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P24.17 Ertapenem resistant Klebsiella pneumoniae acquisition risk factors among hospitalized patients
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Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90
67, C (31) & H (26). Of the H cases, 18 were medical, 3 surgical, 2 ITU & 3 other. E. coli (105 patients) was followed by Klebsiella pneumoniae (12), Citrobacter koseri (4) and Enterobacter cloacae (3). PCR was performed on 68 E. coli, 5 K. pneumoniae, 3 C. koseri & 2 E. cloacae. There were 44 CTX-M15 (40 E. coli, 3 K. pneumoniae, 1 C. koseri), 14 CTX-M9 (12 E. coli, 1 each of K. pneumoniae & C. koseri), 1 CTX-M9 & 15. 19 were non-CTX-M. Responses were obtained from of 85% patients. 93% had received antibiotics and 24% had a urinary catheter. No risk factor was identified for 2 patients. 55% were treated. Options included nitrofurantoin (24), carbapenems (12), trimethoprim (11), fluoroquinolones (4) and co-amoxiclav (3). Discussion: ESBL is a significant problem in Peterborough. CTX-M were the most common type isolated. 25% were community acquired, but most had ≥1 risk factor. P24.15 Prevalence of ESBL production in Enterobacter, Serratia, Citrobacter and Morganella clinical isolates in 3 teaching hospitals in The Netherlands B. Diederen1 , M. van der Aar1 , J. Cohen Stuart2 . 1 The Regional Laboratory of Public Health, Netherlands; 2 University Medical Center Utrecht, Netherlands Background: Although ESBL production is most frequently reported in E. coli and Klebsiella spp., data on ESBL prevalence in Enterobacteriaceae co-expressing chromosomal AmpC betalactamases is sparse. Aim/Objective: The objective of this study was to determine the prevalence of ESBL-production in Enterobacter spp., Serratia spp., Citrobacter spp. and Morganella spp. in 3 teaching hospitals in the North-West of The Netherlands. Methods: To determine the prevalence of ESBL-production in Enterobacteriaceae co-expressing chromosomal AmpC betalactamases, all Enterobacter spp., Serratia spp., Citrobacter spp. and Morganella spp., isolated between February 2009 and May 2009 from clinical samples of hospitalised patients, were tested for ESBLproduction using combination disc tests. Isolates from surveillance cultures were not included. One isolate per patient was tested. The discs contained 30 mg cefotaxime, 30 mg cefotaxime + 10 mg clavulanic acid (CA), 30 mg ceftazidime, 30 mg ceftazidime + 10 mg CA, 30 mg cefepime and 30 mg cefepime + 10 mg CA. Isolates were considered ESBL positive if the zone diameter of the cephalosporin + CA was ≥5 mm larger than the zone diameter of the cephalosporin alone. Results: A total of 284 isolates were obtained (71 Citrobacter spp., 124 Enterobacter spp., 44 Morganella spp. and 45 Serratia spp.). ESBL production was observed in 6 of 118 Enterobacter isolates (ESBL prevalence in Enterobacter spp. 5.1%; 95% CI 2.4–10%)). In none of the Citrobacter spp., Morganella spp. and Serratia spp. isolates, ESBL production was observed. Conclusions: ESBL prevalence in Enterobacter spp. was 5.1%, indicating that detection of ESBL is required for Enterobacter spp. However, ESBL production was not observed in other Enterobacteriaceae with inducible chromosomal AmpC betalactamases, suggesting that detection of ESBL is not necessary for these Enterobacteriaceae, since they are not an important reservoir for ESBLs.
