Introduction: On contact of antibiotics, S. aureus has gradually acquired multiple antibiotic resistances, including the methicillin (MRSA) and without lose its virulence. The aim of the present study was to report the evolution of resistance of S. aureus to different common antibiotics and to determine the antibiotics active against MRSA. Materials and methods: This is a retrospective and descriptive study for 10 years from January 2005 to December 2014 at the Laboratory of Microbiology of the HU-JRA Antananarivo, the biggest academic hospital located in the capital of Madagascar. All demands for standard bacteriological examination were registered in the laboratory for various bacteriological exams or from samples taken from hospitalized patients and we included all positive cultures for S. aureus. The variables selected and used for the study were community or nosocomial sources of patients and results of susceptibility testing. Results: A total of 906 results from 282 (31.12%) community-acquired and 624 (68.88%) nosocomial infections were studied an average of 100±25strains by year of study. Overall, the prevalence of MRSA was 13.83% (39 of 282 isolates)for community-acquired strains, and 15.70% (98 of 624) for nosocomial infections (p> 0.05)with a total of 29.53%. Resistance rate to trimethoprim-sulfamethoxazole was significantly higher in nosocomial infection than in community-acquired. No significant difference was observed in other antibiotics. Of the 137 MRSA, except vancomycin, fusidic acid is the antibiotic that worked the most in 114 cases (83.21%) followed by gentamicin in 96 cases (70.07%). Apart from ciprofloxacin and tetracycline that we have noticed an increase in resistance rates in 2012 and 2013, almost all antibiotics tested have a stable rate of resistance. Conclusion: The antibiotics tested showed extremely high rates of resistance and that the problem of antibiotic resistance in S. aureus is effective in our center.

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Justification: Tetanus, fatal disease, still exists in Madagascar in spite of the vaccination sessions of mass, and attacks also the children. Objective: To describe the epidemiology, the clinical aspect, the treatments and the evolutions of infantile tetanus. Patients and methods: Retrospective study in the pediatric intensive care unit of the University Hospital of Tamatave, on the cases listed during four years (2013-2016). Results: Twenty-seven cases were recensed, with an average age of 10.8 years old and a sex ratio (M/W) equal to 6. Only forty-one percent were already vaccinated before the one year age. No child of more than 11 years-old profited from vaccine recall. The stain of the wound after the ablation of flea was the most frequent cause (76%). Tetanus was generalized in 80%, including 44.4% with respiratory disorder having required intubation. All the children presented hyperthermia above 38°C at the entry and 63% higher or equal to 40°C. Sedation by diazepam, used at all children, was used with an average amount of 4 mg/kg/day. The beta-lactamine antibiotics were used in 100% of the cases. The antitetanus serum was administered at 3000 IU/day. Nosocomial infections occurred in 61%. The mean hospitalization duration was around 11 days. Mortality was 47%. Discussion and conclusion: The vaccine recalls are still negligent in the old children, making these latter vulnerable. Mortality is especially due to superinfections and denutrition.

Urinary tract infection (UTI) is very common in children. The future of kidney function depends on its management. Our objective was to investigate the epidemio-clinical, bacteriological and therapeutic profile of UTIsin the Pediatric Department of Tamatave University Hospital Center, Madagascar for better care of children. Methods: This is a retrospective and descriptive study that was carried out in the Pediatrics Department of Tamatave University Hospital over a three-year period from January 1, 2017 to December 31, 2019. The parameters retained and studied were age, gender, clinical signs, pathogens identified with the results of the antibiotic susceptibility tests and the treatments received. Results: The frequency of UTI was 7.46%. The average age was 11.21 months, with extremes of 2 to 120 months. Fever was the main symptom found (80.95%) followed by urinary signs. Escherichia coli was the most frequently isolated bacteria (61.90%). Almost all of the isolates found (98%) were resistant to amoxicillin, tetracycline and cotrimoxazole. Ceftriaxone alone was the most used (44.44%). Discussion: This study suggests that gentamicin and ceftriaxone (even though ESBLs were found) should be included in the treatment protocol for UTIs in the absence of an antibiogram, which is not always available in our context.

The success of stents to restore blood flow in atherosclerotic peripheral arteries is low relative to coronary arteries. It has been shown that joint flexion induces a mechanical environment that makes stent placement in these arteries highly incompatible, and damage and destruction of stents has been recorded. However, the effect of this environment on the stresses in the arteries is unknown. It is hypothesised that the stresses induced in arteries as a result of this mechanical environment could be sufficient to explain the relatively low success rates. To investigate this hypothesis, a finite element model of the stent-artery interaction was developed. Following stent expansion, bending was simulated by applying a displacement boundary condition to the artery. It is found that high stresses occur at the proximal/distal ends of the stent. As high stress and vascular injury are hypothesised to cause restenosis, the results presented here suggest that the mechanical environment of peripheral arteries could be the predominant cause of high restenosis rates.