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53 Non-tuberculous mycobacteria in cystic fibrosis: A single centre study of prevalence, sampling and microbiological outcomes
Posters
4. Microbiology
53 Non-tuberculous mycobacteria in cystic fibrosis: A single centre study of prevalence, sampling and microbiological outcomes R.P. Dhillon1 . 1 NHS Greater Glasgow and Clyde, Microbiology, Glasgow, United Kingdom Background: The rise in non tuberculous mycobacteria (NTM) from cystic fibrosis patients is of concern. Discerning pathogenicity from colonisation increases difficulty in treatment. Objectives: The aims of the study were to evaluate the impact of NTM’s by calculating prevalence and species distribution. Macrolide use in the context of NTM sampling was analyzed as were microbiological outcomes of patients who received treatment with those not considered for therapy. Methods: This was a single centre study of cystic fibrosis patients in Glasgow. Electronic databases and written case notes were used to gain microbiological and clinical information. Data was collected from patients who had at least one NTM screen processed. Results: The prevalence of NTMs was 14.9%, the majority species was the Mycobacterium abscessus group (MABSC) followed by Mycobacterium avium complex (MAC). The majority received macrolides prior (58%) and equal figures after first positive culture (50%), predominantly within the MAC group. Despite treatment, microbiological eradication rates (57%) were similar to untreated transient colonisation (61%). Data showed MABSC equally likely to be eradicated or persistent post treatment (50% vs 50%). Conclusion: The data showed an increasing prevalence of NTMs with predominance of MABSC. A potential link between macrolide monotherapy and increasing, persisting NTMs is a concern. This requires more research and judicial use of macrolides. The emergence of MABSC highlights that further studies are required regarding subspecies and transmission. These increasing numbers mandate a multidisciplinary approach for management.
S71
55 Is whole genome sequencing necessary to exclude cross infection with Mycobacterium abscessus ST26 in paediatric cystic fibrosis patients? C. Lucas1 , J.D. Wilkinson2 , C. Mitchell3 , D. Kenna4 , J. Turton4 , N. Mustafa4 , C. Williams5 . 1 Royal Hospital for Sick Children, Microbiology, Glasgow, United Kingdom; 2 Royal Hospital for Sick Children, Respiratory Medicine, Glasgow, United Kingdom; 3 Royal Hospital for Sick Children, Infection Control, Glasgow, United Kingdom; 4 Public Health England, Antimicrobial Resistance and Healthcare Associated Infection Reference Unit, London, United Kingdom; 5 University of the West of Scotland, Institute of HAI, Paisley, United Kingdom Objectives: Patients with Cystic Fibrosis (CF) can be colonized or infected with M. abscessus. Our centre along with others in the UK has seen an increase in patients with this organism. We have reviewed M. abcessus cases since 2011 to attempt to ascertain whether there is a genuine increase in the incidence of this infection and whether there is any possibility of cross infection within our patient group. Methods: Retrospective data on paediatric M. abscessus isolates were retrieved from the microbiology laboratory computer system and historical CF databases. Isolates of M. abscessus were sent to PHE, Colindale, for genetic analysis. Results: There has been a genuine increase in M. abscessus colonization amongst our paediatric CF population over time. Sampling patterns have varied but isolation rates were independent of numbers of sputum samples and patients tested. Five of 13 paediatric patients colonized with M. abscessus harboured strains belonging to clonal lineage ST26. Of these 5, no patients had any recorded opportunity for direct contact within the hospital and we could find no epidemiological evidence of any periods when cross infection could have occurred. Remaining patient isolates were distinct. The isolates from the ST26 patients were sequenced and whole genome analysis was performed. Conclusions: The control of cross infection is an important aspect of CF care. Since diverse ST26 strains have been reported in the context of CF, further genetic analysis including whole genome sequencing may be required to determine any relatedness between isolates and exclude the possibility of hospital acquired M. abscessus infection.
54 Limited transmission of non-tuberculous mycobacteria among Danish cystic fibrosis patients
56 Colonization by Rasamsonia argillacea in cystic fibrosis patients: A two-year retrospective study
M. Wang1 , K.J. Handberg1 , C. Bento1 , T. Qvist2 , S. Jensen-Fangel3 , H.V. Olesen4 , N. Høiby5 , N. Nørskov-Lauritsen1 . 1 Aarhus University Hospital, Department of Clinical Microbiology, Aarhus N, Denmark; 2 Copenhagen University Hospital Rigshospitalet, Department of Infectious Diseases, Cystic Fibrosis Centre Copenhagen, Copenhagen, Denmark; 3 Aarhus University Hospital, Department of Infectious Diseases, Aarhus N, Denmark; 4 Aarhus University Hospital, Department of Paediatrics, Aarhus N, Denmark; 5 Copenhagen University Hospital Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
L. Cariani1 , A. Biffi2 , D. Guarneri2 , D. Girelli2 , A. Teri2 , M. D’Accico1 , B. Beltrami1 , M. Arghittu1 , E. Torresani1 , C. Colombo2 . 1 Fondazione IRCCS C`a Granda Ospedale Maggiore Policlinico Milano, UOS Microbiology and Cystic Fibrosis Microbiology, Milano, Italy; 2 Fondazione IRCCS C`a Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre, Milano, Italy
Objectives: To investigate species distribution, antimicrobial susceptibility and possible transmission of non-tuberculous mycobacteria among Danish cystic fibrosis patients. Methods: Thirty-five non-tuberculous mycobacteria cultured from 2006 to 2013 from Danish cystic fibrosis patients from two centres were investigated (one isolate per patient). The isolates were subjected to antimicrobial susceptibility testing to 15 antimicrobial agents by broth microdilution and to PCR for the erm(41) gene. Partial sequencing of the rpoB gene was used to determine species identification of the isolates. Results: Twenty-three isolates were identified as Mycobacterium abscessus subspecies abscessus, 10 isolates as Mycobacterium abscessus subspecies bolletii (six isolates as subtype massiliense and four as subtype bolletii), and two as Mycobacterium chelonae. Conclusion: Strain relatedness was assessed by a Variable Number Tandem Repeat (VNTR) typing scheme which only revealed a few small clusters (2−4 patients) of related strains within the patient population. These clusters will be further investigated by whole-genome sequencing.