P24.16 A parallel increase of ESBL producing Enterobacteriaceae in the hospital and outpatient setting in the Haarlem region, The Netherlands C. Malipaard1 , E. Yzerman2 , M. van der Aar2 , S. Euser2 , B. Diederen2 . 1 Spaarne Hospital, Infection Control Department, Netherlands; 2 The Regional Laboratory of Public Health, Haarlem, Netherlands Introduction: The objective of this study was to determine the prevalence of ESBLs in the hospital setting and outpatient setting between 2005 and 2009 in the Haarlem region in The Netherlands. Methods: Data were collected from the laboratory information system of the Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands. The study included all routine clinical patient samples from three teaching hospitals (Haarlem, Hoofddorp and Beverwijk) with a total of 1691 beds, and an outpatient setting of 750,000 inhabitants. Between 2005 and 2009 all microbiological results of Escherichia coli and Klebsiella pneumoniae isolates were examined. Only one isolate per patient per year was included. Resistance for third generation cefhalosporins was determined using CLSI (M100-S20) criteria. This was used as surrogate marker for ESBL positivity. Results: A total of 40,616 E. coli and 6,084 K. pneumoniae isolates were included in the analysis. Half of all strains (51%) were isolated in the hospital setting, and the other half (49%) in the outpatient setting. Data from the E. coli isolates showed a significant and parallel increase in the proportion of ESBL positive strains between 2005 and 2009 for both settings: for the outpatient setting, from 1.2% in 2005 to 3.2% in 2009 (p < 0.001); for the hospital setting, from 1.6% in 2005 to 4.5% in 2009 (p < 0.001) (Fisher’s exact test). There were no significant differences in the proportion of ESBL positive strains between 2005 and 2009 for the K. pneumoniae isolates. Conclusion: Our data show a parallel emergence of ESBL producing E. coli in both the community and hospital setting in our region, strongly suggesting a community based dissemination. This increase is most probably due to the rapid and widespread presence of CTX-M-type beta-lactamases in the community. It is likely that in the near future clinicians will be forced to use the carbapenems as the first choice for empirical treatment of serious infections. P24.17 Ertapenem resistant Klebsiella pneumoniae acquisition risk factors among hospitalized patients G.B. Orsi1 , A. Carattoli2 , A. Giordano1 , A. Garcia-Fernandez2 , A. Bencardino1 , R. Gianfreda1 , M. Venditti1 . 1 “Sapienza” University of Rome, Italy; 2 Istituto Superiore di Sanit` a, Rome, Italy Background: An Ertapenem-resistant K. pneumoniae (ER-Kp) clone was identified in the teaching hospital Umberto I in Rome and assigned to the ST37 lineage by MLST. Aims: Identify risk factors for ER-Kp acquisition. Methods: Records of 100 patients with K. pneumoniae isolation from July 2008 to December 2009 were reviewed. Strains were isolated and identified by routine procedures and antimicrobial susceptibility determined by Vitek 2 system. Results: 38 ER-Kp (28 infected, 10 colonized) and 62 Ertapenemsusceptible K. pneumoniae (ES-Kp) (43 infected, 19 colonized) were included. In univariable analysis ER-Kp isolation was associated with prior antimicrobial treatment (p < 0.01), drugs number (p < 0.01), Carbapenems (p < 0.01), acute renal failure (p < 0.01), endoscopy (p < 0.01), 2nd generation Cephalosporins (p < 0.02), Daptomicin (p < 0.02), heart disease (p < 0.03), age (p < 0.04), Oxazolidones (p < 0.04) Glicopeptides (<0.04), surgery (p < 0.05). Seventy-one patients developed infection (28 ER-Kp and 43 ESKp) and ER-Kp association was confirmed for acute renal failure, parenteral nutrition, endoscopy, 2nd generation Cephalosporins, Carbapenems, Daptomicin and Oxazolidones. Logistic regression
Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90
