Etude comparative de la résistance aux antibiotiques des

138
Etude comparative de la résistance aux antibiotiques des principales
bactéries isolées au service de Réanimation de brûlés durant deux périodes
(2005-2008, 2008-2011) et dans deux structures hospitalières (Hôpital Aziza
Othmana, Centre de traumatologie et grands brûlés ben Arous)
L. Thabet, A. Zoghlami, J. Boukadida, A. Ghanem, A. A. Messadi
@A01 /;9<->-@5B1 01 8- >I?5?@-:/1 -AD -:@5.5;@5=A1? 01? <>5:/5<-81?
.-/@I>51? 5?;8I1? -A ?1>B5/1 01 &I-:59-@5;: 01 .>O8I? 0A>-:@ 01AD
<I>5;01?1@0-:?01AD?@>A/@A>1?4;?<5@-85J>1?
M<5@-8F5F-#@49-:-1:@>101@>-A9-@;8;3511@3>-:0?.>O8I?.1:
>;A?
()"'! *;8:P
Pré-requis: -?A>B1588-:/1/;:@5:A1018-28;>1.-/@I>51::11@018->I?5?@-:/1
-AD -:@5.5;@5=A1? 01? <>5:/5<-81? .-/@I>51? 59<85=AI1? 0-:? 81? 5:21/@5;:?
:;?;/;95-81?-501G-9I85;>1>81??@>-@I351?@4I>-<1A@5=A1?1@<>IB1:@5B1?
But : ;9<->1>81<>;258.-/@I>5;8;35=A11@8-?1:?5.585@I-AD-:@5.5;@5=A1?01?
<>5:/5<-81? .-/@I>51? 5?;8I1? /41F 81? .>O8I? 4;?<5@-85?I? -A ?1>B5/1 01
>I-:59-@5;: 0A>-:@ 01AD <I>5;01? 01  -:? 1@ 0-:? 01AD ?@>A/@A>1?
4;?<5@-85J>1?
Méthodes : A>-:@ 01AD <I>5;01? 01 @>;5? -:?  <I>5;01 $  
 1@ <I>5;01  $   1@ 0-:? 01AD ?@>A/@A>1?
4;?<5@-85J>1?  M<5@-8F5F- #@49-:- # 1@ /1:@>1 01 (>-A9-@;8;351 1@
3>-:0? .>O8I? (  1@  ?;A/41? :;: >I<I@5@5B1? ;:@ I@I 5?;8I1?
>1?<1/@5B191:@/41F81?.>O8I?G<->@5>010522I>1:@?<>I8JB191:@? 1@>-:?21>@
0A?1>B5/101>I-:59-@5;:-I@I2-5@81018R4M<5@-8F5F-#@49-:--A
( RI@A01 01 8- ?1:?5.585@I -AD -:@5.5;@5=A1? - I@I >I-85?I1 ?18;: 81?
>1/;99-:0-@5;:?0A'!
Résultats : A>-:@8-<I>5;01$$?1A0;9;:-?-1>A35:;?--I@I8-<>5:/5<-81
.-/@I>515?;8I1?A5B501'@-<4E8;/;//A?-A>1A?1@/5:1@;.-/@1>
.-A9-::55<>J?81@>-:?21>@0A?1>B5/101>I-:59-@5;: 01? .>O8I? -A
/1:@>101@>-A9-@;8;3518RI/;8;351.-/@I>51::1-B->5I-B1/'-A>1A?1:
<>1951> 851A ?A5B5 01 $ -1>A35:;?-  1@ 01 $>;@1A? 95>-.585? 