Objectives: Rasamsonia is a new genus which comprises both thermotolerant Talaromyces and thermophilic Geosmithia species. Rasamsonia argillacea (RA) has recently been reported as the cause of invasive mycosis in human chronic granulomatous disease and also as airway colonizer in patients with cystic fibrosis (CF). The aim of this work is to follow patients colonized by emerging fungus Rasamsonia and study their clinical characteristics and conditions. Methods: Over a two years period (2013–2014), seven out of the 798 CF patients, followed at Milan centre, showed at least one positive culture for Rasamsonia. RA was identified macroscopically and microscopically by lactic blue stain. Molecular biology analysis on RA strains will be carried out. Results: No correlation between RA colonization and patient sex (4F, 3M) was found. Six patients carried at least one copy of mutated allele DF508. Five patients received antimycotic oral therapy (4 itraconazole and 1 voriconazole) before RA recovery. Two out of the patients (both treated with itraconazole) were intermittently colonized with RA. One of patients was also chronically colonized with Scedosporium apiospermum. Pulmonary function (FEV1) remained substantially unvaried. Conclusion: All patients were chronically colonized also by various bacteria species: probably the presence of bacteria and the resulting inflammatory response can predispose CF airways to RA acquisition. Further studies are needed to asses the possible association between genotype of patients and colonization by RA, whether antimycotic administration could be a risk factor for RA acquisition and to investigate the RA impact on pulmonary function.
4. Microbiology
53 Non-tuberculous mycobacteria in cystic fibrosis: A single centre study of prevalence, sampling and microbiological outcomes R.P. Dhillon1 . 1 NHS Greater Glasgow and Clyde, Microbiology, Glasgow, United Kingdom Background: The rise in non tuberculous mycobacteria (NTM) from cystic fibrosis patients is of concern. Discerning pathogenicity from colonisation increases difficulty in treatment. Objectives: The aims of the study were to evaluate the impact of NTM’s by calculating prevalence and species distribution. Macrolide use in the context of NTM sampling was analyzed as were microbiological outcomes of patients who received treatment with those not considered for therapy. Methods: This was a single centre study of cystic fibrosis patients in Glasgow. Electronic databases and written case notes were used to gain microbiological and clinical information. Data was collected from patients who had at least one NTM screen processed. Results: The prevalence of NTMs was 14.9%, the majority species was the Mycobacterium abscessus group (MABSC) followed by Mycobacterium avium complex (MAC). The majority received macrolides prior (58%) and equal figures after first positive culture (50%), predominantly within the MAC group. Despite treatment, microbiological eradication rates (57%) were similar to untreated transient colonisation (61%). Data showed MABSC equally likely to be eradicated or persistent post treatment (50% vs 50%). Conclusion: The data showed an increasing prevalence of NTMs with predominance of MABSC. A potential link between macrolide monotherapy and increasing, persisting NTMs is a concern. This requires more research and judicial use of macrolides. The emergence of MABSC highlights that further studies are required regarding subspecies and transmission. These increasing numbers mandate a multidisciplinary approach for management.