analysis for ER-Kp carriage underlined the importance of carbapenems (OR 12.9; 95%CI 3.09–53.7; p < 0.01), 2nd generation cephalosporins (OR 11.8; 95%CI 1.86–74.4; p < 0.01), endoscopy (OR 5.59; 95%CI 1.32–23.6; p < 0.02), acute renal failure (OR 5.32; 95%CI 1.13–25.1; p < 0.04) and 3rd generation cephalosporins (OR 4.15; 95%CI 1.09–15.8; p < 0.04). Overall 30 patients out of 100 died and among the infected, although not significant, mortality was higher in ER-Kp (39.3%) than ES-Kp (27.9%). Conclusion: As ER-Kp is an emerging clinical threat, spread control is crucial. Our findings confirm that prior use of certain antimicrobials, specifically carbapenems and cephalosporins are primary independent risk factors for the development of ER. P24.18 Risk factors associated with resistance to 3rd gen cephalosporins in Enterobacteriaceae isolates from intensive care unit patients in Saudi Arabia D. Baxter, N. Al-Abdullah. King Abdulaziz University Hospital, Saudi Arabia Intensive care units (ICUs) are high-risk areas for the acquisition of HAIs by Gram-negative bacteria, especially Enterobacteriaceae. This study set out to identify the risk factors associated with Enterobacteriaceae HAIs. It was conducted prospectively in four ICUs in tertiary care hospitals in Saudi Arabia from September 2006 to April 2007. ICU-acquired Enterobacteriaceae infections were found in 149 patients, of whom 76 were resistant to third generation cephalosporins (3GCs). Fiftey six had E. coli, 58 had K. pneumoniae and 35 had Enterobacter spp. Previous hospitalisation, impaired immunity, length of ICU stay, exposure to invasive lines and duration of catheterisation were significant risk factors for Enterobacteriaceae HAIs. In multivariate analysis, CVCs and NGTs were independently associated with Enterobacteriaceae infections. Poster Session 25 – Resistant Gram Positive Bacterial Infection P25.01 Methicillin-resistant Staphilococcus Aureus infections in a service of vascular surgery: evaluation of a prevention strategy V. Garc´ıa-Roman, J. Sanchez-Pay ´ a, ´ R. Camargo-Angeles, C. Villanueva-Ruiz, C. Garc´ıa-Gonzalez, ´ M. Fuster-Perez, ´ C. EscrivaPons, J. Barrenengoa-Sanudo. ˜ Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Spain Background: One of the measures to prevent nosocomial MRSA infections, is the check of the situation of carrier condition in patients at the admission moment in a medical center. Objective: Evaluate the effectiveness of initiating this measure in a Service of Vascular Surgery after an increase of the incidence of this kind of infections during the 1 semester of 2009. Methods: Intervention: the current recommendations of extended contact precautions when a case of MRSA is detected, are complemented by the checking of MRSA nasal carrier condition, at the patient’s admission moment, from May, 2009. All the hospitalized patients in the Service of Vascular Surgery were included in the Cohort study, from July, 2008 to April, 2009. The patients have been grouped in four periods: 2 semester of 2008, 1 semester of 2009, 2 semester of 2009 and the period from January to April at this year 2010. The definition criteria of infection case are from the CDC. The Incidence Rate has been calculated for every 10,000 days of hospital stay for each period of time, and the Relative Risk (RR) has been calculated with its 95% confidence intervals (95% CI) using as reference category the 1 semester of 2009. Results: The incidence of infection cases during the second semester of 2008 was 7 cases per 10,000 days of hospital stay, RR: 0.62 (0.10–2.71); during the first semester of 2009, 12 cases
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per 10,000 days of hospital stay; during the second semester of 2009, 4 cases per 10,000 days of hospital stay, RR: 0.39 (0.04– 2.04); and from January to April 2010, there have been 3 cases per 10,000 days of hospital stay, RR: 0.24 (0.01–1.85). Conclusions: The carrying out of the checking of MRSA’s carrier condition at the patient’s admission moment, as a complementary measure to the habitual prevention and control infection measures of this unit, is demonstrating its effectiveness, although the decrease achieved in infections incidence is not statistically significant. P25.02 Are there regional differences in the burden of MRSA, VRE and ESBL in 219 German intensive care units, 2008–2009? F. Schwab, E. Meyer, C. Geffers, P. Gastmeier. Charite University Medicine, Germany Objectives: To determine the burden of multidrug resistant organisms (MDRO) in the years 2009 and 2009 and to analyse the regional