Tesi sul tema "Infections nosocomiales – Résistance aux antibiotiques – Liban"
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Matta, Roula. "Infections nosocomiales et résistance aux antibiotiques chez les bacilles à GRAM négatifs : étude de cohorte multicentrique dans les hôpitaux libanais". Electronic Thesis or Diss., Bordeaux, 2023. http://www.theses.fr/2023BORD0485.
Testo completoHospital-acquired infections and bacterial resistance to antibiotics are widespread worldwide, with a higher prevalence in developing countries with limited resources, including Lebanon. In Lebanon, epidemiological data on resistance among Gram-negative bacteria to antibiotics of last resort in hospitals and on nosocomial infections are scarce. Aims: We conducted three studies to meet the following objectives: a first study to identify and compare the different bacteria identified in communityacquired infections and nosocomial infections, focusing on associated co-morbidities and sociodemographic factors. This was followed by two studies targeting resistance to last-resort antibiotics in Gram-negative bacilli, in order to describe the epidemiology and identify patient characteristics associated with this resistance. Mortality in patients with Gram-negative bacilli resistant to carbapenems was analyzed. Methods. The first study was a retrospective, multicenter cohort study conducted in five hospitals. Data were collected using a standardized form (demographic data: gender and age, underlying diseases and type of acquired infection). The other two studies were based on a prospective cohort study using a database compiled in nine Lebanese hospitals between 2016 and 2017 (patient characteristics, variables related to hospitalization and variables related to the characteristics of the infection). Data were collected and processed using Statistical Package for the Social Sciences SPSS version 24. Logistic regressions were used to define the profile of patients for each type of resistance (3rd generation cephalosporins-3GC, fluoroquinolones, aminoglycosides, carbapenem) observed in Gram-negative bacilli (Enterobacteria, Pseudomonas aeruginosa and Acinetobacter baumannii). A sensitivity analysis based on the extreme results of the missing values for bacterial sensitivity was used to take account of the missing data and provide robust results. Results. The first study showed the importance of Gram-negative bacilli resistant to antibiotics in both hospital and community-acquired infections, with two independent factors in the acquisition of a nosocomial infection: advanced age and immunosuppression. The other two studies showed high percentages of resistance in the targeted Gram-negative bacilli and established different patient profiles for each type of resistance. For example, in Escherichia coli, resistance to 3GC was associated with previous hospital admission and the presence of a urinary catheter. Similarly, resistance to carbapenems in Gram-negative bacilli was associated with surgical patients, the presence of a urinary catheter, and pulmonary or surgical site infection. In terms of overall mortality, the Cox proportional model showed that carbapenem resistance was associated with a significant difference in hospital survival in patients with nonfermenting gram-negative bacilli compared with susceptible bacteria. Conclusions. We report on resistance to antibiotics of last resort in enterobacteria (E. coli and Non-E. coli enterobacterales) and non-fermenting Gram-negative bacilli identified in Lebanese hospitals, where epidemiological data are scarce. Describing the profiles of patients carrying these resistant bacterial strains will enable clinicians to prescribe appropriate probabilistic antibiotic therapy
Monnet, Dominique. "Épidémiologie, identification et surveillance de la résistance aux antibiotiques des bactéries appartenant au genre Klebsiella". Lyon 1, 1995. http://www.theses.fr/1995LYO1T002.
Testo completoNawfal, Dagher Tania. "Etude épidémiologique de la résistance aux antibiotiques d'isolats cliniques au Liban". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0661/document.
Testo completoInfections due to multidrug-resistant gram-negative bacteria especially the resistance to carbapenems, have become a major public health problem. This increase in resistance to antibiotics has led to the resuscitation of colistin, as a last-resort treatment option. Our PhD work focused on the epidemiological study of the antibiotic resistance of clinical isolates in Lebanon. This thesis is divided into 5 chapters with three main objectives; (1) the investigation of carbapenem-resistant bacteria in Lebanese hospitals. (2) the Elucidation of the molecular mechanisms of colistin-resistant bacteria in Lebanese patients, and (3) the emergence of vancomycin-resistant gram-positive bacteria in Lebanon. At the start of this thesis, we have prepared a literature review on the epidemiology and the risk factors associated with bacterial infection in conflict wounded and natural disaster in Asia and the Middle East. The second chapter aimed to see the effect of the shift of treatment from colistin-carbapenem combination to colistin monotherapy on the prevalence and resistance of A. baumannii, in addition to the detection of the plasmid-encoded blaVIM-2 gene. In the third chapter, we have detected the spread of colistin-resistant gram-negative bacteria due to mutation of the two-component systems (pmrA /pmrB, phoP/phoQ), or mgrB. We detect the emergence of vanA of Enterococcus faecium resistant to vancomycin. This observation confirms that colistin resistance in Gram-negative bacteria is indeed increasing. In conclusion, it appears necessary and urgent to set up surveys to monitor the use of antibiotics to prevent the spread of resistant strains in Lebanon
Lepelletier, Didier. "Rôle de l'antibiothérapie et des facteurs liés à l'hôte et à l'hospitalisation sur le risque de colonisation et d'infection par des bactéries résistantes aux antibiotiques". Nantes, 2006. https://archive.bu.univ-nantes.fr/pollux/show/show?id=73871b95-bdbc-4921-80d5-d80b82d39f41.
