PREVALENCE ET RESISTANCE AUX ANTIBIOTIQUES DES GERMES RESPONSABLES DE PYELONEPHRITE AIGUE DE L’ADULTE AU CHU TLEMCEN

Abstract

Acute pyelonephritis (ANP) is the most serious manifestation of urinary tract infections ; it has the potential to cause sepsis, septic shock, and death. Although several international guidelines for its management are available, the clinical features, etiology, and antimicrobial susceptibility profiles may differ from country to country. In order to establish the microbial epidemiology of APN in adults at the CHU Tlemcen and the sensitivity profile of isolated germs, we conducted a prospective descriptive monocentric study over a period of 26 months from september 01, 2019 to october 31, 2021 where 105 urine samples and 14 blood cultures from 105 patients with acute pyelonephritis were analyzed. Our study shows a clear predominance of the female sex in 70% of cases with sex ratio of 0.43. It is a monomicrobial infection in the majority of cases. Thus Enterobacteriaceae remain the most dominant family with predominance of Escherichia coli. Simultaneous resistance of isolated enterobacteriaceae to the two APN treatment leaders (cefotaxime and ciprofloxacin) was around 29.68%. The ESBL production rate was 20%. The CPE were around 3%. The ciprofloxacin resistance rate of all bacteria isolated was 51.61%. ATCD of taking antibiotics and hospitalization were risk factors for resistance to ciprofloxacin (p=0.000 and p=0.042 respectively).Taking antibiotics during the 60 days preceding the episode of PNA and the presence of a urinary catheter had a statistically significant correlation with the acquisition of ESBL for cases of APN from our series (P 0.013, 0.044 respectively). The search for resistance genes in our study found the CTX M1 gene for all ESBL strains, the TEM gene for high level penicillinase producing strains and the NDM-1 gene for CPE strains. The emergence of carbapenemase-producing bacteria, in particular New Delhi metallo-β-lactamase (NDM-1) in the world, is a major public health problem which severely limits the therapeutic arsenal and increases the risk of impasse therapeutic.