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P1925 Teicoplanin versus cefuroxime as prophylaxis in prosthetic joint implant surgery
S552
17th ECCMID / 25th ICC, Posters
86.7% of the classifications. For those classed as ‘Non-invasive infection’ the agreement was 55.6% and for those classed as ‘Colonisation’ the agreement was 85.7%. Conclusions: This study shows that isolation of MRSA from specific specimen types can provide a reasonably accurate indication invasive infection or colonisation. Thus microbiological data from selected specimen types could be used as a proxy marker for infection. However the lack of agreement between clinical evaluation and specimen types classed as indicating non-invasive infection suggests that caution should be exercised in the selection of proxy infection markers. P1923 Characterisation and management of healthcare onset Clostridium difficile associated diarrhoea in a hyperendemic region in Germany H-P. Weil, F. Mattner, R. van den Berg, P. Gastmeier, E. Kuijper, U. Fischer-Br¨ugge (Nordhorn, Hannover, DE; Leiden, NL) Objectives: To investigate whether intensifying infection control measures or an antibiotic use programme is effective to reduce C. difficile incidence rates in three German hospitals (geriatrics [A], diabetology [B] and internal medicine [C]). Methods: A case of CDAD was defined as a patient with diarrhoea and a positive assay for C. difficile toxin A/B. Medication use was subtracted from an electronic pharmacy database. The strains were analysed by PCR-ribotyping and pulsed-field gel electrophoresis (PFGE) and the antibiotic susceptibility was determined by E-test. Results: In 2005, 120, 57 and 123 patients developed CDAD in hospital A, B, or C, respectively. Isolated strains (n = 54) belonged to the two PCR ribotypes 001 (A and C) and/or 046 (A and B), whereas typing by PFGE (n = 38) revealed 9 different strains. Three strains accounted for at least 6, 10, and 9 transmissions in A, B, or C, respectively. The strains were resistant towards erythromycin (89%), clindamycin (96%) and all quinolones (95%). In April 2006 A and B installed infection control measures and reduced the fluoroquinolone use, B also reduced the use of clindamycin. A reduced the incidence rate by 70%, whereas B could not lower the incidence rate. C switched from cefotaxime to ampicillin/sulbactam without special infection control measures, thereby reducing the incidence rate by 76%. Hospital Incidence Transmission Control QuinoClindaCephaloratesa rateb measures lonesc mycinc sporinsc d 2005 p.i. PFGE (%) 2005 p.i. 2005 p.i. 2005 p.i. 2005 p.i. A B C a
58 48 38
17 51 9
6/12 10/13 9/13
(50) no (77) no (69) no
yes 106 yes 176 no 78
46 54 66 134 56 29
36 131 70 119 27 184
142 166 54
(CDAD/10,000PD); b (DDD/1000PD); c Estimated; d After intervention.
Conclusions: Multiresistant C. difficile PCR ribotypes 001 and 046 are hyperendemic in northwest Germany. PFGE typing, rather than PCR-ribotyping, allows the study of nosocomial transmissions. Infection control measures should be installed and the use of fluoroquinolones, clindamycin and cephalosporins should be restricted. P1924 Study on Clostridium difficile-associated diarrhoea in a hospital in Japan Y. Ito, T. Matsushita, Y. Takahashi, T. Nakamura, K. Hayashi, E. Morita, H. Kato (Gifu, Tokyo, JP) Objectives: In Europe and North America, several outbreaks due to NAP1/027 Clostridium difficile have been reported. In our hospital the number of patients with C. difficile-associated diarrhoea (CDAD) increased after January 2005. Our aim of this study is to know nosocomial transmission of specific strains including NAP1/027 among these patients. Methods: Subjects were 15 patients who suffered from CDAD between January 2005 and March 2006 in Gifu Red Cross hospital, general
hospital of 310 beds. The occurrence of CDAD did not concentrate on a single ward, and extended to 5 wards. Five patients had recurrent episodes of CDAD. CDAD was defined as diarrhoea associated with positive for toxigenic culture and/or toxin A assay. The toxin-producing type of isolates was determined by PCR and PCR ribotyping of isolates was performed. Results: Twenty-two strains of C. difficile were isolated from 22 episodes. Twenty strains of C. difficile were toxin-A positive, toxin-B positive and 2 strains were toxin-A negative, toxin-B positive. PCR detecting the binary toxin gene was positive in 3 isolates from 2 patients. Twenty-two isolates were typed into 9 different PCR ribotypes. Type smz, which has been recognized as an epidemic type causing outbreaks in multiple hospitals in Japan, was recovered from 7 episodes of 4 patients and dominant in our hospital. Other three types were isolated from 2 or 3 patients each. Of 5 patients with recurrent CDAD, 4 patients relapsed with the original strain and 1 patient acquired a new strain. PCR ribotype gc8 (Brazier’s PCR ribotype 027) was isolated from one patient with pseudomembranous colitis, who had recurrent diarrhoea caused by the same type. This type was recovered from no other patients. Conclusions: Not a wide spread of a single C. difficile strain but a small scale transmission of several C. difficile strains was found to be related to the occurrence of CDAD. Although nosocomial spread of NAP1/027 strain was not recognized in our hospital, the isolation of the strain in Japan indicates the potential for wide spread of the strain in Japanese hospitals.
