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76 Identification of Pseudomonas aeruginosa infection in a paediatric CF population
S76
4. Microbiology
73 Impact of community-acquired MRSA and hospital-acquired MRSA on pulmonary function of CF patients S. Campana1 , N. Ravenni1 , L. Cariani2 , C. Colombo2 , E. Fiscarelli3 , V. Lucidi3 , V. Raia4 , D.V. Iula5 , T. Pensabene6 , M. Collura6 , C. Braggion1 , G. Taccetti1 . 1 CF Center, Department of Paediatric Medicine, Anna Meyer Children’s University Hospital, Florence, Italy; 2 CF Center and Central Lab CF Microbiology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 3 Cystic Fibrosis Unit, Bambino Ges`u Children’s Hospital, Rome, Italy; 4 CF Center, Department of Translational Medical Sciences, Federico II University, Naples, Italy; 5 Federico II University, Department of Molecular Medicine and Medical Biotechnology, Naples, Italy; 6 CF Center, Ospedale dei Bambini ‘G. Di Cristina’, Palermo, Italy Objectives: Persistent methicillin-resistant Staphylococcus aureus (MRSA) infection affects both pulmonary function and survival of CF patients. Few reports have investigated the genetic background of MRSA strains involved in persistent lung infection. This study compares lung function decline in CF patients persistently infected by community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA). Methods: Seventy-five patients attending five Italian CF centers and persistently infected by MRSA were studied. One strain/year/patient was analyzed. SCCmec analysis was performed as previously described in order to characterize CA- and HA-MRSA strains. The mean annual FEV1 decline was evaluated for each patient. Results: Forty-nine out of 75 (65%) patients maintained the same SCCmec type over time and the mean duration of infection was 3.1 years. Twenty-five patients (mean age 20.6 years) were persistently infected by HA-MRSA and 24 (mean age 18.4 years) by CA-MRSA. The prevalence of chronic P. aeruginosa infection was 52% and 29% in the HA- and CA-MRSA group respectively. The yearly mean FEV1 decline for patients harboring HA-MRSA and CA-MRSA was −1.12±4.7 and −2.2±4 respectively. Conclusion: Most of the studied patients maintained the same SCCmec type for several years. Patients infected by CA-MRSA showed more FEV1 decline in comparison with HA-MRSA infected patients. However this difference is not statistically significant. The knowledge of genetic background of MRSA strains should be improved in order to understand the clinical impact of persistent MRSA infection and optimize prevention and treatment strategies. Grant RF-2010-2316176 Bando Ricerca Finalizzata
74 Burkholderia cepacia complex infection in an adult cystic fibrosis centre over a ten year period D. Keating1 , K. Schaffer1 . 1 St. Vincent’s University Hospital, Microbiology, Dublin, Ireland Objectives: To investigate the B. cepacia complex (Bcc) epidemiology in adult CF patients over a ten year period (2004 to 2014). Methods: The hospital laboratory database was used to identify all CF patients who had Bcc isolated from at least one respiratory specimen. Results: 27 patients had at least one sputum culture positive for Bcc which was molecularly confirmed. New acquisition of Bcc peaked in 2009/2010 and has fallen since. No new Bcc were isolated in 2013 or 2014. Prevalence of Bcc was 2.75% in 2004 and peaked at 7.6% in 2010. This dropped to approx 6% for the last three years. 70% of the patients were male, 30% female. Distribution of Bcc species was as follows. B. multivorans 56%, B. cenocepacia 33%, B. gladioli 7% and B. stabilis 4%. Mortality of patients over the study period ranged from 55% in B. cenocepacia to 13% in B. multivorans and 0% in B. gladioli and B. stabilis. 7 patients died in the 10 years (2 B. multivorans, 5 B. cenocepacia). 30% of patients were culture positive on initial culture. 70% became positive on subsequent visits. PFGE was performed to out rule cross infection. For these 70% mean age of acquisition was 28. Co-infection with P. aeruginosa was the most common (52%). 3 patients were no longer culture positive for Bcc at end of study/time of death. Conclusion: Mortality of patients over the 10 year period varied according to the species with B. cenocepacia having the highest mortality rate, the youngest age of acquisition and the shortest time from acquisition of organism to death. Prevalence of Bcc has remained stable for the last three years possibly due to increased life expectancy in patients and effective infection control practices.
