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K-958 Epidemiology and Outcome of Bloodstream Infections in Febrile Neutropenic Hematologic Cancer Patients 1 2 3 V. KORTEN , H. AKAN , E. SENOL , R. OZTURK 4 5 1 1 , A. OZVEREN , P. GOLABI , O. ERGONUL , O. 2 2 4 3 AKAN , A. CIFTCIOGLU , B. METE , C. EROL , 5 1 M. AKOVA ; Marmara Univ., Istanbul, Turkey, 2 3 Ankara Univ., Ankara, Turkey, Gazi Univ., 4 Ankara, Turkey, Istanbul Univ., Istanbul, Turkey, 5 Hacettepe Univ., Ankara, Turkey. Background: To evaluate the epidemiology and outcome of bloodstream infections (BSI) in febrile neutropenic patients with hematological malignancies. Methods: We retrospectively reviewed medical records of hematologic cancer patients with neutropenic fever and BSI using a standard form in 5 University Hospitals, between 2005-2008 in Turkey. Results: A total of 288 organisms were isolated from initial blood cultures in 261 patients. In addition, there were 62 breakthrough isolates. The overall 30 day mortality rate was 16%. The most frequent initial isolates were S.epidermidis (29%), E.coli (23%), K.pneumoniae (11%), enterococci (7%), P.aeruginosa (4%), S.aureus (4%) and Candida spp. (3%). Methicillin resistance were detected in 27% of S.aureus and 58% of coagulase negative Staphylococcus among initial isolates. 22 of 95 (23%) initial and 5 of 11 (45%) breakthrough E.coli and K.pneumoniae isolates were ESBL producers. Fluoroquinolone resistance was detected in 27% of initial Gram negative isolates. One of 11 P.aeruginosa isolates was resistant to ceftazidime. Only 45% of the patients with ESBL producing E.coli and K.pneumoniae were initially received an invitro active carbapenem or piperacillin/tazobactam. No significant difference was found between the 30 day mortality rates of the patients with or without ESBL producing E.coli and K.pneumoniae ,(%24 vs %12, (p=0.193), respectively. The time to defervescence was significantly longer among patients with E.coli and K.pneumoniae bacteremia receiving inadequate initial antimicrobial therapy (14 vs 7 days, p= 0.04). Conclusion: Bacteremia caused by ESBL producing E. coli and K.pneumoniae is now a significant problem in febrile neutropenic patients leading to the inadequacy of initial antimicrobial therapy. K-959 Changing Epidemiology with Emerging Resistance of Bloodstream Infections Due to Gram-Negative Bacteria in Patients with Hematologic Malignancies O. KARA, P. ZARAKOLU, S. ASCIOGLU, Y. BUYUKASIK, M. AKOVA; Hacettepe Univ. Sch. of Med., Ankara, Turkey. Background: Recent reports indicate Gram-negatives are striking back in blood stream infections (BSIs) in patients with hematologic malignancies (HMs). Emerging resistance may significantly affect the choice of initial empirical therapy. Methods: 3703 neutropenic episodes in 2098 patients with HMs followed between January 2005-November 2009 at Hacettepe University Adult Hospital were included in the study. The patients categorized as highrisk (n=843) and low-risk (n=1255) groups were evaluated for frequency of BSIs and the causative bacteria with their resistance patterns. Results:. Table 1. The frequency of BSIs in high and low-risk group patients with HMs Bacteria BSI/ Neutropenic episode (%) In high-risk group * ** In low-risk group 272/1534 (17.7) 202/2169 (9.3) Gram-negatives (n=282) 165/1534 (10.7) 117/2169 (5.4) Gram-positives (n=192) 107/1534 (7.0) 85/2169 (3.9) * Acute leukemias, myelodysplastic syndrome, patients with allogeneic stem cell transplantation. ** Aplastic anemia, lymphomas, chronic leukemias, multiple myeloma. Table 2. Gram-negative bacteria isolated from BSIs and their resistance patterns by year Bacteria from BSIs (%) Resistance p Frequency of resistance by year (%) atterns 2005 2006 2007 2008 ESBL* 37 36 41 64 Quinolone 65 56 56 61 ESBL 7 18 33 22 Quinolone 7 27 20 12 Acinetobacter spp. (8.1%) MDR** 96 83 86 75 P. aeruginosa (7.5%) Ceftazidime 45 80 6 26 E. coli (19.6%) Klebsiella spp.