Testo completoAntimicrobial resistance is a major heath problem, especially in hospital-acquired infections. Many epidemiological data showed an association between antibiotic use and infection caused by antibiotic-resistant bacteria. To assess the impact of antibiotic use and other factors, we performed two epidemiological studies on clinical Escherichia coli strains isolated from hospital patients. We showed a significant association between antibiotic use and immunosuppression and infection caused by resistant E. Coli. Previous use of β-lactamine was associated with amoxicillin- and third generation cephalosporin resistance, and previous use of fluoroquinolones and cotrimoxazole was associated with strains resistant to those antibiotics. In a second time, we performed a prospective study of the gut flora of 933 patients hospitalised in five different wards, including medicine and surgery wards and intensive-care units. No vancomycin-resistant Enterococci was isolated. 585 patients were colonised by an amoxicillin-resistant Enterobacteriaceae, with third generation cephalosporin- and ofloxacin resistance rates of 9. 4% and 4. 8%, respectively. One hundred and ninety five patients were colonized by Pseudomonas aeruginosa (23% on admission). Antibiotic use was implicated in all observed resistances. Previous hospital stay and hospitalisation in specific wards were also associated with antibiotic resistance. Studies of intestinal microflora are difficult to perform but are useful in epidemic situations and in target resistance surveillance programs
Amarsy-Guerle, Rishma. "Analyse de la résistance aux antibiotiques et des infections nosocomiales à l'échelle d'une grande institution à travers les bases de données des laboratoires". Electronic Thesis or Diss., Sorbonne université, 2024. http://www.theses.fr/2024SORUS018.
Testo completoConsidered as a silent pandemic, antimicrobial resistance (AMR) is a major public health issue, that, combined with hospital-acquired infections (HAIs) threaten the quality and safety of hospital care. Monitoring antibiotic resistance and nosocomial infections is one of the cornerstones of preventing these phenomena. Surveillance programs are key in bringing a comprehensive knowledge of the current situation, essential for an effective implementation of prevention strategies. Surveillance of these phenomena can also be used for comparisons between facilities if we take care to take into account other factors of importance such as antibiotic and alcohol-based hand rub consumptions, and individual patient data.This thesis was conducted at the Assistance Publique - Hôpitaux de Paris (AP-HP), Europe's largest university hospital centre, during the COVID-19 pandemic. The significant rise in intensive care activities and antibiotic consumption has prompted us to redirect our objectives to assess the COVID-19 impacts on HAIs and AMR in our hospitals. Our study focused on bloodstream infections, by using data on blood cultures, collected from AP-HP bacteriology laboratories.We have demonstrated that this period was accompanied not only by an increase in the incidence of bacteraemia, but also in AMR among Enterobacteriales.Of interest, we have observed a decrease in invasive infections induced by Streptococcus pneumoniae and Streptococcus pyogenes, bacterial types which transmission can be controlled by wearing a mask.A review of a carbapenemase-producing Enterobacteriaceae (CPE) outbreak in an intensive care unit heavily impacted by the pandemic completes these studies.Additionally, we explore the irregularity of HAI and AMR rates within the AP-HP. This inconsistency cannot solely be attributed to variations in antibiotic consumption. Through the development of new indicators for resistance and infections, we have identified structural and organisational factors that are linked to a higher frequency of these phenomena.Individual patient factors, such as the severity of illness (case-mix), are likely to be associated with an increased risk of resistance. We will investigate this further in our future research using the AP-HP Clinical Data Warehouse.The systematisation of this surveillance over time will make it possible to identify priority areas and steer prevention policies and targeted actions
Fabe, Claude. "Stenotrophomonas maltophilia dans un service d'hématologie : étude épidémiologique, sensibilité aux antibiotiques". Bordeaux 2, 1996. http://www.theses.fr/1996BOR2P023.