RI@A01018RIB;8A@5;:018-?1:?5.585@I-AD-:@5.5;@5=A1?-9;:@>IA:1@1:0-:/1
38;.-81 G 8- .-5??1 01 8- >I?5?@-:/1 0A>-:@ 81 01AD5J91 ?191?@>1 01 8R-::I1
599I05-@191:@-<>J?81@>-:?21>@ 0A ?1>B5/1 0-:?8-:;AB1881?@>A/@A>1
4;?<5@-85J>1 : 1221@ 81 @-AD 01 81.?58188- <:1A9;:5-1 >I?5?@-:@ G 8-
/12@-F505911?@<-??I1 01 G  /18A501 $-1>A35:;?- >I?5?@-:@ G 8-
/12@-F505911@G8R595<I:J911?@<-??I>1?<1/@5B191:@01G1@01
 G  "I-:9;5:? /1@@1 .-5??1 01 >I?5?@-:/1 - I@I ?A5B51 <-> A:1
-A391:@-@5;:>-<501-A/;A>?018R-::I1<;A>>16;5:0>138;.-8191:@81?
@-AD 01 >I?5?@-:/1? ;.?1>BI1? -A<->-B-:@ G 8R4M<5@-8 F5F- #@49-:-
;:/1>:-:@'-A>1A?81@-AD01'&!'-A>1A?>I?5?@-:@G8-9I@45/5885:1
:R-<-?9;:@>I01B->5-@5;:?53:525/-@5B10A>-:@@;A@18-<I>5;010RI@A01
G # B1>?A?  -A (  .-A9-::55 <;?1 81 <>;.8J91 01
9A@5>I?5?@-:/101??;A/41??;:@>I?5?@-:@1?G8-/12@-F505911@
G8R595<I:J910A>-:@$-B1/A:1-//1:@A-@5;:018->I?5?@-:/1G8R595<I:J91
0A>-:@$=A51?@<-??I1G
Conclusion : ->I?5?@-:/1-AD-:@5.5;@5=A1?<;?1A:<>;.8J91-A?1>B5/101
>I-:59-@5;:01.>O8I?1?91?A>1?<>IB1:@5B1?0;5B1:@K@>1?1:@>1<>5?1?
&I?5?@-:/1-AD-:@5.5;@5=A1?I/;8;351.-/@I>51::1.>O8I?<>IB1:@5;:
L. Thabet, A. Zoghlami, J. Boukadida, A. Ghanem, A. A. Messadi
;9<->-@5B1?@A0E;2-:@5.5;@5/>1?5?@-:/15:.-/@1>5-5?;8-@102>;9
@41.A>:10<-@51:@?0A>5:3@C;<1>5;0?-:0
5:@C;4;?<5@-8?;?<5@-8F5F-#@49-:-@>-A9--:0.A>:/1:@1>
()"'! *;8:P
Background: ;:@5:A;A? 9;:5@;>5:3 ;2 @41 .-/@1>5-8 28;>- -:0 -:@5.5;@5/
>1?5?@-:/1 ;2 @41 9-5: .-/@1>5- 5:B;8B10 5: :;?;/;95-8 5:21/@5;:? 418<?
59<>;B1@>1-@91:@-:0<>1B1:@5;:?@>-@1351?
Aim: (;/;9<->1@41.-/@1>5;8;35/-8<>;2581-:0-:@5.5;@5/?A?/1<@5.585@E;2@41
9-5:.-/@1>5-85?;8-@1?C5@45:@41.A>:10<-@51:@?;B1>@C;<1>5;0?;2E1->?
-:05:@C;4;?<5@-8?
Methods: A>5:3@C;@4>11E1-><1>5;0? <1>5;0  $
-:0<1>5;0$ -:0 5:@C;4;?<5@-8?;?<5@-8F5F-
#@49-:- # -:0 @41 @>-A9-@;8;3E -:0 .A>: /1:@1> (  -:0
 :;:>1<1@5@5B1 ?@>-5:? C1>1 5?;8-@10 2>;9 .A>: <-@51:@? 2>;9 05221>1:@
?-9<81?(41@>-:?21>;2@415:@1:?5B1/->1A:5@C-?9-01;:2>;9
@41;?<5@-8F5F-#@49-:-@;((41?@A0E;2-:@5.5;@5/?1:?5@5B5@EC-?
<1>2;>910-//;>05:3@;'!