(12.4%) *Extended spectrum beta-lactamases, **MDR: Multiple-drug resistance. Conclusions: The dominating cause of BSIs in patients with HMs in our hospital are ESBL-producing and/or quinolone-resistant E. coli and Klebsiella spp. in addition to MDR Acinetobacter spp.. which has made empirical antimicrobial choice a highly-challenging issue in this patient population. K-253 The Trends of Nosocomial Infections for Six-Years: Prospective Study 1 2 2 T. HAZNEDAROGLU , O. ONCUL , A. ACAR , M. 1 3 1 OZYURT , V. TURHAN , O. BAYLAN , S. 2 2 1 CAVUSLU , L. GORENEK ; GATA Haydarpasa Training Hosp. Dept. of Microbiol., Istanbul, 2 Turkey, GATA Haydarpasa Training Hosp. Dept. 3 of Infectious Diseases, Istanbul, Turkey, GATA Haydarpasa Training Hosp., Istanbul, Turkey. Background: To measure the trends of nosocomal infection (NI) including invasive device utilization and invasive device-associated infection (IDAI) rates and antibiotic resistance profiles of pathogens for six years. Methods: We conducted active targeted prospective surveillance at six different medical/surgical intensive care units (ICU) by using CDC and NNIS criteria. Results: Totally, 6324 patients hospitalized at ICU for an aggregate duration of 73,836 days, 864 patients acquired 1034 NI for an overall NI rate of 16.3 per 1000 patients-days for six years. Catheter-related urinary tract infection (52% of IDAIs; 7.3 cases per 1000 catheter-days) was the most common IDAI. Catheter-related bloodstream infection (35% of IDAIs; 6.0 cases per 1000 catheter-days), followed by ventilator-associated pneumonia (13% of IDAIs; 4.4 cases per 1000 ventilator-days) were seen. The most frequently isolated microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Escherichia coli, respectively. Overall, 44.8% of all S.aureus were methicillin-resistant. The rates of multidrug-resistant Acinetobacter spp. and P.aeuruginosa increased from 21.5% and 11.2% in 2004 to 68.3% and 48.6% in 2009, respectively (P<0.01). Extended Spectrum Beta-Lactamase activity in E.coli and Klebsiella spp. were 3.6% and 3.9 in 2004, whereas 26% and 34.7% in 2009, respectively (P<0.01). The crude unadjusted attributable mortality increased from 24.8% in 2004 to 27.5% in 2009. Conclusions: Although low invasive device utilization rates, IDAIs rates in our ICU were higher than NNIS published aggregated medical/surgical ICU IDAI rates with the high antibacterial resistance. These data show that strictly infection control policies should be implemented and comprehensively education should be required. K-314 Epidemiological Properties of Stenotrophomonas maltophilia Infections in a Training Hospital for Three-Years 1 2 3 A. ACAR , O. ONCUL , M. OZYURT , V. TURHAN 1 1 3 , S. BUDAK , T. HAZNEDAROGLU , L. 1 1 GORENEK ; GATA Haydarpasa Training Hosp. Dept. of Infectious Diseases, Istanbul, Turkey, 2 GATA Haydarpasa Training Hosp., Istanbul, 3 Turkey, GATA Haydarpasa Training Hosp. Dept. of Microbiol., Istanbul, Turkey. Background: To measure epidemiological properties of Stenotrophomonas maltophilia related infections in a training hospital with 1000-bed capacity by using CDC and NNIS criteria. Methods: The data including S. maltophilia’s infection frequency, risk factors, clinical features, treatment rates and antibiotic susceptibility were collected retrospectively from the surveillance data recorded between 2007 and 2009. Results: Among 59 902 hospitalized patients [3885 in Intensive Care Unit (ICU), 56 017 in services] 30 patients [17 in ICU (60 cases/100,000 days), 13 in service (3 cases/100,000 days) developed 31 S. maltophilia related infection episodes. The most frequent infections were soft tissue infections (37%), blood stream infections (33%) and pneumoniae (27%). Of all the patients, 50% and 25% had history of previous hospitalization and antibiotic usage in last three months. Dementia, congestive heart failure, and malignity were the most concomitant chronic diseases with the rates of 33.3%, 40% and 23.3%, respectively. All of the cases were hospitalized more than 14 days. 79% of them were treated with broad spectrum antibiotics and 60% of them had invasive devices. In 75% of the cases, one or more infection attacks were diagnosed prior to S. maltophilia infection. Antibiotic susceptibility rates for Trimethoprimsulfamethoxazole, Levofloxacin and Doxycycline were 87%, 90% and 93%, respectively. The crude mortality rate for S.maltophilia infections, either directly or indirectly was 33.3% (10/30) and 70 % (7/10), respectively. Conclusions: Although S.maltophlilia related infection rate was rare, the mortality rate was high in patients with high risk. Case control studies are needed to be done to identify the risk factors and new strategies should be developed for prevention. E-808 In Vitro Activity of NXL104 in Combination with Beta-Lactams against Gram-Negative Bacteria, Including OXA-48 Beta-Lactamase Producing Klebsiella pneumoniae 1 1 2 1 Z. AKTAS , C. KAYACAN , O. ONCUL ; Istanbul Univ. Med. Faculty Dept. of Clinical Microbiol., 2 Istanbul, Turkey, GATA Haydarpasa