Posters
75 A single clone of Achromobacter xylosoxidans colonizes Belgian cystic fibrosis patients from different centres P. Cools1 , E. Ho2 , P. Schelstraete3 , B. W¨urth4 , H. Franckx4 , L. Van Simaey1 , S. Van Daele3 , S. Verhulst2 , F. De Baets3 , M. Vaneechoutte1 . 1 University of Ghent, Ghent, Belgium; 2 University of Antwerp, University Hospital, Edegem, Belgium; 3 Ghent University Hospital, Ghent, Belgium; 4 Rehabilitation Centre, De Haan, Belgium Objectives: Several major infection problems with Achromobacter xylosoxidans were observed for CF patients in Belgium. We tried to assess the epidemiology. Methods: We typed 50 strains from 24 CF patients − from Ghent University Hospital (UZG, n = 17) and from the University of Antwerp Hospital (UZA, n = 7), most of which (14 from Ghent and 5 from Antwerp) had stayed at the rehabilitation centre. CF-related strains had been collected over a period of 10 years. We also included 8 unrelated strains: 7 clinical strains from non-CF patients and the type strain. McRAPD (arbitrarily primed PCR in combination with melting curve analysis)(Deschaght et al. 2011. Res Microbiol 162: 386–392), nrdA gene sequencing (Spilker et al. 2013. J Cystic Fibrosis 12: 298–301) and MALDI-TOF typing (newly developed) were used for typing. Results: Typing revealed that most isolates from CF patients were indistinguishable by any of the three approaches. Only 6 CF patients had invididual types of A. xylosoxidans. Non-CF strains, including the one isolated from a non-CF patient at the rehabilitation centre, belonged to separate genotypes. The major clone observed in this study had previously been recognized as a major cluster (10 patients) in the rehabilitation centre of De Haan and its distinctness from a previously established minor cluster in De Haan (4 patients, Van Daele et al. 2005. J Clin Microbiol 43: 2998–3002) was confirmed in this study. Conclusion: These data indicate that most CF patients from different CF centres in Belgium are colonized by a single clone of genuine A. xylosoxidans, that is spreading since at least 10 years. We thank the MucoVereniging Belgium
76 Identification of Pseudomonas aeruginosa infection in a paediatric CF population E.R. Willis1 , J. Panickar1 . 1 Royal Manchester Children’s Hospital, Paediatric Respiratory Medicine, Manchester, United Kingdom Objectives: To analyse the importance of obtaining regular sputum samples in identifying P. aeruginosa infection in a paediatric cystic fibrosis (CF) population. Royal Manchester Children’s Hospital provides care to 182 children with CF. Sputum and/or cough swab samples are taken at each clinic visit. Our local practice is to encourage families to also send sputum samples/ cough swabs to us twice a month. Methods: Analysis of cough swab and sputum samples of all our CF patients during a 2-year period (October 2012 to September 2014). Children were classified according to the Leeds criteria for P. aeruginosa infection, with an additional category of “first growth”. Results: 5973 samples were obtained over the 2-year period from our CF population. Table 1. P. aeruginosa status
Number of children (total = 182)
Never infected
61 (33%)
Free of infection
67 (37%)
Intermittent infection
29 (16%)
Chronic infection
18 (10%)
First growth
7 (4%)
We then analysed P. aeruginosa status if only samples taken at clinic were used. Table 2. P. aeruginosa status
Number of children All samples
Clinic samples only
Intermittent infection
29
14
First growth
7
4
If clinic samples alone were analysed, we would have identified 14/29 children with intermittent infection and 4/7 children with first growth. Conclusion: Potentially significant pathogens may not be identified if sputum/cough swab samples are only obtained at clinic visits. In our CF population, 18 children (10%) with P. aeruginosa growth would not have been identified if samples had only been taken at clinic.