distribution in 219 German intensive care units participating in the German Nosocomial Infection Surveillance System (ICU-KISS). Methods: The ICUs reported data on MRSA, VRE and ESBLproducing E. coli (EC) and K. pneumoniae (KP)-cases and presence of these MDRO both on admission (defined as known carriage or detection within 48 hours of admission) and on acquisition during the ICU-stay (defined as detection ≥ 48 hours after admission). For the regional analysis the 16 German Federal States were grouped into 5 geographic regions (east, south east, south west, north and west). Incidence densities (ID) of MDR-bacteria per 1000 patient days (pd). Results: 219 ICUs with 378,500 patients and 1,390,268 pd provided data. There were significant differences in IDs of MRSA, VRE, ESBLEC and ESBL-KP between the 5 regions. The ID of MRSA ranged between 2.4 in north and 5.3 in east Germany. ESBL-EC was also highest in east Germany and only 0.6 in the north as it was VRE (0.9 in the east and 0.1 in the north). ESBL-KP ranged from 0.2 in the south-west to o.7 in the east. The regions also differed in the proportion of ICUs per region that had encountered at least one case of MDR-bacteria. These differences ranged from 30% to 70% for VRE, from 65% to 88% for ESBL-EC and from 42% to 69% for ESBL-KP but only 93–98% for MRSA. Conclusion: MRSA shows the highest incidence density of the analysed bacteria and is endemic in all German regions. The burden of ESBL-ECO/KLE and VRE is still lower, however, there are larger regional differences indicating ongoing regional spread. The strong regional variation of the incidence of MRSA, VRE and ESBL-ECO/KLE in Germany indicates that high incidences of these bacteria are not only due to problems with infection control in individual ICUs and that a nationwide strategy for the reduction of antimicrobial resistance is needed. P25.03 Bed occupancy and methicillin-resistant Staphylococcus aureus infection rate in intensive care units: 2003–2008 1 , D. Bordonaba-Bosque2 , M.J. Hernandez-Navarrete ´ 1 1 C. Lapresta-Moros , G. Santana-Lopez ´ , S. Belkebir3 , S. PastorEixarch1 . 1 Miguel Servet Teaching Hospital, Spain; 2 The Health Science Aragones Institute, Spain; 3 Teaching Unit of Preventive Medicine and Public Health, Spain Background: There is an increasing concern about the levels of bed occupancy and its effect on the rate of healthcare-associated infections (HAIs). Objective: To detect the impact of workload in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods: Routine active surveillance data collected from four adults ICUs from 2003 to 2008. The MRSA surveillance was passive
Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90
67, C (31) & H (26). Of the H cases, 18 were medical, 3 surgical, 2 ITU & 3 other. E. coli (105 patients) was followed by Klebsiella pneumoniae (12), Citrobacter koseri (4) and Enterobacter cloacae (3). PCR was performed on 68 E. coli, 5 K. pneumoniae, 3 C. koseri & 2 E. cloacae. There were 44 CTX-M15 (40 E. coli, 3 K. pneumoniae, 1 C. koseri), 14 CTX-M9 (12 E. coli, 1 each of K. pneumoniae & C. koseri), 1 CTX-M9 & 15. 19 were non-CTX-M. Responses were obtained from of 85% patients. 93% had received antibiotics and 24% had a urinary catheter. No risk factor was identified for 2 patients. 55% were treated. Options included nitrofurantoin (24), carbapenems (12), trimethoprim (11), fluoroquinolones (4) and co-amoxiclav (3). Discussion: ESBL is a significant problem in Peterborough. CTX-M were the most common type isolated. 25% were community acquired, but most had ≥1 risk factor. P24.15 Prevalence of ESBL production in Enterobacter, Serratia, Citrobacter and Morganella clinical isolates in 3 teaching hospitals in The Netherlands B. Diederen1 , M. van der Aar1 , J. Cohen Stuart2 . 