Training Hosp. Dept. of Infectious Disease, Istanbul, Turkey. Background.The objective of this study was to investigate the in vitro antibacterial activity of combinations of cefepime, ceftazidime and imipenem with NXL104 against Gram-negative bacteria. Methods:Bacterial isolates; PER-1 positive Pseudomonas aeruginosa (14); PER-1, OXA-51 and OXA-58 positive Acinetobacter baumannii (20); OXA-48 positive K pneumoniae (25) and Escherichia coli (1); IMP-1 metallo-beta-lactamase and ESBL positive E. coli (1), carbapenem nonsusceptible Serratia marcescens (1), ); CTX-M-15 positive E. coli (20) and K. pneumoniae (12) isolates. The MICs of cefepime, ceftazidime and imipenem were determined in combination with 4 mg/L NXL104 by the CLSI method on Mueller-Hinton agar. Susceptibility results, including those for the combinations with NXL104, were interpreted according to the CLSI criteria established for the beta-lactams when tested alone. Results:The study results (MIC :mg/L) are shown in Table 1. 90 Conclusions.The combination of NXL104 to cefepime, ceftazidime or imipenem restored their antibacterial activity against both OXA48 and CTX-M15 producing K.pneumoniae and E.coli; the use of NXL combinations could therefore represent a promising therapeutic strategy in the treatment of infections due to these organisms. Table 1. The results of MIC of the 90 antimicrobials PER-1 + P.aeruginosaa (14) MIC Antibiotics 90 PER-1, OXA-51-58 + A.b IMP/ IMP+NXL4 64/16 128/64 FEP/ FEP+NXL4 32/2 128/64 CAZ/CAZ+NXL4 128/16 >512/256 CTX-M-15 + K.pneumoniae (12) CTX-M-15 + E.coli (20) IMP/ IMP+NXL4 1/0.06 1/<0.008 FEP/ FEP+NXL4 64/0.03 32/ <0.008 CAZ/ CAZ+NXL4 64/0.25 32/<0.008 K-1718 Importance of Inflammation Markers in Febril Neutropenic Patients 1 1 2 M. COBAN , A. ACAR , O. SAYAN , V. TURHAN 1 1 1 1 , O. ONCUL , L. GORENEK ; GATA Haydarpasa Training Hosp. Dept. of Infectious 2 Diseases, Istanbul, Turkey, GATA Haydarpasa Training Hosp. Dept. of Hematology, Istanbul, Turkey. Background: In spite of advantages in prophylactic and empirical antimicrobial therapy, unrecognized or ineffectively treated infections are a common cause of death in patients with febrile neutropenia. Serum and plasma concentrations of infection-induced mediators such as acute-phase reactants or cytokines have been proposed to reflect the presence of microbial pathogens. Methods: Between January 2007 and December 2008, 43 patients who were neutropenic due to hematological malignancies and febrile enrolled to the study. Blood samples were obtained on the first and third day of fever for the measurement of C-reactive protein (CRP), interleukin-1β (IL1β), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) levels. Results: On the first day of fever IL-6, IL-10, TNF-α and PCT, on the third day CRP, IL-6, IL-10, TNF-α and PCT levels were practical parameters for presence of microbiologically documented infections in febrile neutropenic patients. On ROC analyse AUC of PCT and IL-6 were higher than other parameters on both days representing a statistical significance (0,993 and 0,920 for the first day; 0,988 and 0,916 for the third respectively). For PCT; >1,2 ng/ml first day cut-off level had 94,6 % sensitivity, 100 % specify, 100 % positive predictive value and 96,2 % negative predictive value. On the other hand for IL-6; >623,8 pg/ml first day cut-off level had 89,2 % and 92,2 % sensitivity and specify, respectively. There was a relationship between mortality and only PCT levels measured on the third day of fever. Conclusions: PCT and IL-6 measurement on the early period of fever in neutropenic patients can help management of such patients when considered promptly indication of treatment and treatment costs. K-1734 Nosocomial Infections in Burn Patients: Analysis of Nine-Year Active Surveillance 1 1 2 1 O. ONCUL , A. ACAR , E. ULKUR , V. TURHAN , 2 1 1 F. UYGUR , S. CAVUSLU , L. GORENEK ; 1 GATA Haydarpasa Training Hosp. Dept. of 2 Infectious Diseases, Istanbul, Turkey, GATA Haydarpasa Training Hosp. Dept. of Plastic Surgery, Istanbul, Turkey. Background: To analysis active targeted prospective surveillance results of nosocomial infection (NI) including etiological agents, antibacterial resistance patterns and risk factors during 9-years period in burn patients. Methods: Active targeted prospective surveillance was performed in a Turkish Burn Care Unit (BCU) with nine-bed capacity, according to CDC and NNIS criteria between January 2001 and December 2009. Results: Among 566 hospitalized