4. Microbiology
73 Impact of community-acquired MRSA and hospital-acquired MRSA on pulmonary function of CF patients S. Campana1 , N. Ravenni1 , L. Cariani2 , C. Colombo2 , E. Fiscarelli3 , V. Lucidi3 , V. Raia4 , D.V. Iula5 , T. Pensabene6 , M. Collura6 , C. Braggion1 , G. Taccetti1 . 1 CF Center, Department of Paediatric Medicine, Anna Meyer Children’s University Hospital, Florence, Italy; 2 CF Center and Central Lab CF Microbiology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 3 Cystic Fibrosis Unit, Bambino Ges`u Children’s Hospital, Rome, Italy; 4 CF Center, Department of Translational Medical Sciences, Federico II University, Naples, Italy; 5 Federico II University, Department of Molecular Medicine and Medical Biotechnology, Naples, Italy; 6 CF Center, Ospedale dei Bambini ‘G. Di Cristina’, Palermo, Italy Objectives: Persistent methicillin-resistant Staphylococcus aureus (MRSA) infection affects both pulmonary function and survival of CF patients. Few reports have investigated the genetic background of MRSA strains involved in persistent lung infection. This study compares lung function decline in CF patients persistently infected by community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA). Methods: Seventy-five patients attending five Italian CF centers and persistently infected by MRSA were studied. One strain/year/patient was analyzed. SCCmec analysis was performed as previously described in order to characterize CA- and HA-MRSA strains. The mean annual FEV1 decline was evaluated for each patient. Results: Forty-nine out of 75 (65%) patients maintained the same SCCmec type over time and the mean duration of infection was 3.1 years. Twenty-five patients (mean age 20.6 years) were persistently infected by HA-MRSA and 24 (mean age 18.4 years) by CA-MRSA. The prevalence of chronic P. aeruginosa infection was 52% and 29% in the HA- and CA-MRSA group respectively. The yearly mean FEV1 decline for patients harboring HA-MRSA and CA-MRSA was −1.12±4.7 and −2.2±4 respectively. Conclusion: Most of the studied patients maintained the same SCCmec type for several years. Patients infected by CA-MRSA showed more FEV1 decline in comparison with HA-MRSA infected patients. However this difference is not statistically significant. The knowledge of genetic background of MRSA strains should be improved in order to understand the clinical impact of persistent MRSA infection and optimize prevention and treatment strategies. Grant RF-2010-2316176 Bando Ricerca Finalizzata
74 Burkholderia cepacia complex infection in an adult cystic fibrosis centre over a ten year period D. Keating1 , K. Schaffer1 . 1 St. Vincent’s University Hospital, Microbiology, Dublin, Ireland Objectives: To investigate the B. cepacia complex (Bcc) epidemiology in adult CF patients over a ten year period (2004 to 2014). Methods: The hospital laboratory database was used to identify all CF patients who had Bcc isolated from at least one respiratory specimen. Results: 27 patients had at least one sputum culture positive for Bcc which was molecularly confirmed. New acquisition of Bcc peaked in 2009/2010 and has fallen since. No new Bcc were isolated in 2013 or 2014. Prevalence of Bcc was 2.75% in 2004 and peaked at 7.6% in 2010. This dropped to approx 6% for the last three years. 70% of the patients were male, 30% female. Distribution of Bcc species was as follows. B. multivorans 56%, B. cenocepacia 33%, B. gladioli 7% and B. stabilis 4%. Mortality of patients over the study period ranged from 55% in B. cenocepacia to 13% in B. multivorans and 0% in B. gladioli and B. stabilis. 7 patients died in the 10 years (2 B. multivorans, 5 B. cenocepacia). 30% of patients were culture positive on initial culture. 70% became positive on subsequent visits. PFGE was performed to out rule cross infection. For these 70% mean age of acquisition was 28. Co-infection with P. aeruginosa was the most common (52%). 3 patients were no longer culture positive for Bcc at end of study/time of death. Conclusion: Mortality of patients over the 10 year period varied according to the species with B. cenocepacia having the highest mortality rate, the youngest age of acquisition and the shortest time from acquisition of organism to death. Prevalence of Bcc has remained stable for the last three years possibly due to increased life expectancy in patients and effective infection control practices.