Results: A>5:3@41<1>5;0$$?1A0;9;:-?-1>A35:;?-C-?@419-5:.-/@1>5-
5?;8-@10 2;88;C10 .E '@-<4E8;/;//A? -A>1A?  -:0/5:1@;.-/@1>
.-A9-::55  2@1> @41 @>-:?21> ;2 5:@1:?5B1 /->1 .A>: A:5@ @; @41
@>-A9-@;8;3E/1:@1>1/;8;3E.-/@1>5-8B->510C5@4'-A>1A?5:@4125>?@
<8-/12;88;C10.E$-1>A35:;?--:0$>;@1A?95>-.585?(41?@A0E
;2@411B;8A@5;:;2-:@5.5;@5/?A?/1<@5.585@E?4;C10-:;B1>-880;C:C->0@>1:0
;2 >1?5?@-:/1 5: @41 ?1/;:0 4-82 ;2  599105-@18E -2@1> @41 @>-:?21> ;2
?1>B5/1 5: @41 :1C 4;?<5@-8 ?@>A/@A>1 (41 >-@1 ;2 /12@-F5059 >1?5?@-:@
81.?58188-<:1A9;:5-101/>1-?102>;9@;'5958->E@41>1?5?@-:/1
;2$-1>A35:;?-@;/12@-F50591-:0595<1:1901/>1-?10>1?<1/@5B18E2>;9
@;-:02>;9@;"1B1>@4181??@41>10A/@5;:;2>1?5?@-:/1
C-?2;88;C10.E->-<505:/>1-?5:30A>5:3@41E1->@;>1-/4;B1>-88>-@1?
;2>1?5?@-:/1<>1B5;A?8E;.?1>B105:@414;?<5@-8F5F-#@49-:-;:/1>:5:3
' -A>1A? @41 >-@1 ;2 !&' 91@45/5885:>1?5?@-:@ ' -A>1A? ?4;C10 :;
?53:525/-:@B->5-@5;:@4>;A34;A@@41?@A0E<1>5;0B1>?A?-@#
-:0(.-A9-::55.>5:3?A<@41<>;.819;29A@5>I?5?@-:/1;2
?@>-5:?C1>1>1?5?@-:@@;/12@-F50591-:0@;595<1:190A>5:3$C5@4-:
19<4-?5?;:>1?5?@-:/1@;595<1:190A>5:3$5:/>1-?10@;
Conclusion: &1?5?@-:/15?-<>;.8195:@415:@1:?5B1/->1.A>:A:5@$>1B1:@5B1
91-?A>1?4-B1@;.1@-71:
:@5.5;@5/>1?5?@-:/1.-/@1>5-81/;8;3E.A>:<>1B1:@5;:
-95-(4-.1@E;A.,;348-95-818;A7-050-.018>-;A124-:1991:88-4!1??-05
-Laboratoire de Biologie Médicale -Service de chirurgie générale - Service de réanimation des brûlés ; Centre de Traumatologie et
Grands Brûlés, Ben Arous, Tunisie -Laboratoire de Microbiologie, Hôpital Farhat Hached, Sousse, Tunisie
Faculté de Médecine de Tunis, Université Tunis EL Manar
ARTICLE ORIGINAL

L. Thabet - Résistance aux antibiotiques
139
R5:21/@5;::;?;/;95-81>1?@1A:1/-A?19-61A>1019;>@-85@I
1@9;>.505@I/41F81.>O8I R-A391:@-@5;:018->I?5?@-:/1
-AD-:@5.5;@5=A1?01? 31>91?59<85=AI? 0-:?/1?5:21/@5;:?
-33>-B181<>;:;?@5/01/1?<-@51:@?1@/;:?@5@A1A:I:;>91
<>;.8J91 @4I>-<1A@5=A1  - /;::-5??-:/1 01 8RI/;8;351
.-/@I>51::1 1@ 01 8- >I?5?@-:/1 -AD -:@5.5;@5=A1? 01?