burn patients, 402 cases acquired totally 517 NI (53 pneumonia, 137 mixed, 186 burn wound infection (BWI), 28 urinary tract infection, 113 blood stream infection) for an overall NI rate of 22.8 per 1000 patients-days. The mean age (34.8±8.6), the mean hospitalization time (41.5±9.3 days) and total burn surface area (TBSA) (36.3±12.0) of the patents with NI were higher than those with non-NI (20.8±6.4), (25.1±7.1) and (18.2±4.3) respectively (P=0.01). Of all the cases, 103 (18.1%) died. By multiple logistic regression analysis, TBSA (odds ratio (OR: 3.0), full-thickness injury (OR: 2.7), inhalation injury (OR: 1.2), and age (> 65 years) (OR: 0.9) were independent risk factors for NI. Any difference between rates of death has not been detected in nine years, whereas multidrug resistant Acinetobacter baumannii and Pseudomonas aeruginosa rates increased after 2004 (P=0.01). P.aeruginosa (202), A.baumannii (174) and S.aureus (56) were most common identified bacteria in 485 strains. Twenty-one (10.4%) strains of P.aeruginosa and 29 (16.7%) strains of A.baumanniii were found as panresistant to all tested antibiotics. Twenty-four (43%) of S.aureus strains were detected as methicillin resistant. Conclusions: Considering the high incidence of BWI and panresistant strains in our BCU, more strictly infection control policies are required and more comprehensive education campaign should be implemented. K-275 Hospital-Acquired Pandemic (H1N1) 2009 Influenza S. SEN 1,2 1 1 , A. ERBAY , Y. TEZER TEKCE , H. 1 1 CABADAK ; Türkiye Yüksek İhtisas Ed. and 2 Res. Hosp., Ankara, Turkey, Türkiye Yüksek Ýhtisas Ed. and Res. Hosp., Ankara, Turkey. Background: In April 2009, cases of human infection with 2009 pandemic influenza A (H1N1) virus were identified in the United States and Mexico, and the virus then spread rapidly around the world. This report describes characteristics and outcomes of patients followed up with hospital acquired pandemic (H1N1) 2009 influenza. Methods: Two nosocomial outbreaks of H1N1 2009 influenza analyzed prospectively. In November 2009 in the intensive care unit (ICU) of cardiology, and in December 2009 in the ICU of cardiovascular surgery two outbreaks occurred. The index cases and occasions which were possibly related to the outbreak were investigated through chart review, interviews with patients and staff. Results: First outbreak occurred in Cardiology ICU and involved one index case and 5 affected cases. The index patient hospitalized with the initial diagnosis of pulmonary edema and admitted to Cardiology ICU. At the second day of hospitalization she was diagnosed as H1N1 influenza. After this diagnosis oseltamivir prophylaxis was administered to other 7 patients in the same ICU. At the third day of her hospitalization fever were developed in 4 patients and in one nurse. Polymerase-chain-reaction (PCR) assay confirmed the diagnosis of H1N1 in these cases. Unfortunately 4 of these 6 patients died and 3 of them died due to influenza. One month later, a second outbreak occurred in cardiovascular surgery department. The index case was mother of an infant patient. After the transmission of H1N1 influenza to her child, influenza symptoms were observed in 2 more patients. H1N1 confirmed with PCR. Two patients were in postoperative period and 1 patient was waiting for urgent cardiac transplantation. Oseltamivir was administered to all patients, however 54 years old female patient who had a prosthetic valve replacement operation th died at the 11 day of the disease. The reason of the mortality was ARDS. Conclusions: These nosocomial outbreaks show the difficulties involved in a pandemic situation in recognising which patients and visitors had probable H1N1. C2-699 Surveillance of Antibiotic Resistance Determinants in Commensal and Environmental Bacteria from International Sources 1,2 B. M. MARSHALL , S. LEVY 3 1,2 4 1 , D. OECHING , D. 5 6 GUR , A. NANUASHVILI , Y. KIM , H. ENDTZ , A. 1 1 SOSA ; Alliance for Prudent Use of Antibiotics, 2 Boston, MA, Tufts Univ. Sch. of Med., Boston, MA, 3 Hacettepe Univ. Sch. of Med., Ankara, Turkey, 4 Tbilisi Med. Academy of Postgraduate Ed., Tbilisi, 5 Georgia, Alliance for Prudent Use of Antibiotics, 6 Seoul, Korea, Republic of, ICDDR, Mohakhali, Bangladesh. Background: Commensal and environmental flora form a large reservoir of mobile genetic elements bearing genes for antibiotic resistance which can transfer resistance to pathogens. APUA, in conjunction with the National Biodefense Analysis and