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Clinico-microbiological spectrum of infective endocarditis at a tertiary care centre
138
17th International Congress on Infectious Diseases / International Journal of Infectious Diseases 45S (2016) 1–477
Type: Poster Presentation
Type: Poster Presentation
Final Abstract Number: 41.145 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Final Abstract Number: 41.146 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Phenotypic and genotypic characterization of V.cholerae O1 strains isolated in Democratic Republic of Congo in sanctuaries areas
Clinico-microbiological spectrum of infective endocarditis at a tertiary care centre
Kamwiziku 1,∗ ,
G. J.J. Muyembe 4
M.L.
Quilici 2 ,
D.
Bompangue 3 ,
1
University of Kinshasa, faculty of medecine,Unit of Research and Training-Ecology and Infectious Disease Control, Kinshasa, Congo, Democratic Republic of 2 Institut Pasteur, Paris, France 3 Kinshasa University, Kinshasa, Congo, Democratic Republic of 4 University of Kinshasa, Kinshasa, Congo, Democratic Republic of Background: Cholera is the most severe of acute diarrhea epidemic caused by V. cholerae. It is classified into two biotypes: classic and El Tor, and three serotypes: Inaba, Ogawa and Hikojima. The first six cholera pandemics were caused by the classical biotype. In 1961, El Tor replaced the classical biotype upon occurrence of the seventh pandemic. Since the last decade, a new variant of El Tor has been documented. The project objective was to investigate the V. cholerae strains circulating in sanctuaries sites in DRC. Methods & Materials: Phenotypic and genotypic characterization of ten strains of V. cholerae O1from Kalemie and Uvira isolated in 2014 and 2015 were investigated by classical bacteriological techniques, PCR and PFGE. Results: These strains belong to the El Tor biotype and serotype Ogawa. The presence of ctxB1 virulence gene suggests the existence of a variant of El Tor. Strains from Kalémie presented four antibiotic resistance (colistin, nitrofurans, nalidixic acid and Norfloxacin) whereas Uvira resistance was observed for seven antibiotics (colistin, nitrofurans, nalidixic acid, Norfloxacin, Sulfonamides, Streptomycin Sulfonamides and trimethoprim Quinolone resistance and mutations on gyrA and parC genes were observed. The molecular genotyping method in this study; the pulsed field coupled to two enzymes Not I and Sfi I allowed to differentiate two different strains circulating in Uvira and Kalemie. Conclusion: Two different strains circulating in Uvira and Kalemie have been highlighted both by their PFGE profiles and antibiotic resistance. http://dx.doi.org/10.1016/j.ijid.2016.02.338
P. Kanne 1,∗ , L. Vemu 2 , S. Sudhaharan 2 , N. Mamidi 2 1 Nizams Institute of Medical Sciences, Telangana, Telangana, India 2 Nizams Institute of Medical Sciences, Telangana, India
Background: Background: Infective endocarditis (IE) is a microbial infection of the endothelial surface of the cardiac valves. Despite advances it is associated with morbidity and mortality. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential for good patient outcome. Methods & Materials: Materials and methods: The medical records of 191 patients clinically diagnosed with infective endocarditis were reviewed for clinical and microbiology data admitted between January 2011 to Sep 2015. Blood cultures were detected by using BacT/Alert FAN and SN aerobic bottles.68/191 cases were positive for bacterial pathogens. The isolates were identified and sensitivity was tested using API and Vitek 2 systems Results: Results: The age range of the patients were17-54 years with a female preponderance. Chronic Rheumatic heart disease (CRHD) was the most common predisposing factor followed by valvular abnormalities, mostly mitral stenosis. 24/191 cases had Prosthetic valve endocarditis (PVE), 167/191 had Native valve endocarditis (NVE).19/24(79.1%) PVE cases and 49/167 (29.34%) NVE were culture positive. Culture negative endocarditis was 123/191(64.39%). Isolates for NVE belonged to the Streptococcus species and include Streptococcus mitis (15) Streptococcus sanguinis (8) Streptococcus pyogenes (3), Streptococcus pneumonia (1), Enterococcus faecalis (5), Enterococcus faecium (6), Nutritionally variant streptococci (2),Gemella morbillorum (2) Methicillin Resistant Staphylococcus aureus (1) Methicillin Sensitive Staphylococcus aureus (2),Brucella melitensis (2),and also includes Brevundimonas diminuta (1),Corynebacterium diphtheria (1). The isolates for PVE were Methicillin Resistant Staphylococcus aureus (4),Methicillin Sensitive Staphylococcus aureus (2) Methicillin Resistant coagulase negative Staphylococcus (7), Klebsiella pneumonia (3), Achromobacter denitrificans (1), Burkholderia.cepacia (2) The NVE were treated with a combination of a B-lactam or glycopeptide with an aminoglycoside intravenously for prolonged period of 4-6 weeks with a successful outcome The PVE cases were treated with the appropriate antibiotics as per the antibiotic susceptibility report. Conclusion: Conclusion: Despite recent advances, the management of IE remains a serious and challenging problem The high morbidity and mortality rates, accurate identification of aetiological agents and appropriate antimicrobial therapy are associated with IE. Strict infection control measures will help to reduce the
17th International Congress on Infectious Diseases / International Journal of Infectious Diseases 45S (2016) 1–477
139
incidence of PVE, which is most often due to hospital acquired pathogens http://dx.doi.org/10.1016/j.ijid.2016.02.339 Type: Poster Presentation
Final Abstract Number: 41.147 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Fig. 2. Delay of antibiotic use and SAB persistence.