S71
55 Is whole genome sequencing necessary to exclude cross infection with Mycobacterium abscessus ST26 in paediatric cystic fibrosis patients? C. Lucas1 , J.D. Wilkinson2 , C. Mitchell3 , D. Kenna4 , J. Turton4 , N. Mustafa4 , C. Williams5 . 1 Royal Hospital for Sick Children, Microbiology, Glasgow, United Kingdom; 2 Royal Hospital for Sick Children, Respiratory Medicine, Glasgow, United Kingdom; 3 Royal Hospital for Sick Children, Infection Control, Glasgow, United Kingdom; 4 Public Health England, Antimicrobial Resistance and Healthcare Associated Infection Reference Unit, London, United Kingdom; 5 University of the West of Scotland, Institute of HAI, Paisley, United Kingdom Objectives: Patients with Cystic Fibrosis (CF) can be colonized or infected with M. abscessus. Our centre along with others in the UK has seen an increase in patients with this organism. We have reviewed M. abcessus cases since 2011 to attempt to ascertain whether there is a genuine increase in the incidence of this infection and whether there is any possibility of cross infection within our patient group. Methods: Retrospective data on paediatric M. abscessus isolates were retrieved from the microbiology laboratory computer system and historical CF databases. Isolates of M. abscessus were sent to PHE, Colindale, for genetic analysis. Results: There has been a genuine increase in M. abscessus colonization amongst our paediatric CF population over time. Sampling patterns have varied but isolation rates were independent of numbers of sputum samples and patients tested. Five of 13 paediatric patients colonized with M. abscessus harboured strains belonging to clonal lineage ST26. Of these 5, no patients had any recorded opportunity for direct contact within the hospital and we could find no epidemiological evidence of any periods when cross infection could have occurred. Remaining patient isolates were distinct. The isolates from the ST26 patients were sequenced and whole genome analysis was performed. Conclusions: The control of cross infection is an important aspect of CF care. Since diverse ST26 strains have been reported in the context of CF, further genetic analysis including whole genome sequencing may be required to determine any relatedness between isolates and exclude the possibility of hospital acquired M. abscessus infection.
54 Limited transmission of non-tuberculous mycobacteria among Danish cystic fibrosis patients
56 Colonization by Rasamsonia argillacea in cystic fibrosis patients: A two-year retrospective study
M. Wang1 , K.J. Handberg1 , C. Bento1 , T. Qvist2 , S. Jensen-Fangel3 , H.V. Olesen4 , N. Høiby5 , N. Nørskov-Lauritsen1 . 1 Aarhus University Hospital, Department of Clinical Microbiology, Aarhus N, Denmark; 2 Copenhagen University Hospital Rigshospitalet, Department of Infectious Diseases, Cystic Fibrosis Centre Copenhagen, Copenhagen, Denmark; 3 Aarhus University Hospital, Department of Infectious Diseases, Aarhus N, Denmark; 4 Aarhus University Hospital, Department of Paediatrics, Aarhus N, Denmark; 5 Copenhagen University Hospital Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
L. Cariani1 , A. Biffi2 , D. Guarneri2 , D. Girelli2 , A. Teri2 , M. D’Accico1 , B. Beltrami1 , M. Arghittu1 , E. Torresani1 , C. Colombo2 . 1 Fondazione IRCCS C`a Granda Ospedale Maggiore Policlinico Milano, UOS Microbiology and Cystic Fibrosis Microbiology, Milano, Italy; 2 Fondazione IRCCS C`a Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre, Milano, Italy
Objectives: To investigate species distribution, antimicrobial susceptibility and possible transmission of non-tuberculous mycobacteria among Danish cystic fibrosis patients. Methods: Thirty-five non-tuberculous mycobacteria cultured from 2006 to 2013 from Danish cystic fibrosis patients from two centres were investigated (one isolate per patient). The isolates were subjected to antimicrobial susceptibility testing to 15 antimicrobial agents by broth microdilution and to PCR for the erm(41) gene. Partial sequencing of the rpoB gene was used to determine species identification of the isolates. Results: Twenty-three isolates were identified as Mycobacterium abscessus subspecies abscessus, 10 isolates as Mycobacterium abscessus subspecies bolletii (six isolates as subtype massiliense and four as subtype bolletii), and two as Mycobacterium chelonae. Conclusion: Strain relatedness was assessed by a Variable Number Tandem Repeat (VNTR) typing scheme which only revealed a few small clusters (2−4 patients) of related strains within the patient population. These clusters will be further investigated by whole-genome sequencing.
Objectives: Rasamsonia is a new genus which comprises both thermotolerant Talaromyces and thermophilic Geosmithia species. Rasamsonia argillacea (RA) has recently been reported as the cause of invasive mycosis in human chronic granulomatous disease and also as airway colonizer in patients with cystic fibrosis (CF). The aim of this work is to follow patients colonized by emerging fungus Rasamsonia and study their clinical characteristics and conditions. Methods: Over a two years period (2013–2014), seven out of the 798 CF patients, followed at Milan centre, showed at least one positive culture for Rasamsonia. RA was identified macroscopically and microscopically by lactic blue stain. Molecular biology analysis on RA strains will be carried out. Results: No correlation between RA colonization and patient sex (4F, 3M) was found. Six patients carried at least one copy of mutated allele DF508. Five patients received antimycotic oral therapy (4 itraconazole and 1 voriconazole) before RA recovery. Two out of the patients (both treated with itraconazole) were intermittently colonized with RA. One of patients was also chronically colonized with Scedosporium apiospermum. Pulmonary function (FEV1) remained substantially unvaried. Conclusion: All patients were chronically colonized also by various bacteria species: probably the presence of bacteria and the resulting inflammatory response can predispose CF airways to RA acquisition. Further studies are needed to asses the possible association between genotype of patients and colonization by RA, whether antimycotic administration could be a risk factor for RA acquisition and to investigate the RA impact on pulmonary function.