Countermeasures Center, has undertaken an international surveillance of the reservoirs of antibiotic resistance (ISRAR) in commensal bacteria to track geographically, and eventually temporally, the emergence and spread of resistance genes through its online Reservoirs of Antibiotic Resistance (ROAR) database. Methods Protocols were developed to optimize isolation of 9 targeted bacterial genera from healthy animals and environmental sites. Isolates obtained from 8 APUA country (Bangladesh, Georgia, India, Turkey, Uganda, S. Africa, S. Korea, Vietnam) chapter laboratories were speciated (API) and susceptibility tested (E-test) using appropriate classes of antibiotics. Results: There was 85% recovery of target species. Between 2008-2010, 1079 total isolates: E. coli, (389) Staphylococcus (329), Streptococcus/Enterococcus (79), Salmonella (121), Pseudomonas (49), Acinetobacter (49), Aeromonas (33) and Stenotrophomonas (50) were derived from healthy animals (807) water/sewage (193), plants (36) and soil (43). >70% of all isolates expressed resistance to one or more antibiotics; ~30% demonstrated multidrug resistance (>3 drugs). Resistance patterns were different among environmental sources and geographic sites. Conclusions: This study has revealed significant differences in the frequency of particular antibiotic resistance markers in bacteria isolated from geographically diverse environmental sites. K-255 Surveillance of Device-Associated Infections in Intensive Care Units of a Turkish Referral Hospital E. TUTUNCU, Y. GURBUZ, I. SENCAN, B. OZTURK, G. CICEK SENTURK; SB Diskapi Yildirim Beyazit Training and Res. Hosp., Ankara, Turkey. Background: Surveillance data regarding device associated infections (DAIs) are limited in most developing countries. The aim of the present study was to evaluate DAI rates in a tertiary referral hospital in Turkey and to compare them with both national and international data. Methods: This prospective surveillance study was conducted in Medical-Surgical ICUs (MS-ICU), Neurology ICU (N-ICU), Neurosurgical ICU (NS-ICU) and Cardiovascular surgery ICU (CVS-ICU) of our hospital. The study period was between January 1, 2007 and March 31, 2010. DAIs were diagnosed according to the standard definitions of the CDC. Results: 6005 patients were followed in the ICUs for a total of 46355 patient-days. Device days, device-utilization ratios, ventilator associated pneumonia (VAP), catheter associated urinary tract infection (CA-UTI), and catheter associated bloodstream infection (CA-BSI) rates from four different ICUs were shown in table 1. Overall the most common causes of VAP, CA-UTI and CA-BSI were Acinetobacter spp., E. coli and Candida spp. respectively. All DAI rates were found to be higher than those reported by the NHSN. When compared with Turkish HAIs Surveillance Report, VAP rates of all ICUs were over 50%, except NS-ICU which was in between 25-50%. CA-UTI rates of all ICUs were in between 75-90%, except CVS-ICU which was in between 50-75%. CA-BSI rates of all ICUs were at 50% or less. Conclusions: There is a high incidence of DAIs in our ICUs. To reduce these infection rates, comprehensive infection control programs should be implemented. VAP, CA-UTI, and CA-BSI rates from four different ICUs MS-ICU NS- N- ICU ICU CVS-ICU Patients (n) 3476 789 622 1118 Patient days 29257 5910 7990 3198 Ventilator associated 12926 1802 1851 1201 0.37 pneumonia Device days Device 0.44 2 0.30 4 0.2 16 1.4 1 utilization VAP Rate per 100 76 7.9 2 5.3 3 43 3.32 patients Rate per 1000 device days 21.35 23.30 6.9 23. 23 Catheter associated UTI Device 28381 5587 7901 3031 0.95 days Device utilization CA-UTI Rate 0.97 3 0.95 5 0.9 8 0.7 2. per 100 patients Rate per 1000 device 46 9.9 9 7.48 9 12 days 5 12.1 10.56 3 19 9 64 .77 15.57 Catheter associated BSI Device 12980 2167 1625 3167 0.99 days Device utilization CVCA- 0.44 3 0.36 1 0.2 3 0.09 0 BSI Rate per 100 patients Rate per 8 1.1 1 1.4 0 4 .95 1000 device days 2.93 5.07 0.6 5 2. 