1 The Regional Laboratory of Public Health, Netherlands; 2 University Medical Center Utrecht, Netherlands Background: Although ESBL production is most frequently reported in E. coli and Klebsiella spp., data on ESBL prevalence in Enterobacteriaceae co-expressing chromosomal AmpC betalactamases is sparse. Aim/Objective: The objective of this study was to determine the prevalence of ESBL-production in Enterobacter spp., Serratia spp., Citrobacter spp. and Morganella spp. in 3 teaching hospitals in the North-West of The Netherlands. Methods: To determine the prevalence of ESBL-production in Enterobacteriaceae co-expressing chromosomal AmpC betalactamases, all Enterobacter spp., Serratia spp., Citrobacter spp. and Morganella spp., isolated between February 2009 and May 2009 from clinical samples of hospitalised patients, were tested for ESBLproduction using combination disc tests. Isolates from surveillance cultures were not included. One isolate per patient was tested. The discs contained 30 mg cefotaxime, 30 mg cefotaxime + 10 mg clavulanic acid (CA), 30 mg ceftazidime, 30 mg ceftazidime + 10 mg CA, 30 mg cefepime and 30 mg cefepime + 10 mg CA. Isolates were considered ESBL positive if the zone diameter of the cephalosporin + CA was ≥5 mm larger than the zone diameter of the cephalosporin alone. Results: A total of 284 isolates were obtained (71 Citrobacter spp., 124 Enterobacter spp., 44 Morganella spp. and 45 Serratia spp.). ESBL production was observed in 6 of 118 Enterobacter isolates (ESBL prevalence in Enterobacter spp. 5.1%; 95% CI 2.4–10%)). In none of the Citrobacter spp., Morganella spp. and Serratia spp. isolates, ESBL production was observed. Conclusions: ESBL prevalence in Enterobacter spp. was 5.1%, indicating that detection of ESBL is required for Enterobacter spp. However, ESBL production was not observed in other Enterobacteriaceae with inducible chromosomal AmpC betalactamases, suggesting that detection of ESBL is not necessary for these Enterobacteriaceae, since they are not an important reservoir for ESBLs.
P24.16 A parallel increase of ESBL producing Enterobacteriaceae in the hospital and outpatient setting in the Haarlem region, The Netherlands C. Malipaard1 , E. Yzerman2 , M. van der Aar2 , S. Euser2 , B. Diederen2 . 1 Spaarne Hospital, Infection Control Department, Netherlands; 2 The Regional Laboratory of Public Health, Haarlem, Netherlands Introduction: The objective of this study was to determine the prevalence of ESBLs in the hospital setting and outpatient setting between 2005 and 2009 in the Haarlem region in The Netherlands. Methods: Data were collected from the laboratory information system of the Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands. The study included all routine clinical patient samples from three teaching hospitals (Haarlem, Hoofddorp and Beverwijk) with a total of 1691 beds, and an outpatient setting of 750,000 inhabitants. Between 2005 and 2009 all microbiological results of Escherichia coli and Klebsiella pneumoniae isolates were examined. Only one isolate per patient per year was included. Resistance for third generation cefhalosporins was determined using CLSI (M100-S20) criteria. This was used as surrogate marker for ESBL positivity. Results: A total of 40,616 E. coli and 6,084 K. pneumoniae isolates were included in the analysis. Half of all strains (51%) were isolated in the hospital setting, and the other half (49%) in the outpatient setting. Data from the E. coli isolates showed a significant and parallel increase in the proportion of ESBL positive strains between 2005 and 2009 for both settings: for the outpatient setting, from 1.2% in 2005 to 3.2% in 2009 (p < 0.001); for the hospital setting, from 1.6% in 2005 to 4.5% in 2009 (p < 0.001) (Fisher’s exact test). There were no significant differences in the proportion of ESBL positive strains between 2005 and 2009 for the K. pneumoniae isolates. Conclusion: Our data show a parallel emergence of ESBL producing E. coli in both the community and hospital setting in our region, strongly suggesting a community based dissemination. This increase is most probably due to the rapid and widespread presence of CTX-M-type beta-lactamases in the community. It is likely that in the near future clinicians will be forced to use the carbapenems as the first choice for empirical treatment of serious infections. P24.17 Ertapenem resistant Klebsiella pneumoniae acquisition risk factors among hospitalized patients G.B. Orsi1 , A. Carattoli2 , A. Giordano1 , A. Garcia-Fernandez2 , A. Bencardino1 , R. Gianfreda1 , M. Venditti1 . 