P1925 Teicoplanin versus cefuroxime as prophylaxis in prosthetic joint implant surgery M. Gali`e, E. Pistella, F. Napoleoni, G. Condarelli, C. Santini (Rome, IT) Objectives: Infections after joint replacement require prolonged antibiotic therapy and often graft removal. Staphylococci cause up to 70−90% of these infections. Antistaphylococcal prophylaxis decrease the infection rate and Iº or IIº generation cephalosporins are routinary employed. Glycopeptides (teicoplanin and vancomycin) represent a valid alternative for the centres where methicillin-resistant staphylococci are prevalent. Due to the risk of reduced susceptibility to glycopeptides and to the lower activity against methicillin-susceptible strains the use of glycopeptides for prophylaxis is recommended only as alternative and for short periods. Aim of the study was to compare the efficacy of cefuroxime and teicoplanin in a hospital with high (60−80%) incidence of methicillin-resistant staphylococci. Methods: All the patients undergoing elective total joint replacement over a 12-month period were randomly assigned to receive one of the following prophylactic regimen: teicoplanin (a single dose of 400 mg i.v. preoperatively) or cefuroxime (2 g i.v. preoperatively and 1g i.v. every 8 h postoperatively for 24 hours). Patients where daily controlled for wound infection and antibiotics side effects. Gram stains and cultures of wound secretions were routinary performed. Results: Ninety consecutive patients were enrolled; 48 received cefuroxime and 42 teicoplanin. The 2 groups were comparable with the exception of a higher rate of patients >75 years, with femoral fractures and with diabetes mellitus in the cefuroxime group. Three patients (7.1%) in the teicoplanin group and 1 patient (2.0%) in cefuroxime group developed a surgical wound infection. Methicillin-sensitive S. aureus (2) and Corynebacterium spp. (1) were isolated from wound infections in teicoplanin group and methicillin-resistant S. epidermidis (1) was isolated from wound infection in cefuroxime group. Conclusion: Our study confirms the prevalent staphylococcal aetiology and the efficacy of cefuroxime. Two infections caused by methicillin sensitive S. aureus occurred in the teicoplanin group. The present study confirms that by virtue of their excellent activity against methicillinsensitive Staphylococci, Iº and IIº generation cephalosporins should be preferred for routinary perioperative prophylaxis in orthopaedic surgery. Teicoplanin may represent a reasonable option when the risk of methicillin-resistant staphylococcal infection is high.
17th ECCMID / 25th ICC, Posters
86.7% of the classifications. For those classed as ‘Non-invasive infection’ the agreement was 55.6% and for those classed as ‘Colonisation’ the agreement was 85.7%. Conclusions: This study shows that isolation of MRSA from specific specimen types can provide a reasonably accurate indication invasive infection or colonisation. Thus microbiological data from selected specimen types could be used as a proxy marker for infection. However the lack of agreement between clinical evaluation and specimen types classed as indicating non-invasive infection suggests that caution should be exercised in the selection of proxy infection markers. P1923 Characterisation and management of healthcare onset Clostridium difficile associated diarrhoea in a hyperendemic region in Germany H-P. Weil, F. Mattner, R. van den Berg, P. Gastmeier, E. Kuijper, U. Fischer-Br¨ugge (Nordhorn, Hannover, DE; Leiden, NL) Objectives: To investigate whether intensifying infection control measures or an antibiotic use programme is effective to reduce C. difficile incidence rates in three German hospitals (geriatrics [A], diabetology [B] and internal medicine [C]). Methods: A case of CDAD was defined as a patient with diarrhoea and a positive assay for C. difficile toxin A/B. Medication use was subtracted from an electronic pharmacy database. The strains were analysed by PCR-ribotyping and pulsed-field gel electrophoresis (PFGE) and the antibiotic susceptibility was determined by E-test. Results: In 2005, 120, 57 and 123 patients developed CDAD in hospital A, B, or C, respectively. Isolated strains (n = 54) belonged to the two PCR ribotypes 001 (A and C) and/or 046 (A and B), whereas typing by PFGE (n = 38) revealed 9 different strains. Three strains accounted for at least 6, 10, and 9 transmissions in A, B, or C, respectively. The strains were resistant towards erythromycin (89%), clindamycin (96%) and all quinolones (95%). In April 2006 A and B installed infection control measures and reduced the fluoroquinolone use, B also reduced the use of clindamycin. A reduced the incidence rate by 70%, whereas B could not lower the incidence rate. C switched from cefotaxime to ampicillin/sulbactam without special infection control measures, thereby reducing the incidence rate by 76%. Hospital Incidence Transmission Control QuinoClindaCephaloratesa rateb measures lonesc mycinc sporinsc d 2005 p.i. PFGE (%) 2005 p.i. 2005 p.i. 2005 p.i. 2005 p.i. A B C a
58 48 38
17 51 9
6/12 10/13 9/13
(50) no (77) no (69) no
yes 106 yes 176 no 78
46 54 66 134 56 29
36 131 70 119 27 184
142 166 54
(CDAD/10,000PD); b (DDD/1000PD); c Estimated; d After intervention.