46 D-757 Practical Use of CHROMagar Salmonella Plus Medium in Isolation of Aeromonas Species from Stool Specimens I. AKYAR, T. KOCAGOZ, S. KOCAGOZ; Acibadem Univ., Istanbul, Turkey. Background: The spectrum of intestinal diaseses caused by Aeromonas ranges from acute, self-limited gastroenteritis of moderate intensity to chronic diarrhoea that can persist for weeks or months. Aeromonas species require special media for identification in samples. Methods: We evaluated the practical use of CHROMagar Salmonella plus medium in isolation of aeromonas species in 4625 stool specimens in our central laboratory, which receives samples from 16 hospitals, between May 2009 and May 2010. For comparison Aeromonas suspected strains and reference strain Aeromonas hydrophilia ATCC 7966 were inoculated onto; CHROMagar Salmonella plus, CHROMagar orientation, Cefsulodin-Irgasan-Novobiocin (CIN), Sheep Blood Agar, EMB and Hektoen Enteric Agar media. Results: Aeromonas colonies were pink like Salmonella colonies on CHROMagar Salmonella plus medium at first glance. However there was a prominent difference which enabled us to differentiate Aeoromonas colonies from Salmonella colonies. Aeromonas pink pigment diffused into the medium creating a pink cloudy appearance around the colonies. These colonies were identified as Aeromonas and with the automated system (Phoenix, BD, USA). After identification of Aeromonas species those strains were inoculated onto other media and the supporting data was gained such as haemolysis on blood agar and growth of oxidase positive Aeromonas colonies on CIN agar. We have detected 18 (0,4%) Aeromonas spp. in a year period behind 120 (2,6%) Salmonella species. Aeromonas species detected were as: 6 A. sobria, 6 A. veronii, 5 A. caviae and 1 A. hydrophila. Most of those strains were resistant to ceftazidime and cefoxitin. Conclusions: It is practical to observe Aeromonas species on routinely used Salmonella plus CHROMagar behind Salmonella species, without using any other medium or method. This may enable the identification of Aeromonas species in stool samples without any extra cost, time and effort. D-775 The Diagnostic and Prognostic Significance of Soluble Urokinase Plasminogen Activator Receptor in Systemic Inflammatory Response Syndrome G. YILMAZ, I. KOKSAL, S. KARAHAN, A. MENTESE; Karadeniz Tech Univ Faculty of Med, TRABZON, Turkey. Background:This study was intended to investigate the value of Soluble Urokinase Plasminogen Activator Receptor (suPAR), C-reactive protein (CRP) and procalcitonin (PCT) in the determination and prognosis of systemic inflammatory response syndrome (SIRS) patients. Methods:The study was a cross-sectional performed among patients applying to the Karadeniz Technical University Medical Faculty Hospital with at least two SIRS criteria. A control group was established made up of healthy blood donors. Patients with SIRS criteria were divided into four groups - sepsis, urinary tract infection, pneumonia and non-infectious patients. PCT, CRP and suPAR were analyzed from the blood specimens taken. Results:Eighty-five patients were enrolled in the SIRS group (44 sepsis, 20 urinary tract infection, 12 pneumonia and 9 non-infection), and 53 individuals in the control group. A significant correlation was determined between suPAR, PCT and CRP values in both groups (P<0.0001). A suPAR cutoff value of 2.8 ng/mL was associated with an NPV of 87% and PPV of 91%, with 92% sensitivity and 85% specificity. A relatively high suPAR level that might predict fatality was also determined in fatal cases (P=0.001). A PCT cutoff value of 0.5 ng/ml was associated with an NPV of 63% and PPV of 82%, with 80% sensitivity and 55% specificity. A CRP cutoff value of 0.5 was associated with an NPV of 82% and PPV of 76%, with 93% sensitivity and 53% specificity. Conclusions:PCT and CRP are useful in sepsis diagnosis, but are insufficient for differential diagnosis and cannot be used to estimate prognosis. suPAR, on the other hand, possesses high sensitivity and specificity levels in terms of differential diagnosis, and high suPAR levels can predict fatality. This shows that the measurement of plasma suPAR levels can be used in the differential diagnosis of SIRS in patients admitted to hospital with suspicion of infection and that it is important as a potential predictor of mortality. E-1570 In Vitro Activities of Nisin Alone or in Combination with Vancomycin and Ciprofloxacin against Methicillin-Resistant and Methicillin Susceptible Staphylococcus aureus Strains S. DOSLER, A. A. GERÇEKER; Istanbul Univ., Istanbul, Turkey. Background: Since levels of antibiotic resistance have been increasing at an alarming rate worldwide, cationic peptides seems to be one of the most preferable class of antimicrobial substances in the near future as therapeutic agents. Among them nisin, which is a lanthionine containing cationic peptide, has bactericidal activity against Gram positive bacteria furthermore it is nontoxic for human. Therefore, we investigated the