<>5:/5<-81? .-/@I>51? 5?;8I1? /41F /1? <-@51:@? ;<@595?1 81
/4;5D 01 8R-:@5.5;@4I>-<51 1@ -9I85;>1 81? ?@>-@I351?
<>IB1:@5B1? -:? /1 /-0>1 A:1 ?A>B1588-:/1 <I>5;05=A1 01
8RI/;8;351.-/@I>51::1-I@I5:?@-A>I1/41F81?.>O8I?01<A5?
<>J?81@>-:?21>@1:0A?1>B5/101?.>O8I?0-:?
A: :;AB1-A /1:@>1 4;?<5@-851> /1@@1 ?A>B1588-:/1 - I@I
<;A>?A5B51
";@>1 @>-B-58 ?1 <>;<;?1 01 /;9<->1> 81 <>;258
.-/@I>5;8;35=A1 1@ 8- ?1:?5.585@I -AD -:@5.5;@5=A1? 01?
<>5:/5<-81? .-/@I>51? 5?;8I1? /41F 81? .>O8I? 0-:? 81? 01AD
?@>A/@A>1? 4;?<5@-85J>1?Q  M<5@-8F5F- ;@49-:- # 1@
/1:@>101(>-A9-@;8;3511@3>-:0?.>O8I?1:>;A?(1@
/10A>-:@01AD<I>5;01?01@>;5?-:?
M AT E R I E L E T M E T H O D E S
A>-:@01AD<I>5;01?01@>;5?-:?Q<I>5;01$Q
Q 1@ <I>5;01 $Q   1@ 0-:?
01AD?@>A/@A>1?4;?<5@-85J>1?Q#1@(1@
?;A/41?:;:>I<I@5@5B1?;:@I@I5?;8I1?>1?<1/@5B191:@/41F
81?.>O8I?G<->@5>010522I>1:@?<>I8JB191:@?
1@>-:?21>@0A?1>B5/101>I-:59-@5;:-I@I2-5@8101
8R4M<5@-8 F5F- #@49-:- -A ( R501:@525/-@5;:
.-/@I>51::1-I@I>I-85?I1<->81?9I@4;01?/;:B1:@5;::1881?
1@ 8RI@A01 01 8- ?1:?5.585@I -AD -:@5.5;@5=A1? >I-85?I1 <-> 8-
9I@4;01010522A?5;:1:95851A3I8;?I?18;:81?:;>91?018-
';/5I@I >-:H-5?1 01 !5/>;.5;8;351  R-:-8E?1 01?
0;::I1?-I@I>I-85?I1<->818;35/518C4;:1@
R E S U LTAT S
1?.-/@I>5I951?I@-51:@0A1?<>5:/5<-8191:@GA.baumannii
G8R4M<5@-8F5F-#@49-:--/@A188191:@S.aureus 1?@
81 <>1951> -31:@ 59<85=AI  -A ( (-.81-A  P.
aeruginosa B51:@ 1: @K@1 01? ?A<<A>-@5;:? /A@-:I1? 01?
.>O8A>1?  0-:? 8R-:/51::1 ?@>A/@A>1 4;?<5@-85J>1
?A<<8-:@I 8->3191:@ <-> S. aureus -A ( ;N  01?
?A<<A>-@5;:??;:@0A1G/1@@1.-/@I>51(-.81-A RI/;8;351
.-/@I>51::1 01? 5:21/@5;:? A>5:-5>1? I@-5@ 0;95:I1 <-> 81?
1:@I>;.-/@I>51? 1@ /1 0-:? 81? 01AD ?@>A/@A>1? 4;?<5@-85J>1?
