Madagascar is the country that reports the most cases of plague in the world. This is an evaluation study of plague diagnosis over a 2-year period from January 2017 to December 2018. For all suspected plague cases, peripheral RDT (performed locally), central RDT (performed in the laboratory) and PCR were performed. Parameters of the diagnostic tests used, year of study, performance and study of concordance between tests were studied. 2981 cases were collected, 21.6% were confirmed, 28.4% probable and 50% suspected. The sensitivities of peripheral RDT, central RDT and PCR were 96.55, 100 and 97.41%, respectively; the specificities were 41.43, 51.17 and 89.24%. Cohen's kappa was 0.12 between peripheral RDT and culture; 0.17 between culture and central RDT and 0.64 between CRP and culture. For pneumonic plague (PP) patient samples, sensitivities were 80.00, 66.66 and 93.33%, Cohen's kappa was 0.017 between peripheral RDT and culture; 0.013 between central RDT and culture and 0.371 between PCR and culture; sensitivities of peripheral RDT and central RDT were 75.00 and 62.50% for 2017, respectively. The null hypothesis between diagnostic tests was rejected, discordance between tests was found. Sensitivity is lowered during lung sampling and during 2017.
Introduction: Infections of the urinary tract remain among the most common problems facing the clinician. This work aims to determine the antibiotic resistance of E. coli, E. gergoviae and K. pneumoniae during urinary tract infections in the Microbiology laboratory of the Joseph Ravoahangy Andrianavalona Antananarivo University Hospital Center to allow a better therapeutic approach. Material & Methods: We carried out a retrospective and descriptive study on all of the E. coli, E. gergoviae and K. pneumoniae strains isolated from the urine of patients who attended the laboratory of Microbiology on CHUJRA Antananarivo with a suspected UTI between January 2004 and december 2014. Susceptibility to antibiotics was assessed by the disc diffusion technique on Mueller-Hinton agar (MH) or MH + 5% sheep blood, as recommended by the Antibiogram Committee of the French Microbiology Society as the antibiotics tested. Results: E. coli, E. gergoviae and K. pneumoniae were isolated from 577 of the 5836 patients who submitted a urine sample (9.89%). Almost three quarters of isolates were E. coli (72.96%), E. gergoviae was found in 7.80% of cases and K. pneumoniae in 19.23% of cases.Ampicillin, amoxicillin + clavulanic acid, ticarcillin, first generation cephalosporins, second generation cephalosporins, cyclins, and cotrimoxazole represent a very high resistance level for E. coli, E. gergoviae and K. pneumoniae in the vast majority of cases. Since 2008, the presence of ESBL has been lower than in previous years (p=0.02). Antibiotics that remain effective in the majority of UTI cases are nitrofurans, colistin, imipenem, amikacin and Piperacillin / tazobactam. Conclusions: These results confirm the presence of multi-resistant strains as in hospitals and community settings and the associated resistance to the most accessible antibiotics inevitably limits the choice of antibiotic in the establishment of adequate treatment.
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