beta- lactamases (67.1% versus 83.4% in the community). Escherichia coli was the most frequent species (40.9%). It was frequently associated with resistance to fluoroquinolones (in more than 73% of cases). Imipenem-resistant Acinetobacter baumannii was mostly responsible for hospital acquired infections (77%). Co- resistances concerned most of the antibiotics but spared colistin. Methicillin-resistant Staphylococcus aureus infections were more frequent in the city (20.5% versus 19.3% in hospitals). Resistance associated was mainly to fusidic acid (49.6%). Glycopeptides have maintained their activity and only 2% were of decreased sensitivity to vancomycin. CONCLUSION The emergence of MDR always represents a public health challenge. Thus, hygiene measures associated with an optimization of antibiotic therapy are necessary for a better control of their diffusion.
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Affiliation(s)
- Hajer Rhim
- 1. Laboratoire de Microbiologie, CHU Fattouma Bourguiba de Monastir / Université de Monastir/Faculté de Pharmacie de Monastir
| | - Rahma Ben Trad
- 1. Laboratoire de Microbiologie, CHU Fattouma Bourguiba de Monastir / Université de Monastir/Faculté de Pharmacie de Monastir
| | - Ons Haddad
- 1. Laboratoire de Microbiologie, CHU Fattouma Bourguiba de Monastir / Université de Monastir/Faculté de Pharmacie de Monastir
| | - Yosr Kadri
- 2. Laboratoire de Microbiologie, CHU Fattouma Bourguiba de Monastir / Université de Monastir/Faculté de Médecine de Monastir
| | - Maha Mastouri
- 1. Laboratoire de Microbiologie, CHU Fattouma Bourguiba de Monastir / Université de Monastir/Faculté de Pharmacie de Monastir
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Haddad O, Merghni A, Elargoubi A, Rhim H, Kadri Y, Mastouri M. Comparative study of virulence factors among methicillin resistant Staphylococcus aureus clinical isolates. BMC Infect Dis 2018; 18:560. [PMID: 30424731 PMCID: PMC6234561 DOI: 10.1186/s12879-018-3457-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023] Open
Abstract
Background Methicillin resistant Staphylococcus aureus (MRSA) is recognized worldwide as a leading cause of hospital and community infections. Biofilm formation by MRSA is an extremely important virulence factor to be understood. Our aim was to establish phenotypic and genotypic characterization of virulence factors among 43 MRSA clinical isolates in a Tunisian hospital. Methods We investigated enzymatic profiles, biofilm production and prevalences of genes encoding intracellular adhesion molecules (icaA and icaD), Microbial Surface Components Recognizing Adhesive Matrix Molecules genes (fnbA, fnbB and cna) and exoenzymes genes (geh, sspA and sspB). Results Our findings revealed that caseinase, gelatinase, lipase and lecithinase activities were detected in 100%, 100%, 76.6% and 93.3% of cases respectively. This study showed that 23 strains (76.7%) were slime producers on Congo red medium. Furthermore, 46.5% and 53.5% of isolates were respectively highly and moderately biofilm-forming on polystyrene. Significant association was found between both biofilm tests. PCR detection showed that 74.4%, 18.6%, 69.8%, 65.1% and 74.4% of isolates harbored fnbA, fnbB, icaA, icaD and cna genes respectively. In addition, 34.9%, 18.6% and 30.2% of MRSA strains were found positive for sspA, sspB and geh genes respectively. Further, statistical data showed that the presence of the fnbA and fnbB genes was significantly associated with a high biofilm production on polystyrene. However, no statistical association was observed for the icaA, icaD and cna genes. Conclusions This study indicates that the detection of fnbA and fnbB contributing to the first step of biofilm formation has been predictable of high biofilm production. As studied factors contribute to MRSA virulence, this research could be of value in orienting towards the development of new preventive and therapeutic measures.
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Affiliation(s)
- Ons Haddad
- Laboratoire de Microbiologie, CHU Fatouma Bourguiba de Monastir, Monastir, Tunisie. .,Laboratoire des Maladies Transmissible et Substances Biologiquement Actives, LR99ES27, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie.