(-.81-A;:/1>:-:@81?/-@4I@1>?A.baumannii I@-5@81
<>5:/5<-8 -31:@ 5:/>595:I 0A>-:@ $   -8;>? =A1
P.aeruginosa B51:@ 1: <>1951>  0A>-:@ 8- 01AD5J91
<I>5;01(-.81-A
1?<>I8JB191:@? >1?<5>-@;5>1??;:@/-A?I? 1??1:@5188191:@
<-> P.aeruginosa  G 8R# 1@ A. baumannii  -A
((-.81-A RI@A01018RIB;8A@5;:018-?1:?5.585@I-AD
-:@5.5;@5=A1?-9;:@>IA:1@1:0-:/138;.-81G8-.-5??1018-
>I?5?@-:/1 0A>-:@ 81 01AD5J91 ?191?@>1 01 8R-::I1 
599I05-@191:@ -<>J? 8R;AB1>@A>1 0A :;AB1-A ?1>B5/1 :
1221@ 81 @-AD 01 Klebsiella pneumoniae >I?5?@-:@ G 8-
/12@-F505911?@<-??I101G/18A501P. aeruginosa
Germe
P1
81 (8%)
19 (2%)
5 (1%)
139 (13.5%)
78 (7.5%)
173 (17%)
39 (2%)
Tm °C Position Taille de l’amplification
<.
<.
Tableau 1 : &I<->@5@5;:01?31>91?5?;8I??18;:81<>I8JB191:@0A>-:@81?01AD<I>5;01?0RI@A01$#1@$(

LA TUNISIE MEDICALE - 2013 ; Vol 91 (n°02)
140
>I?5?@-:@ G 8- /12@-F50591 1@ G 8R595<I:J91 1?@ <-??I
>1?<1/@5B191:@01G1@01G253
"I-:9;5:? /1@@1 .-5??1 01 >I?5?@-:/1 - I@I ?A5B51 <-> A:1
-A391:@-@5;:>-<501-A/;A>?018R-::I1<;A>>16;5:0>1
38;.-8191:@81?@-AD01>I?5?@-:/1?;.?1>BI1?-A<->-B-:@G
8R4M<5@-8F5F-#@49-:-53A>1
K.P CAZ R : Klebsiella pneumoniae résistante céftazidime
P.A CAZ R : Pseudomonas aeruginosa résistant céftazidime
P.A IMP R : Pseudomonas aeruginosa résistant Imipénème
A.B IMP R : Acinetobacter baumannii résitant Imipénème
SARM : Staphylococcus aureus résistant méthicilline
;:/1>:-:@S. aureus81@-AD01'&!S. aureus >I?5?@-:@G
8- 9I@45/5885:1 :R- <-? 9;:@>I 01 B->5-@5;: ?53:525/-@5B1
0A>-:@@;A@18-<I>5;010RI@A01QG#B1>?A?
-A(53A>1
A. baumannii <;?181<>;.8J91019A@5>I?5?@-:/1QQ
01? ?;A/41? ?;:@ >I?5?@-:@1? G 8- /12@-F50591 1@  G
8R595<I:J910A>-:@$-B1/A:1-//1:@A-@5;:018->I?5?@-:/1
G8R595<I:J910A>-:@$=A51?@<-??I1G53
D I S C U S S I O N
S. aureus 1?@ 8- <>5:/5<-81 .-/@I>51 5?;8I1 0-:? 81?
.-/@I>5I951? 0-:? 81 :;AB1-A /1:@>1 4;?<5@-851> 8 1?@
I3-8191:@81<>1951>-31:@ 59<85=AI0-:? 81??A>5:21/@5;:?
/A@-:I1? 01? .>O8A>1? 0A 2-5@ 01 ?;: /;991:?-85?91 1@ ?1?
:;9.>1AD2-/@1A>?01B5>A81:/1$8A?51A>?-A@1A>?>-<<;>@1:@
8R5?;8191:@ 2>I=A1:@ 01 S. aureus /41F 81? .>O8I?   
1<1:0-:@0-:?8R-:/51::1?@>A/@A>14;?<5@-85J>1#81?
.-/@I>5I951?I@-51:@<>5:/5<-8191:@0A1?GA. baumannii 1@
81??A>5:21/@5;:?/A@-:I1?GP. aeruginosa
1? I@A01? /;:/1>:-:@ 8R5:28A1:/1 01 8R->/45@1/@A>1 ?A> 81?