Testo completoRogues, Anne-Marie. "Déterminants de la consommation des antibiotiques et de la résistance de Staphylococcus Aureus à la méticiline dans les établissements de santé". Bordeaux 2, 2006. http://www.theses.fr/2006BOR21309.
Testo completoDue to the high resistance rate and excessive use of antibiotics, French government has recommended that hospitals should monitor antibiotics consumption and incidence of methicillin-resistant Staphylococcus aureus (MRSA). Our aim was to determine factors that correlate with antibiotics use and Staphylococcus aureus resistance among 99 hospitals in south western France and to study relationship between these two indicators and policies developed by hospitals. Hospital type and hospitals areas stratification seems to be not enough homogenous to make valid comparisons. Number of beds could be used to explain difference when indicator of case mix is not available. Antibiotics policies and infection control program were associated with high consumption and high resistance rates. Fluoroquinolone use correlated with MRSA incidence but the relationships between antibiotic use and MRSA are complex and aggregated data do not prove causality link. However, such aggregated data may be helpful for comparison purpose
Muller, Arno. "Approche éco-épidémiologique de la relation entre la consommation antibiotique et la résistance bactérienne dans un hôpital universitaire français". Besançon, 2005. http://www.theses.fr/2005BESAA005.
Testo completoDuring the past sixty years, consumption of antibiotics has had an ecological impact on bacteria and has resulted in the emergence and dissemination of antimicrobial resistance. Control and prevention of this growing problem requires the collection and analysis of both antimicrobial use and resistance data. This thesis presents a new eco-epidemiological approach to better understand this problem using statistical methods such as time series analysis and multilevel analysis. The studies that were performed confirm the existence of a temporal relationship between antibiotic exposure and emergence of bacterial resistance, as weIl as an ecological effect of antibiotic use in a defined population. A substantial part of the thesis was devoted to data management and computer programming for the exploration of antibiotic use and bacterial resistance data. After validation, these computer tools could be applied to surveillance and be used in routine
Zaffreya, Sophie. "Etude de la sensibilité de "Staphylococcus aureus" résistant à la méticilline à divers antiseptiques et produits apparentés, agents alkylants, métaux lourds". Paris 5, 1992. http://www.theses.fr/1992PA05P050.
Testo completoAl, Bayssari Charbel. "Etude des mécanismes moléculaires de la résistance aux antibiotiques dans le bassin méditerranéen". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5028.
Testo completoThe detection, monitoring and dissemination of bacterial resistance to antibiotics are a major issue worldwide since the discovery and spread of multi-resistant bacteria, in particular resistance to carbapenems, specifically among Enterobacteriaceae and bacteria of the genus Pseudomonas and Acinetobacter.The emergence and dissemination of carbapenem-resistant Gram-negative pathogens is a significant contributor to patient morbidity and mortality. Despite radical efforts in infection control and improvements in molecular diagnostics, carbapenem-resistant Gram-negative bacilli remain a formidable threat as few antimicrobial agents are reliably active and very little is expected to be available in the near future.The origin and source of resistance genes in the world are not well known and recent works suggest that domestic and wild animals, the environment (soil, water, rivers ..) but also the digestive tract of mammals and humans could represent a reservoir and an important source of resistance genes that may be transmissible to humans.It is in this context that this thesis project articulates with the following objectives: (i) The achievement of molecular epidemiological studies on carbapenem-resistant clinical and animal isolates collected from countries in the Mediterranean basin (Lebanon, Libya, France) and the characterization of the genetic determinants of this resistance; (ii) the description of new resistance mechanisms to imipenem; and finally (iii) The genome sequencing of clinical isolates resistant to carbapenems, the analysis of these genomes and the identification of mechanisms and genetic supports of the resistance to carbapenems and other antibiotics
Youenou, Benjamin. "Les sols anthropisés, incubateurs d'agents bactériens pathogènes de l'homme : typage génétique, métabolique et antibio-résistance d'agents opportunistes". Thesis, Lyon 1, 2014. http://www.theses.fr/2014LYO10150.