1 “Sapienza” University of Rome, Italy; 2 Istituto Superiore di Sanit` a, Rome, Italy Background: An Ertapenem-resistant K. pneumoniae (ER-Kp) clone was identified in the teaching hospital Umberto I in Rome and assigned to the ST37 lineage by MLST. Aims: Identify risk factors for ER-Kp acquisition. Methods: Records of 100 patients with K. pneumoniae isolation from July 2008 to December 2009 were reviewed. Strains were isolated and identified by routine procedures and antimicrobial susceptibility determined by Vitek 2 system. Results: 38 ER-Kp (28 infected, 10 colonized) and 62 Ertapenemsusceptible K. pneumoniae (ES-Kp) (43 infected, 19 colonized) were included. In univariable analysis ER-Kp isolation was associated with prior antimicrobial treatment (p < 0.01), drugs number (p < 0.01), Carbapenems (p < 0.01), acute renal failure (p < 0.01), endoscopy (p < 0.01), 2nd generation Cephalosporins (p < 0.02), Daptomicin (p < 0.02), heart disease (p < 0.03), age (p < 0.04), Oxazolidones (p < 0.04) Glicopeptides (<0.04), surgery (p < 0.05). Seventy-one patients developed infection (28 ER-Kp and 43 ESKp) and ER-Kp association was confirmed for acute renal failure, parenteral nutrition, endoscopy, 2nd generation Cephalosporins, Carbapenems, Daptomicin and Oxazolidones. Logistic regression
Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90
analysis for ER-Kp carriage underlined the importance of carbapenems (OR 12.9; 95%CI 3.09–53.7; p < 0.01), 2nd generation cephalosporins (OR 11.8; 95%CI 1.86–74.4; p < 0.01), endoscopy (OR 5.59; 95%CI 1.32–23.6; p < 0.02), acute renal failure (OR 5.32; 95%CI 1.13–25.1; p < 0.04) and 3rd generation cephalosporins (OR 4.15; 95%CI 1.09–15.8; p < 0.04). Overall 30 patients out of 100 died and among the infected, although not significant, mortality was higher in ER-Kp (39.3%) than ES-Kp (27.9%). Conclusion: As ER-Kp is an emerging clinical threat, spread control is crucial. Our findings confirm that prior use of certain antimicrobials, specifically carbapenems and cephalosporins are primary independent risk factors for the development of ER. P24.18 Risk factors associated with resistance to 3rd gen cephalosporins in Enterobacteriaceae isolates from intensive care unit patients in Saudi Arabia D. Baxter, N. Al-Abdullah. King Abdulaziz University Hospital, Saudi Arabia Intensive care units (ICUs) are high-risk areas for the acquisition of HAIs by Gram-negative bacteria, especially Enterobacteriaceae. This study set out to identify the risk factors associated with Enterobacteriaceae HAIs. It was conducted prospectively in four ICUs in tertiary care hospitals in Saudi Arabia from September 2006 to April 2007. ICU-acquired Enterobacteriaceae infections were found in 149 patients, of whom 76 were resistant to third generation cephalosporins (3GCs). Fiftey six had E. coli, 58 had K. pneumoniae and 35 had Enterobacter spp. Previous hospitalisation, impaired immunity, length of ICU stay, exposure to invasive lines and duration of catheterisation were significant risk factors for Enterobacteriaceae HAIs. In multivariate analysis, CVCs and NGTs were independently associated with Enterobacteriaceae infections. Poster Session 25 – Resistant Gram Positive Bacterial Infection P25.01 Methicillin-resistant Staphilococcus Aureus infections in a service of vascular surgery: evaluation of a prevention strategy V. Garc´ıa-Roman, J. Sanchez-Pay ´ a, ´ R. Camargo-Angeles, C. Villanueva-Ruiz, C. Garc´ıa-Gonzalez, ´ M. Fuster-Perez, ´ C. EscrivaPons, J. Barrenengoa-Sanudo. ˜ Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Spain Background: One of the measures to prevent nosocomial MRSA infections, is the check of the situation of carrier condition in patients at the admission moment in a medical center. Objective: Evaluate the effectiveness of initiating this measure in a Service of Vascular Surgery after an increase of the incidence of this kind of infections during the 1 semester of 2009. Methods: Intervention: the current recommendations of extended contact precautions when a case of MRSA is detected, are complemented by the checking of MRSA nasal carrier condition, at the patient’s admission moment, from May, 2009. All the hospitalized patients in the Service of Vascular Surgery were included in the Cohort study, from July, 2008 to April, 2009. The patients have been grouped in four periods: 2 semester of 2008, 1 semester of 2009, 2 semester of 2009 and the period from January to April at this year 2010. The definition criteria of infection case are from the CDC. The Incidence Rate has been calculated for every 10,000 days of hospital stay for each period of time, and the Relative Risk (RR) has been calculated with its 95% confidence intervals (95% CI) using as reference category the 1 semester of 2009. Results: The incidence of infection cases during the second semester of 2008 was 7 cases per 10,000 days of hospital stay, RR: 0.62 (0.10–2.71); during the first semester of 2009, 12 cases