5:21/@5;:?:;?;/;95-81??;:@/;:@>;B1>?I1?4-:
>-<<;>@1A:10595:A@5;:0A@-AD01?5:21/@5;:?:;?;/;95-81?
018-9;>@-85@I-5:?5=ARA:1
I>-05/-@5;: 0A <E;/E-:5=A1 1@ 01 Prov idencia -<>J?
-9I:-3191:@ 0RA:1 :;AB1881 A:5@I /41F 01? .>O8I? -:?
:;@>1/-?;:-;.?1>BIA:1B->5-@5;:0A013>I0R59<85/-@5;:
01/1>@-5:1?.-/@I>51?0-:?81?.-/@I>5I951?81??A>5:21/@5;:?
01 .>O8A>1? 1@ 81? <>I8JB191:@? >1?<5>-@;5>1? ?-:?
I>-05/-@5;:0131>91?<->@5/A851>?";A?:R-B;:?<-?I@A05I
8R59<-/@ 01 8- :;AB1881 ->/45@1/@A>1 1: 9-@5J>1 0R5:21/@5;:
:;?;/;95-81Q RI@A01 01 8- ?1:?5.585@I -AD -:@5.5;@5=A1? -
9;:@>I 38;.-8191:@ 01? @-AD 01 >I?5?@-:/1? I81BI1? -AD
-:@5.5;@5=A1?4-.5@A188191:@<>1?/>5@?
Figure 1 : B;8A@5;:01?<>5:/5<-81?>I?5?@-:/1?-AD-:@5.5;@5=A1?
0A>-:@81?01AD<I>5;01?0RI@A01
Figure 2 : @A01/;9<->-@5B1018->I?5?@-:/1-AD-:@5.5;@5=A1?0-:?81?01AD?@>A/@A>1?4;?<5@-85J>1?
A – S.aureus B- K.pneumoniae C- P.aeruginosa D-A .baumannii

L. Thabet - Résistance aux antibiotiques
141
;:/1>:-:@S. aureus:;A?:R-B;:?<-?;.?1>BIA:1.-5??1
?53:525/-@5B1 01 8- >I?5?@-:/1 G 8- 9I@45/5885:1 -<>J?
8R;AB1>@A>1 0A :;AB1-A /1:@>1 4;?<5@-851> Q  1: $
B1>?A?1:$ 1@-AD01'&!S. aureus >I?5?@-:@G
8-9I@45/5885:1B->5101G?18;:81?I@A01?/41F81?
.>O8I?
1? '&! ?;:@ ?;AB1:@ 9A8@5>I?5?@-:@? -AD -:@5.5;@5=A1?
-95:;?501?  28A;>;=A5:;8;:1?  1? 38E/;<1<@501?
/;:?@5@A1:@ 01 /1 2-5@ 81? -:@5.5;@5=A1? 01 /4;5D <;A> 81
@>-5@191:@ 01? 5:21/@5;:? :;?;/;95-81? G '&! 
A/A:1?;A/4101?1:?5.585@I0595:AI1-AD38E/;<1<@501?:R-
I@I>1@>;ABI1<->95:;?5?;8-@?
!-83>I8-915881A>105?<;:5.585@I01?<;5:@?0R1-A<->>-<<;>@
G8R-:/51::1?@>A/@A>14;?<5@-85J>181'&!/;:@5:A1G<;?1>
A: <>;.8J91 /41F 81? .>O8I? - /4->31 01 @>-B-58 <8A?
59<;>@-:@1-B1/A:<1>?;::189I05/-81@<->-9I05/-8>I0A5@
2-5@ =A1 81 8-B-31 01? 9-5:? :R1?@ <-? ?;AB1:@ >1?<1/@I  81
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28;>10A?1>B5/1

LA TUNISIE MEDICALE - 2013 ; Vol 91 (n°02)
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