Testo completoOpportunistic bacterial pathogens (obp) of Man are found in hospital setting where they are responsible for nosocomial infections as well as in terrestrial and aquatic natural environments. Obp often show high intrinsic antibiotic resistance level. Moreover, the intensive use of antibiotics in clinical settings can lead to the emergence of "Multi Drug Resistant" strains. The anthropisation of the natural environment leads to modifications in bacterial diversity of these environments and can affect the prevalence and the antibiotic resistance properties of obp. My research focused on the impact of organic amendments on the prevalence, genetic diversity and antibiotic resistance properties of obp. A study on the species Stenotrophomonas maltophilia, Pseudomonas aeruginosa and the “Burkholderia cepacia complex" (Bcc) was conducted on sites in Burkina Faso amended or not with raw urban wastes. This study showed differences in antibiotic resistance properties between the 3 models. S. maltophila frequently showed MDR phenotypes unlike P. aeruginosa and Bcc. A comparative genomics study between S. maltophilia strains from environmental or clinical origin showing sensitive or MDR phenotypes was performed to elucidate the genetic origins of heterogeneity in the resistance phenotypes. A variation in the efflux pumps content was observed between strains. The expression of an efflux pump specific to an environmental MDR strain was then evaluated and confirmed its likely involvement in antibiotic resistance and adaptation to environmental parameters such as temperature
Deboscker, Stéphanie. "Les entérocoques résistants aux glycopeptides : épidémiologie et modélisation de leur transmission hospitalière". Thesis, Strasbourg, 2019. http://www.theses.fr/2019STRAJ106.
Testo completoThe objective of our work was to study the factors associated with acquisition of glycopeptide-resistant enterococci (GRE) during a single-strain outbreak, to describe their natural history and to model their transmission between 3 specialized wards. The Bayesian multivariable analysis of our first study showed that a history of hospitalization and the use of antibiotics and antacids during hospitalization were associated with an increased risk of GRE acquisition. The description of GRE-carriers followed since 2007 then showed that half of the patients had negative screenings after 3months. Finally, the literature review revealed that the most relevant model for simulating GRE hospital diffusion was an agent-based model. The simulations confirmed the importance of hand hygiene for patient care in comparison to other barrier measures. With 80% compliance, there were no secondary cases in 50% of the simulations
Assab, Rania. "Modéliser la diffusion des infections nosocomiales : l'importance des données de réseaux au sein des établissements de soins". Thesis, Paris, CNAM, 2018. http://www.theses.fr/2018CNAM1199/document.
Testo completoEach year nosocomial infections affect more than 4 million patients in Europe, with a significant impact in terms of mortality, morbidity and cost. Of these infections, those caused by multi-resistant bacteria (BMR) play a major role. Mathematical modeling of epidemics is an important tool to better understand the dynamics of dissemination of BMR and evaluate the effectiveness of prevention measures.The main objective of this project is to study the BMR propagation dynamics within a network of hospitals, taking into account different levels: intra-ward and inter-wards and inter-hospitals. This is to establish a research methodology based on mathematical and computer modeling and supported by data collected in the Paris Île de France Ouest (PIFO), to better understand the role played by each hospital in the emergence and selection of BMR, to quantify the risk of their dissemination (including in the general population), and to identify effective control measures. This work will be based on statistical inference methods, analytical sensitivity and uncertainty analysis
Juarez, Paulo. "Regulatory mechanisms of mexEF-oprN efflux operon in Pseudomonas aeruginosa : from mutations in clinical isolates to its induction as response to electrophilic stress". Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCE015/document.