Conclusion: In our study, persistence of SAB were associated with MRSA as a pathogen, delay in susceptible antibiotic use, but not with clinical backgrounds nor with vancomycin susceptibilities.
Risk factors associated with persistence of staphylococcus aureus bacteremia
http://dx.doi.org/10.1016/j.ijid.2016.02.340
T. Kitazawa ∗ , K. Seo, I. Koga, Y. Ota
Type: Poster Presentation
Teikyo University, Tokyo, Japan Background: Staphylococcus aureus bacteremia (SAB) is one of the serious nosocomial or community acquired infections. SAB can persist longer as compared to bacteremia with other bacteria, although whether risk factors associated with persistent SAB which pointed out in previous studies are related to its persistency of SAB in the settings with different antibiotic resistant rate and different antibiotic use. In this study, we determined clinical characteristics and risk factors for persistent SAB by comparing persistent SAB cases and non-persistent SAB cases in Japan. Methods & Materials: All the first episodes of adult SAB cases in 1,150 bed academic medical hospital in Japan form May 2009 through April 2014 were enrolled. The onset of SAB was defined as the time when the first positive blood cultures were collected. Persistent SAB was defined as a case in which positive blood culture persisted 72 hours or longer, and non-persistent SAB was defined as a case negativity of blood culture was verified within 72 hours. Clinical backgrounds, primary infection sites, methicillin resistant or not (MRSA or MSSA), vancomycin susceptibility, and antibiotic use were retrospectively reviewed from medical records. Results: Of 618 SAB cases, MRSA cases and MSSA cases were 293 and 325 cases, respectively. Persistent SAB were 42 cases, non-persistent SAB were 34 cases. Median persistent periods of persistent SAB and non-persistent SAB were 2 days and 8 days, respectively. Clinical backgrounds and primary infection sites primary infection sites were similar between the two groups. The rate of MRSA was in persistent SAB was statistically higher than that of non-persistent SAB (93% vs 35%, P<0.001)(Fig. 1). Although susceptibilities to vancomycin, were similar between the two groups, the timing of susceptible antibiotics use in persistent SAB was later than that in non-persistent SAB (2 days vs 0 days, P <0.001) (Fig. 2).
Fig. 1. Methicillin susceptibility of SA and SAB persistence.
Final Abstract Number: 41.148 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Comparison of the outcome of clostridium difficile infection between patients treated with metronidazole and patients treated with vancomycin: A multi-center retrospective cohort study in Japan K.-I. Kobayashi 1,∗ , Y. Ainoda 2 , N. Sekiya 3 , H. Kurai 4 , A. Imamura 5 1 Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan 2 Department of Infectious Disease, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo, Japan 3 Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan 4 Shizuoka Cancer Center Hospital, Shizuoka, Japan 5 Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
Background: The rising incidence and worsening severity of Clostridium difficile infection (CDI) have prompted improvements in the treatment of CDI in many countries. Vancomycin (VCM) and Metronidazole (MNZ) are both widely used. VCM may bring about a better clinical response and outcome than MNZ in treating CDI, especially severe CDI. The optimal treatment for CDI, however, has yet to be established in Japan. Dosages and durations of medications for CDI have not been clearly described in previous studies, and MNZ has only recently been approved for CDI under the national health insurance system. Our group conducted Japan’s first multicenter retrospective study to investigate the optimal treatment for CDI by comparing outcomes between MNZ- and VCM-treated groups at variable dosages and treatment durations. Methods & Materials: CDI patients hospitalized at four teaching hospitals from April 2012 through September 2013 were enrolled. CDI was diagnosed when CD toxin was positive by enzyme immunoassay test in stool. The patients were treated for 10-14 days with oral MNZ (1000 or 1500 mg per day: MNZ group) or oral VCM (500 mg per day: VCM group). Kaplan-Meier curves were created to compare the survival curves between MNZ- and VCM-treated patients.