Conclusions: Multiresistant C. difficile PCR ribotypes 001 and 046 are hyperendemic in northwest Germany. PFGE typing, rather than PCR-ribotyping, allows the study of nosocomial transmissions. Infection control measures should be installed and the use of fluoroquinolones, clindamycin and cephalosporins should be restricted. P1924 Study on Clostridium difficile-associated diarrhoea in a hospital in Japan Y. Ito, T. Matsushita, Y. Takahashi, T. Nakamura, K. Hayashi, E. Morita, H. Kato (Gifu, Tokyo, JP) Objectives: In Europe and North America, several outbreaks due to NAP1/027 Clostridium difficile have been reported. In our hospital the number of patients with C. difficile-associated diarrhoea (CDAD) increased after January 2005. Our aim of this study is to know nosocomial transmission of specific strains including NAP1/027 among these patients. Methods: Subjects were 15 patients who suffered from CDAD between January 2005 and March 2006 in Gifu Red Cross hospital, general
hospital of 310 beds. The occurrence of CDAD did not concentrate on a single ward, and extended to 5 wards. Five patients had recurrent episodes of CDAD. CDAD was defined as diarrhoea associated with positive for toxigenic culture and/or toxin A assay. The toxin-producing type of isolates was determined by PCR and PCR ribotyping of isolates was performed. Results: Twenty-two strains of C. difficile were isolated from 22 episodes. Twenty strains of C. difficile were toxin-A positive, toxin-B positive and 2 strains were toxin-A negative, toxin-B positive. PCR detecting the binary toxin gene was positive in 3 isolates from 2 patients. Twenty-two isolates were typed into 9 different PCR ribotypes. Type smz, which has been recognized as an epidemic type causing outbreaks in multiple hospitals in Japan, was recovered from 7 episodes of 4 patients and dominant in our hospital. Other three types were isolated from 2 or 3 patients each. Of 5 patients with recurrent CDAD, 4 patients relapsed with the original strain and 1 patient acquired a new strain. PCR ribotype gc8 (Brazier’s PCR ribotype 027) was isolated from one patient with pseudomembranous colitis, who had recurrent diarrhoea caused by the same type. This type was recovered from no other patients. Conclusions: Not a wide spread of a single C. difficile strain but a small scale transmission of several C. difficile strains was found to be related to the occurrence of CDAD. Although nosocomial spread of NAP1/027 strain was not recognized in our hospital, the isolation of the strain in Japan indicates the potential for wide spread of the strain in Japanese hospitals.
P1925 Teicoplanin versus cefuroxime as prophylaxis in prosthetic joint implant surgery M. Gali`e, E. Pistella, F. Napoleoni, G. Condarelli, C. Santini (Rome, IT) Objectives: Infections after joint replacement require prolonged antibiotic therapy and often graft removal. Staphylococci cause up to 70−90% of these infections. Antistaphylococcal prophylaxis decrease the infection rate and Iº or IIº generation cephalosporins are routinary employed. Glycopeptides (teicoplanin and vancomycin) represent a valid alternative for the centres where methicillin-resistant staphylococci are prevalent. Due to the risk of reduced susceptibility to glycopeptides and to the lower activity against methicillin-susceptible strains the use of glycopeptides for prophylaxis is recommended only as alternative and for short periods. Aim of the study was to compare the efficacy of cefuroxime and teicoplanin in a hospital with high (60−80%) incidence of methicillin-resistant staphylococci. Methods: All the patients undergoing elective total joint replacement over a 12-month period were randomly assigned to receive one of the following prophylactic regimen: teicoplanin (a single dose of 400 mg i.v. preoperatively) or cefuroxime (2 g i.v. preoperatively and 1g i.v. every 8 h postoperatively for 24 hours). Patients where daily controlled for wound infection and antibiotics side effects. Gram stains and cultures of wound secretions were routinary performed. Results: Ninety consecutive patients were enrolled; 48 received cefuroxime and 42 teicoplanin. The 2 groups were comparable with the exception of a higher rate of patients >75 years, with femoral fractures and with diabetes mellitus in the cefuroxime group. Three patients (7.1%) in the teicoplanin group and 1 patient (2.0%) in cefuroxime group developed a surgical wound infection. Methicillin-sensitive S. aureus (2) and Corynebacterium spp. (1) were isolated from wound infections in teicoplanin group and methicillin-resistant S. epidermidis (1) was isolated from wound infection in cefuroxime group. Conclusion: Our study confirms the prevalent staphylococcal aetiology and the efficacy of cefuroxime. Two infections caused by methicillin sensitive S. aureus occurred in the teicoplanin group. The present study confirms that by virtue of their excellent activity against methicillinsensitive Staphylococci, Iº and IIº generation cephalosporins should be preferred for routinary perioperative prophylaxis in orthopaedic surgery. Teicoplanin may represent a reasonable option when the risk of methicillin-resistant staphylococcal infection is high.