in vitro activities of nisin alone or in combination with vancomycin and ciprofloxacin against each four of methicillin resistant Staphylococcus aureus (MRSA) and methicillin susceptible S. aureus (MSSA) strains. Methods: The minimum inhibitory concentrations (MIC) were determined by microbroth dilution technique and in order to determine the concentration dependent bactericidal activity of nisin alone and in combination with vancomycin or ciprofloxacine the time-kill curve (TKC) method was used. Results: For both MSSA and MRSA strains, the MIC range of nisin was between 4 - 16 mg/L. The results of TKC analysis demonstrated concentration dependent rapid bactericidal activity of nisin and synergism almost in all strains when nisin was used in combination with ciprofloxacin, and early synergistic interactions in some of the strains when it was used in combination with vancomycin. Conclusions: Nisin seems to be a good candidate for further investigations in the treatment of Gram positive bacteria, alone or in combination with antibiotics. These findings strengthen the opinion in terms of cationic peptides will may take a place as a new and active group of antimicrobial agent, either as a single agent or as an adjuvant for antimicrobial chemotherapy in the near future. E-2050 In Vitro Activities of the Novel Ceragenin, CSA-13, Alone or in Combination with Colistin, Tobramycin and Ciprofloxacin against Pseudomonas aeruginosa Strains Isolated from Cystic Fibrosis Patients 1 2 C. BOZKURT GÜZEL , P. B. SAVAGE , A. A. 1 1 GERÇEKER ; Istanbul Univ., Faculty of Pharmacy, Dept. of Pharmaceutical Microbiol., 2 Istanbul, Turkey, Dept. of Chemistry and Biochemistry, Brigham Young Univ, Provo, UT. Background: The rise in the rates of antibiotic resistance among Pseudomonas aeruginosa strains from cystic fibrosis (CF) patients is concerning and underscores the need for the development of novel potent compounds. Among them ceragenin CSA-13, which is a cationic steroid molecule, mimics the activity of naturally occuring antimicrobial peptides. Therefore, the in vitro activities of CSA-13 either alone or in combination with colistin (sulphate), tobramycin and ciprofloxacin were investigated using 50 P. aeruginosa strains isolated from CF patients. Methods: MICs and MBCs were determined by microbroth dilution technique as described by CLSI. Antibiotic combinations were assessed by using the chequerboard technique. Additionally, in order to determine the concentration dependent bactericidal activity of CSA-13 alone and in combination with colistin the time-kill curve (TKC) method was used for two strains. Results: The MIC values of CSA-13, 90 colistin, tobramycin and ciprofloxacin were 2 mg/L, 1 mg/L, 1 mg/L and 2 mg/L, respectively. The MBCs were equal to or twice greater than those of the MICs. With a FIC index of ≤ 0.5 as borderline, synergistic interactions were mostly seen with CSA-13-colistin (54 %) whereas in the CSA-13-tobramycin (25 %) combination the least synergistic interactions were observed. No antagonism was observed. The results of TKC analysis demonstrated concentration dependent bactericidal activity of CSA-13 and early synergism in one strain. Conclusions: Consequently, CSA-13 appears to be a good candidate for further investigations in the treatment of P. aeruginosa strains in CF patients, alone or in combination. However, future studies should be performed to correlate the safety, efficacy and pharmacokinetic parameters of this molecule. K-1720 Piperacillin/Tazobactam (P/T) Versus Cefoperazone/Sulbactam (C/S) in Adult Low Risk Febrile Neutropenia (FEN) Cases O. R. SIPAHI, B. ARDA, A. NAZLI, H. PULLUKCU, M. TASBAKAN, T. YAMAZHAN, S. CALIK, H. SIPAHI, S. ULUSOY; Ege Univ. Faculty of Med., Izmir, Turkey. Background: It was aimed to compare the efficacy of P/T and C/S in the empirical treatment of adult FEN. Methods: We extracted data and outcomes of adult cases with low risk (MASCC score 21 or more) FEN (absolute neutrophil count <500 mm3 or a count <1000 mm3 but expected to fall 38.5 or 38.0°C on two or more occasions within 12 h) and treated with P/T (4.5 gx4) or C/S (3x2 g) between 2005 and 2010 from our database. Data were collected prospectively by daily visits. Initial evaluation of the cases was performed according to IDSA guidelines. Primary outcomes were -fever defervescence at 72 h- and -success without modification- which referred to episodes where the patient recovered from fever with disappearance of signs of infection without