| | - Abderrahmen Merghni
- Laboratoire des Maladies Transmissible et Substances Biologiquement Actives, LR99ES27, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie
| | - Aida Elargoubi
- Laboratoire de Microbiologie, CHU Fatouma Bourguiba de Monastir, Monastir, Tunisie.,Laboratoire des Maladies Transmissible et Substances Biologiquement Actives, LR99ES27, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie
| | - Hajer Rhim
- Laboratoire de Microbiologie, CHU Fatouma Bourguiba de Monastir, Monastir, Tunisie.,Laboratoire des Maladies Transmissible et Substances Biologiquement Actives, LR99ES27, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie
| | - Yosr Kadri
- Laboratoire de Microbiologie, CHU Fatouma Bourguiba de Monastir, Monastir, Tunisie.,Laboratoire des Maladies Transmissible et Substances Biologiquement Actives, LR99ES27, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie
| | - Maha Mastouri
- Laboratoire de Microbiologie, CHU Fatouma Bourguiba de Monastir, Monastir, Tunisie.,Laboratoire des Maladies Transmissible et Substances Biologiquement Actives, LR99ES27, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie
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Cheikh HB, Domingues S, Silveira E, Kadri Y, Rosário N, Mastouri M, Da Silva GJ. Molecular characterization of carbapenemases of clinical Acinetobacter baumannii- calcoaceticus complex isolates from a University Hospital in Tunisia. 3 Biotech 2018; 8:297. [PMID: 29963357 DOI: 10.1007/s13205-018-1310-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to identify the carbapenemases from clinical carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (CRABC) isolates and to assess their potential dissemination by conjugation and natural transformation. CRABC (n = 101) were collected consecutively from inpatients of the University Hospital of Monastir, Tunisia, from 2013 to 2016. Antimicrobial susceptibility was determined by the disk diffusion method and E-test. Carbapenemase-encoding genes were screened by PCR. Genotyping was performed by Pasteur MLST scheme. Isolates were resistant to all beta-lactams, fluoroquinolones and aminoglycosides while 80 and 90% were susceptible to tigecycline and colistin, respectively. Resistance and intermediate resistance to imipenem were 87 and 13%, respectively. The genes blaOXA-24-like, blaOXA-58-like, blaOXA-143-like, blaOXA-48-like, blaVIM, blaIMP, and blaKPC were not found. The blaOXA-51-like and blaOXA-23-like genes were present in 100 and 82.17% isolates, respectively. One isolate (< 1%) carried blaNDM-1 and blaOXA-51-like and belonged to Sequence Type 85 (ST85). Absence of transconjugants suggests a chromosomal location of NDM-1 determinant. The blaNDM-1 gene was inserted in a truncated form of Tn125, which may explain the absence of blaNDM-1 carrier-transformants. To our knowledge, this is the first report of the finding of NDM-positive A. baumannii in Tunisian territory. The study shows that despite the low prevalence and potential spread of NDM-1 enzyme among CRABC, continuous regional antimicrobial resistance surveillance and improved infection control measures are required in Tunisia to prevent further dissemination.
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Affiliation(s)
- Hadhemi Ben Cheikh
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- 2Faculty of Science, Bizerta Carthage University, Bizerta, Tunisia
- Laboratory of Contagious Disease and Biologically Active Substances LR99-ES27, Monastir's Pharmacy Faculty, Monastir, Tunisia
| | - Sara Domingues
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- 4Laboratory of Microbiology, Center for Neuroscience and Cell Biology (CNC), Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de Sta Comba, 3000-548 Coimbra, Portugal
| | | | - Yosr Kadri
- Laboratory of Contagious Disease and Biologically Active Substances LR99-ES27, Monastir's Pharmacy Faculty, Monastir, Tunisia
- 5Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Natasha Rosário
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Maha Mastouri
- Laboratory of Contagious Disease and Biologically Active Substances LR99-ES27, Monastir's Pharmacy Faculty, Monastir, Tunisia
- 5Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Gabriela Jorge Da Silva
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- 4Laboratory of Microbiology, Center for Neuroscience and Cell Biology (CNC), Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de Sta Comba, 3000-548 Coimbra, Portugal
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Mhalla S, Kadri Y, Alibi S, Letaief A, Boukadida J, Hannachi N. Hepatitis D Virus Infection Among Hepatitis B Surface Antigen Carriers and in "Isolated anti-HBc" Antibodies Profile in Central Tunisia. Hepat Mon 2016; 16:e32354. [PMID: 27110257 PMCID: PMC4834381 DOI: 10.5812/hepatmon.32354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/31/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis D Virus (HDV) causes accelerated liver diseases in patients with Hepatitis B Virus (HBV) infection. There is lack of data about its prevalence, related risk factors and interaction with HBV carriers in our country. OBJECTIVES The aim of this study was to estimate the prevalence of hepatitis delta and associated risk factors among Hepatitis B surface antigen (HBsAg) and "isolated anti-HBc" profile carriers in central Tunisia. PATIENTS AND METHODS In this cross-sectional study, 540 patients with positive HBsAg and 109 "isolated anti-HBc" profile receiving care in a teaching hospital were tested for the presence of HDV serum-markers using commercially available enzyme immunoassay kit. HBV-DNA was detected by nested PCR in "isolated anti-HBc" profile group. RESULTS Prevalence of HDV was 8.1% in HBsAg carriers group, but it was significantly higher in active than inactive hepatitis (30.2% and 4.5%, respectively, OR = 9, 95% CI: [4.48-18.58]). There was no significant association between studied risk factors and HDV infection. In the "isolated anti-HBc" profile group, prevalence of HDV was 4.6% and HBV-DNA had negative result in all patients with positive results for HDV. CONCLUSIONS Although HDV had low prevalence in our area, it is vital to plan preventive strategies for HDV spread as well as HBV prevention. It is particularly important to suspect HDV infection in active HBV carriers to manage a particularly severe dual infection. HDV infection should be suspected even in negative HBsAg patients having "isolated anti-HBc" profile.
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Affiliation(s)
- Salma Mhalla
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
- Corresponding Author: Salma Mhalla, Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia. E-mail:
| | - Yosr Kadri
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Sana Alibi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Disease, F. Hached Teaching Hospital, University of Sousse, Sousse, Tunisia
| | - Jalel Boukadida
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Naila Hannachi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
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Mhalla S, Kadri Y, Bahri O, Triki H. PIX-12 Viral etiology of hemorrhagic cyctitis after bone marrow transplantation among Tunisian patients. J Clin Virol 2009. [DOI: 10.1016/s1386-6532(09)70217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khalfallah T, Haddad M, Kadri Y, Chaari N, Henchi M, Henry B, Akrout M. Qualité de l’air aux blocs opératoires de l’Hôpital Universitaire de Monastir, Tunisie. ARCH MAL PROF ENVIRO 2004. [DOI: 10.1016/s1775-8785(04)93085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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