Posters
75 A single clone of Achromobacter xylosoxidans colonizes Belgian cystic fibrosis patients from different centres P. Cools1 , E. Ho2 , P. Schelstraete3 , B. W¨urth4 , H. Franckx4 , L. Van Simaey1 , S. Van Daele3 , S. Verhulst2 , F. De Baets3 , M. Vaneechoutte1 . 1 University of Ghent, Ghent, Belgium; 2 University of Antwerp, University Hospital, Edegem, Belgium; 3 Ghent University Hospital, Ghent, Belgium; 4 Rehabilitation Centre, De Haan, Belgium Objectives: Several major infection problems with Achromobacter xylosoxidans were observed for CF patients in Belgium. We tried to assess the epidemiology. Methods: We typed 50 strains from 24 CF patients − from Ghent University Hospital (UZG, n = 17) and from the University of Antwerp Hospital (UZA, n = 7), most of which (14 from Ghent and 5 from Antwerp) had stayed at the rehabilitation centre. CF-related strains had been collected over a period of 10 years. We also included 8 unrelated strains: 7 clinical strains from non-CF patients and the type strain. McRAPD (arbitrarily primed PCR in combination with melting curve analysis)(Deschaght et al. 2011. Res Microbiol 162: 386–392), nrdA gene sequencing (Spilker et al. 2013. J Cystic Fibrosis 12: 298–301) and MALDI-TOF typing (newly developed) were used for typing. Results: Typing revealed that most isolates from CF patients were indistinguishable by any of the three approaches. Only 6 CF patients had invididual types of A. xylosoxidans. Non-CF strains, including the one isolated from a non-CF patient at the rehabilitation centre, belonged to separate genotypes. The major clone observed in this study had previously been recognized as a major cluster (10 patients) in the rehabilitation centre of De Haan and its distinctness from a previously established minor cluster in De Haan (4 patients, Van Daele et al. 2005. J Clin Microbiol 43: 2998–3002) was confirmed in this study. Conclusion: These data indicate that most CF patients from different CF centres in Belgium are colonized by a single clone of genuine A. xylosoxidans, that is spreading since at least 10 years. We thank the MucoVereniging Belgium
76 Identification of Pseudomonas aeruginosa infection in a paediatric CF population E.R. Willis1 , J. Panickar1 . 1 Royal Manchester Children’s Hospital, Paediatric Respiratory Medicine, Manchester, United Kingdom Objectives: To analyse the importance of obtaining regular sputum samples in identifying P. aeruginosa infection in a paediatric cystic fibrosis (CF) population. Royal Manchester Children’s Hospital provides care to 182 children with CF. Sputum and/or cough swab samples are taken at each clinic visit. Our local practice is to encourage families to also send sputum samples/ cough swabs to us twice a month. Methods: Analysis of cough swab and sputum samples of all our CF patients during a 2-year period (October 2012 to September 2014). Children were classified according to the Leeds criteria for P. aeruginosa infection, with an additional category of “first growth”. Results: 5973 samples were obtained over the 2-year period from our CF population. Table 1. P. aeruginosa status
Number of children (total = 182)
Never infected
61 (33%)
Free of infection
67 (37%)
Intermittent infection
29 (16%)
Chronic infection
18 (10%)
First growth
7 (4%)
We then analysed P. aeruginosa status if only samples taken at clinic were used. Table 2. P. aeruginosa status
Number of children All samples
Clinic samples only
Intermittent infection
29
14
First growth
7
4
If clinic samples alone were analysed, we would have identified 14/29 children with intermittent infection and 4/7 children with first growth. Conclusion: Potentially significant pathogens may not be identified if sputum/cough swab samples are only obtained at clinic visits. In our CF population, 18 children (10%) with P. aeruginosa growth would not have been identified if samples had only been taken at clinic.