17th International Congress on Infectious Diseases / International Journal of Infectious Diseases 45S (2016) 1–477
Type: Poster Presentation
Type: Poster Presentation
Final Abstract Number: 41.145 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Final Abstract Number: 41.146 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Phenotypic and genotypic characterization of V.cholerae O1 strains isolated in Democratic Republic of Congo in sanctuaries areas
Clinico-microbiological spectrum of infective endocarditis at a tertiary care centre
Kamwiziku 1,∗ ,
G. J.J. Muyembe 4
M.L.
Quilici 2 ,
D.
Bompangue 3 ,
1
University of Kinshasa, faculty of medecine,Unit of Research and Training-Ecology and Infectious Disease Control, Kinshasa, Congo, Democratic Republic of 2 Institut Pasteur, Paris, France 3 Kinshasa University, Kinshasa, Congo, Democratic Republic of 4 University of Kinshasa, Kinshasa, Congo, Democratic Republic of Background: Cholera is the most severe of acute diarrhea epidemic caused by V. cholerae. It is classified into two biotypes: classic and El Tor, and three serotypes: Inaba, Ogawa and Hikojima. The first six cholera pandemics were caused by the classical biotype. In 1961, El Tor replaced the classical biotype upon occurrence of the seventh pandemic. Since the last decade, a new variant of El Tor has been documented. The project objective was to investigate the V. cholerae strains circulating in sanctuaries sites in DRC. Methods & Materials: Phenotypic and genotypic characterization of ten strains of V. cholerae O1from Kalemie and Uvira isolated in 2014 and 2015 were investigated by classical bacteriological techniques, PCR and PFGE. Results: These strains belong to the El Tor biotype and serotype Ogawa. The presence of ctxB1 virulence gene suggests the existence of a variant of El Tor. Strains from Kalémie presented four antibiotic resistance (colistin, nitrofurans, nalidixic acid and Norfloxacin) whereas Uvira resistance was observed for seven antibiotics (colistin, nitrofurans, nalidixic acid, Norfloxacin, Sulfonamides, Streptomycin Sulfonamides and trimethoprim Quinolone resistance and mutations on gyrA and parC genes were observed. The molecular genotyping method in this study; the pulsed field coupled to two enzymes Not I and Sfi I allowed to differentiate two different strains circulating in Uvira and Kalemie. Conclusion: Two different strains circulating in Uvira and Kalemie have been highlighted both by their PFGE profiles and antibiotic resistance. http://dx.doi.org/10.1016/j.ijid.2016.02.338
P. Kanne 1,∗ , L. Vemu 2 , S. Sudhaharan 2 , N. Mamidi 2 1 Nizams Institute of Medical Sciences, Telangana, Telangana, India 2 Nizams Institute of Medical Sciences, Telangana, India
Background: Background: Infective endocarditis (IE) is a microbial infection of the endothelial surface of the cardiac valves. Despite advances it is associated with morbidity and mortality. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential for good patient outcome. Methods & Materials: Materials and methods: The medical records of 191 patients clinically diagnosed with infective endocarditis were reviewed for clinical and microbiology data admitted between January 2011 to Sep 2015. Blood cultures were detected by using BacT/Alert FAN and SN aerobic bottles.68/191 cases were positive for bacterial pathogens. The isolates were identified and sensitivity was tested using API and Vitek 2 systems Results: Results: The age range of the patients were17-54 years with a female preponderance. Chronic Rheumatic heart disease (CRHD) was the most common predisposing factor followed by valvular abnormalities, mostly mitral stenosis. 24/191 cases had Prosthetic valve endocarditis (PVE), 167/191 had Native valve endocarditis (NVE).19/24(79.1%) PVE cases and 49/167 (29.34%) NVE were culture positive. Culture negative endocarditis was 123/191(64.39%). Isolates for NVE belonged to the Streptococcus species and include Streptococcus mitis (15) Streptococcus sanguinis (8) Streptococcus pyogenes (3), Streptococcus pneumonia (1), Enterococcus faecalis (5), Enterococcus faecium (6), Nutritionally variant streptococci (2),Gemella morbillorum (2) Methicillin Resistant Staphylococcus aureus (1) Methicillin Sensitive Staphylococcus aureus (2),Brucella melitensis (2),and also includes Brevundimonas diminuta (1),Corynebacterium diphtheria (1). The isolates for PVE were Methicillin Resistant Staphylococcus aureus (4),Methicillin Sensitive Staphylococcus aureus (2) Methicillin Resistant coagulase negative Staphylococcus (7), Klebsiella pneumonia (3), Achromobacter denitrificans (1), Burkholderia.cepacia (2) The NVE were treated with a combination of a B-lactam or glycopeptide with an aminoglycoside intravenously for prolonged period of 4-6 weeks with a successful outcome The PVE cases were treated with the appropriate antibiotics as per the antibiotic susceptibility report. Conclusion: Conclusion: Despite recent advances, the management of IE remains a serious and challenging problem The high morbidity and mortality rates, accurate identification of aetiological agents and appropriate antimicrobial therapy are associated with IE. Strict infection control measures will help to reduce the
17th International Congress on Infectious Diseases / International Journal of Infectious Diseases 45S (2016) 1–477
139
incidence of PVE, which is most often due to hospital acquired pathogens http://dx.doi.org/10.1016/j.ijid.2016.02.339 Type: Poster Presentation
Final Abstract Number: 41.147 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Fig. 2. Delay of antibiotic use and SAB persistence.