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per 10,000 days of hospital stay; during the second semester of 2009, 4 cases per 10,000 days of hospital stay, RR: 0.39 (0.04– 2.04); and from January to April 2010, there have been 3 cases per 10,000 days of hospital stay, RR: 0.24 (0.01–1.85). Conclusions: The carrying out of the checking of MRSA’s carrier condition at the patient’s admission moment, as a complementary measure to the habitual prevention and control infection measures of this unit, is demonstrating its effectiveness, although the decrease achieved in infections incidence is not statistically significant. P25.02 Are there regional differences in the burden of MRSA, VRE and ESBL in 219 German intensive care units, 2008–2009? F. Schwab, E. Meyer, C. Geffers, P. Gastmeier. Charite University Medicine, Germany Objectives: To determine the burden of multidrug resistant organisms (MDRO) in the years 2009 and 2009 and to analyse the regional distribution in 219 German intensive care units participating in the German Nosocomial Infection Surveillance System (ICU-KISS). Methods: The ICUs reported data on MRSA, VRE and ESBLproducing E. coli (EC) and K. pneumoniae (KP)-cases and presence of these MDRO both on admission (defined as known carriage or detection within 48 hours of admission) and on acquisition during the ICU-stay (defined as detection ≥ 48 hours after admission). For the regional analysis the 16 German Federal States were grouped into 5 geographic regions (east, south east, south west, north and west). Incidence densities (ID) of MDR-bacteria per 1000 patient days (pd). Results: 219 ICUs with 378,500 patients and 1,390,268 pd provided data. There were significant differences in IDs of MRSA, VRE, ESBLEC and ESBL-KP between the 5 regions. The ID of MRSA ranged between 2.4 in north and 5.3 in east Germany. ESBL-EC was also highest in east Germany and only 0.6 in the north as it was VRE (0.9 in the east and 0.1 in the north). ESBL-KP ranged from 0.2 in the south-west to o.7 in the east. The regions also differed in the proportion of ICUs per region that had encountered at least one case of MDR-bacteria. These differences ranged from 30% to 70% for VRE, from 65% to 88% for ESBL-EC and from 42% to 69% for ESBL-KP but only 93–98% for MRSA. Conclusion: MRSA shows the highest incidence density of the analysed bacteria and is endemic in all German regions. The burden of ESBL-ECO/KLE and VRE is still lower, however, there are larger regional differences indicating ongoing regional spread. The strong regional variation of the incidence of MRSA, VRE and ESBL-ECO/KLE in Germany indicates that high incidences of these bacteria are not only due to problems with infection control in individual ICUs and that a nationwide strategy for the reduction of antimicrobial resistance is needed. P25.03 Bed occupancy and methicillin-resistant Staphylococcus aureus infection rate in intensive care units: 2003–2008 1 , D. Bordonaba-Bosque2 , M.J. Hernandez-Navarrete ´ 1 1 C. Lapresta-Moros , G. Santana-Lopez ´ , S. Belkebir3 , S. PastorEixarch1 . 1 Miguel Servet Teaching Hospital, Spain; 2 The Health Science Aragones Institute, Spain; 3 Teaching Unit of Preventive Medicine and Public Health, Spain Background: There is an increasing concern about the levels of bed occupancy and its effect on the rate of healthcare-associated infections (HAIs). Objective: To detect the impact of workload in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods: Routine active surveillance data collected from four adults ICUs from 2003 to 2008. The MRSA surveillance was passive