Download K-958 Epidemiology and Outcome of Bloodstream Infections in

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.