modifications to initial empirical treatment. Mortality referred to death resulting from a documented or presumed infection during the neutropenic episode.Treatment was switched to amoxicillin/clavulonate+ciprofloxacin in cases with 72 h fever defervescence and whose neutrophil counts recovered. For statistical comparison we used chi-square and T-tests. Results: P/T and C/S groups were similar in terms of patient characteristics and efficacy (Table 1). Conclusions: C/S is not ststistically inferior than P/T in the empirical treatment of adult FEN. To our knowledge this is the first study comparing these two agents in this indication. K-236 Antimicrobial Resistance of Nosocomial Gram-Negative Bacteria in Gulhane Military Medical Academy Hospital Intensive Care Units B. SIMSEK, O. BEDIR, R. GUMRAL, A. KILIC, A. BASUSTAOGLU; Gulhane Military Med. Academy Dept. of Med. Microbiol., Ankara, Turkey. Background: Gram-negative nosocomial pathogens display a difficulty for efficient therapy in intensive care units’ (ICUs) patients due to the resistance to antimicrobials. The objective of the study was to evaluate antimicrobial resistance of nosocomial gram-negatives in Gulhane Military Medical Academy (GMMA) ICUs. Methods: Antimicrobial susceptibility testing of nosocomial gram-negative organisms isolated from GMMA ICU patients with nosocomial infections was performed by Kirby Bauer disk diffusion method TM and Phoenix 100 (Becton Dickinson, USA) automatized system. Results: A total of 830 non-duplicate gram-negative isolates were isolated from patients in four GMMA ICUs during 2008-2010. The 263 of 830 isolates were accepted as nosocomial pathogens of those 42.96% urine, 31.56% blood and 25.48% were other samples (wound, abscess, aspirate, catheter etc.). Dominant pathogens were: E. coli (25.85%), P. aeruginosa (19.01%), K. pneumoniae (17.49%), A. baumannii (16.34%), Proteus spp. (9.12%). Resistance rates (intermediate + resistant strains, %) for key pathogens were as follows: E. coli K. pneumoniae (n=46) (%) A. b (n=68) (%) Amikacin 19.12 2.17 74.4 Amoxicillin/clavulanic acid 72.06 73.91 - Ampicillin 94.12 97.83 - Aztreonam 64.71 76.09 100 Cefazolin 79.41 76.09 - Cefotaxime 66.18 78.26 100 Cefoxitin 20.59 52.17 - Ceftazidime 63.24 71.74 88.3 Ciprofloxacin 72.06 60.87 95.3 Gentamicin 39.71 43.48 83.7 Imipenem 0 0 83.7 Meropenem 0 0 83.7 Piperacillin-Tazobactam 54.41 41.30 95.3 Trimethoprim-Sulfamethoxazole 69.12 67.39 90.6 Based on CLSI recommendations and Phoenix TM 100 automatized system 44.23% Enterobacteriaceae strains were found to be ESBL-producers. K. pneumoniae and E. coli strains are the most frequent ESBL-producers with the rates 56.52%, 54.41% respectively. Conclusions: A. baumannii displayed high level resistance to all agents tested. ESBL-production is widespread among K. pneumoniae and E. coli with carbapenems possessing the highest activity against these pathogens. P-1765 Bibliometric Analysis of Publications in Infectious Diseases and Clinical Microbiology Areas: Which Coutries Leaded in 1996-2008 and 2008 Periods? O. R. SIPAHI, H. SIPAHI, M. TASBAKAN, H. PULLLUKCU, B. ARDA, T. YAMAZHAN, S. ULUSOY; Ege Univ. Faculty of Med., Izmir, Turkey. Background: In this study it was aimed to make the bibliometric analysis of 1996-2008 and 2008 publications related to infectious diseases and clinical microbiology areas. Methods:Bibliomeric data related to 1996-2008 and 2008 were retrieved from SCImago journal and country rank web site (www.scimagojr.org). Data related to infectious diseases and clinical microbiology were accessed by using the infectious diseases subcategory and clinical microbiology subcategory of the database. Top 10 European countries according to total publication number was also detailed with data of citable publications (articles+reviews), total citations, citation per paper and H index. Results: When evaluated according to total number of publications, United States, United Kingdom, France, Brazil and Germany were the top five countries in the infectious diseases area in 1996-2008 period. In 2008 top four did not change but the fifth was china. In the medical microbiology area in 1996-2008 period top five countries were United States, Japan, Spain, China and Germany whereas in 2008 top five countries were United States, India, China, Spain and Japan (See table). Conclusions: US is the leading country in both medical microbiology and infectious diseases areas. China is increasing its place in the top five countries.