Testo completoPseudomonas aeruginosa is a Gram negative opportunistic pathogen, responsible for several nosocomial infections in immunocompromised patients, and the main cause of mortality and morbidity of patients suffering from cystic fibrosis. Treatment of P. aeruginosa infections turns to be difficult due to its natural resistance to antibiotics, increased in part by the overproduction of RND efflux pumps capable to export antibiotics out of the cell. Amongst these systems, MexEF-OprN exports several antibiotics such as fluoroquinolones, chloramphenicol and trimethoprim. This efflux pump is quiescent in wild-type strains but it is highly produced in nfxC mutants, making them resistant to MexEF-OprN substrates. In addition, these mutants are characterized by their concomitant resistance to carbapenems and their low-virulence profile. MexEF-OprN is encoded by a three-gene operon, mexEF-oprN, whose transcription is activated by MexT, a member of the LysR family of transcriptional regulators. In the clinical context, nfxC mutants being poorly described, we evaluated their prevalence and characterized the genetic events responsible for mexEF-oprN overexpression. A collection of 221 clinical isolates from the University Hospital of Besançon exhibiting a reduced susceptibility to ciprofloxacin and imipenem was screened. We found that 19.5% of these strains overexpressed mexEF-oprN and further characterization of the 22 non-redundant mutants showed that only 13.6% of these mutants harbored a disrupted mexS gene. Moreover, 40.9% of nfxC clinical strains harbored missense mutations in mexS conducing to the substitution of a single amino-acid residue in the encoding protein. Interestingly, these mutations were associated to moderate effects on resistance and virulence factor production while disruptive mutations produced highly resistant but completely non-virulent strains. For the 45.5% of remaining strains, we failed to identify genetic mutations, which could explain mexEF-oprN overexpression; this indirectly suggested that there might be additional regulatory loci controlling the expression of this operon.We thus studied chloramphenicol resistant mutants selected in vitro derived from reference strain PA14 and found a new class of MexEF-OprN overproducers, which we called nfxC2, harboring gain-of-function mutations in a so-far uncharacterized gene, PA14_38040 (hereafter called cmrA) coding for an AraC transcriptional regulator. In nfxC2 mutants, the mutated CmrA increases its proper gene expression and upregulates the expression of mexEF-oprN through MexS and MexT, resulting in a multi-drug resistant phenotype without altering virulence factor production. Transcriptomic experiments showed that CmrA positively regulates the expression of 11 genes, including PA14_38020, which is required for the MexS/MexT-dependent activation of mexEF-oprN. Gene PA14_38020 is predicted to code a quinol monooxygenase sharing conserved domains with YgiN of Escherichia coli, which was reported to be involved in the response of the bacterium to electrophiles. Interestingly, exposure of strain PA14 to sub-inhibitory concentrations of toxic electrophiles (glyoxal, methylglyoxal or cinnamaldehyde) strongly activates the CmrA-pathway and upregulates mexEF-oprN sufficiently to provoke the resistance to the pump substrates. Finally, we found that the same exposure to electrophiles is capable to activate two other RND pumps, MexAB-OprM and MexXY/OprM. The regulatory pathways conducing to activation of these two efflux operons will be elucidated at the laboratory
Nekkab, Narimane. "Spread of hospital-acquired infections and emerging multidrug resistant enterobacteriaceae in healthcare networks : assessment of the role of interfacility patient transfers on infection risks and control measures". Thesis, Paris, CNAM, 2018. http://www.theses.fr/2018CNAM1180/document.
Testo completoLa propagation des infections nosocomiales (IN), notamment liées aux bactéries multi-résistantes, au sein du réseau des hôpitaux, est un grand enjeu de santé publique. L’évaluation du rôle joué par les transferts inter-établissements des patients sur cette propagation pourrait permettre l’élaboration de nouvelles mesures de contrôle. L’identification de nouvelles mesures de contrôle est particulièrement importante pour les bactéries résistantes aux antibiotiques comme les entérobactéries productrices de carbapenemase (EPC) pour lesquelles les possibilités de traitement sont très limitées. L’utilisation des données de réseaux de contact inter-individus et de transferts inter-établissement dans la modélisation mathématique ont rendu ces modèles plus proches de la réalité. Toutefois, ces derniers restent limités à quelques milieux hospitaliers et quelques pathogènes. La thèse a eu pour objectifs de 1) mieux comprendre la structure des réseaux hospitaliers français et leur impact sur la propagation des IN ; et 2) évaluer le rôle des transferts sur la propagation des EPC.Les réseaux hospitaliers français sont caractérisés par des flux de patients vers des hubs et par deux niveaux de communautés des hôpitaux. La structure du réseau de transfert des patients présentant une IN n’est pas différente de celle du réseau général de transfert des patients. Au cours des dernières années, le nombre d’épisode d’EPC a augmenté en France et les prédictions prévoient une poursuite de cette augmentation, avec des pics de saisonnalité en octobre. Ce travail a également montré que, depuis 2012, les transferts de patients jouent avec les années un rôle de plus en plus important sur la diffusion des EPC en France. Des évènements de propagation multiple liée aux transferts sont également de plus en plus souvent observés.En conséquence, la structure du réseau des hôpitaux pourrait servir de base pour la proposition des nouvelles stratégies de contrôles des IN en général, et des EPC en particulier. Les hôpitaux très connectés des grandes métropoles et les flux des patients entre les communautés locale et régionale doivent être considérés pour le développement de mesures de contrôle coordonnées entre établissements de santé