Conclusion: In our study, persistence of SAB were associated with MRSA as a pathogen, delay in susceptible antibiotic use, but not with clinical backgrounds nor with vancomycin susceptibilities.
Risk factors associated with persistence of staphylococcus aureus bacteremia
http://dx.doi.org/10.1016/j.ijid.2016.02.340
T. Kitazawa ∗ , K. Seo, I. Koga, Y. Ota
Type: Poster Presentation
Teikyo University, Tokyo, Japan Background: Staphylococcus aureus bacteremia (SAB) is one of the serious nosocomial or community acquired infections. SAB can persist longer as compared to bacteremia with other bacteria, although whether risk factors associated with persistent SAB which pointed out in previous studies are related to its persistency of SAB in the settings with different antibiotic resistant rate and different antibiotic use. In this study, we determined clinical characteristics and risk factors for persistent SAB by comparing persistent SAB cases and non-persistent SAB cases in Japan. Methods & Materials: All the first episodes of adult SAB cases in 1,150 bed academic medical hospital in Japan form May 2009 through April 2014 were enrolled. The onset of SAB was defined as the time when the first positive blood cultures were collected. Persistent SAB was defined as a case in which positive blood culture persisted 72 hours or longer, and non-persistent SAB was defined as a case negativity of blood culture was verified within 72 hours. Clinical backgrounds, primary infection sites, methicillin resistant or not (MRSA or MSSA), vancomycin susceptibility, and antibiotic use were retrospectively reviewed from medical records. Results: Of 618 SAB cases, MRSA cases and MSSA cases were 293 and 325 cases, respectively. Persistent SAB were 42 cases, non-persistent SAB were 34 cases. Median persistent periods of persistent SAB and non-persistent SAB were 2 days and 8 days, respectively. Clinical backgrounds and primary infection sites primary infection sites were similar between the two groups. The rate of MRSA was in persistent SAB was statistically higher than that of non-persistent SAB (93% vs 35%, P<0.001)(Fig. 1). Although susceptibilities to vancomycin, were similar between the two groups, the timing of susceptible antibiotics use in persistent SAB was later than that in non-persistent SAB (2 days vs 0 days, P <0.001) (Fig. 2).
Fig. 1. Methicillin susceptibility of SA and SAB persistence.
Final Abstract Number: 41.148 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)
Comparison of the outcome of clostridium difficile infection between patients treated with metronidazole and patients treated with vancomycin: A multi-center retrospective cohort study in Japan K.-I. Kobayashi 1,∗ , Y. Ainoda 2 , N. Sekiya 3 , H. Kurai 4 , A. Imamura 5 1 Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan 2 Department of Infectious Disease, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Tokyo, Japan 3 Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan 4 Shizuoka Cancer Center Hospital, Shizuoka, Japan 5 Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
Background: The rising incidence and worsening severity of Clostridium difficile infection (CDI) have prompted improvements in the treatment of CDI in many countries. Vancomycin (VCM) and Metronidazole (MNZ) are both widely used. VCM may bring about a better clinical response and outcome than MNZ in treating CDI, especially severe CDI. The optimal treatment for CDI, however, has yet to be established in Japan. Dosages and durations of medications for CDI have not been clearly described in previous studies, and MNZ has only recently been approved for CDI under the national health insurance system. Our group conducted Japan’s first multicenter retrospective study to investigate the optimal treatment for CDI by comparing outcomes between MNZ- and VCM-treated groups at variable dosages and treatment durations. Methods & Materials: CDI patients hospitalized at four teaching hospitals from April 2012 through September 2013 were enrolled. CDI was diagnosed when CD toxin was positive by enzyme immunoassay test in stool. The patients were treated for 10-14 days with oral MNZ (1000 or 1500 mg per day: MNZ group) or oral VCM (500 mg per day: VCM group). Kaplan-Meier curves were created to compare the survival curves between MNZ- and VCM-treated patients.