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Comparison of phenotypic methods for the detection of IMP producing enterobacteriaceae in queensland
ABSTRACTS
in management changes. Similarly, call-backs were inappropriate when LPs were performed for non-infective indications. An algorithm for call-backs may be useful, however, this seems difficult to accomplish secondary to the variability in ordering practises. Further study is needed to determine if delay results in significant degradation in CSF parameters.
ACTINOBACULUM SCHAALII – A REVIEW OF CASES AND THE DEVELOPMENT OF A PHENOTYPIC SCREEN Robert Stevens and Peter Taylor SEALS Microbiology, Kogarah, NSW, Australia Introduction: Actinobaculum shaalii is an anaerobic and aerotolerant, non-motile, catalase negative, Gram positive bacillus increasingly recognised as a human pathogen. It is easily dismissed as a contaminant, and is difficult to identify. Aim: To determine the epidemiological and clinical characteristics of A. schaalii, develop and perform preliminary evaluation of a phenotypic screen. Methods: Patient demographics from all A. schaalii isolates from 10/05/2012–10/11/2013 were reviewed and clinical details extracted. Isolates were presumptively identified using urease activity and characteristic antibiogram. Isolate identity was confirmed using MALDI-TOF (Bruker) or 16S rRNA sequencing. Results: 20 isolates were identified over the time period. Mean age was 83.65 years (range 67–96, 70% female). The majority of isolates were from the urinary tract with one patient also bacteraemic. All isolates were urease negative, susceptible to penicillin, and resistant to trimethoprim and ciprofloxacin on CDS testing. This combination of tests had 100% sensitivity and specificity for presumptively identifying A. schaalii, proving more reliable than MALDI-TOF. Discussion: A. schaalii is an important but difficult to identify pathogen of the urinary tract in the elderly. Urease activity and antibiogram are highly sensitive and specific simple screening tools and warrant further evaluation prior to wider application to identify A. schaalii.
CD4 COUNTS IN HIV POSITIVE PATIENTS IN WEST TIMOR, INDONESIA – A SNAPSHOT Samson Ehe Teron1, Don Bosko Joni Dumbaris1, Rasvitri Utami2 and Smathi Chong3,4 1Department of Clinical Pathology, 2Department of Medicine, Prof. Johannes Hospital, Kupang, West Timor, Indonesia, 3Flinders Overseas Health Group, Australia, and 4Clinipath Pathology, Perth, WA, Australia Background: Data regarding HIV patients’ CD4 counts reported from Indonesia are scarce, especially from the outer islands. Until recently CD4 counts have only been available in large academic
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tertiary referral hospitals in Java or Bali. In 2013, the Alere Pima CD4 Analyser was rolled out across many sites in Indonesia including Prof. Johannes Hospital. Aims: To describe the CD4 count distributions of patients with HIV/AIDS at Prof. Johannes Hospital. This data will also serve as a baseline to monitor the HIV/AIDS program and as a basis for comparison when HIV viral load testing becomes available in the near future. Methods: This is a retrospective single centre study based at Prof. Johannes Hospital in Kupang involving analysis of routinely captured data from the laboratory CD4 count logbook. Patient files and pharmacy records will be reviewed to determine whether the patients were on anti-retrovirals. Results/Discussion: Results for 2013 will be presented. Preliminary analysis reveals that the majority of patients have CD4 counts eligible for starting anti-retroviral therapy. Public health and health personnel education needs to be improved to enable earlier diagnosis and initiation of anti-retrovirals and prophylaxis for opportunistic infections to eligible HIV patients to improve morbidity and mortality.
COMPARISON OF PHENOTYPIC METHODS FOR THE DETECTION OF IMP PRODUCING ENTEROBACTERIACEAE IN QUEENSLAND Nicola Townell1, Hanna E. Sidjabat2, Graeme Nimmo1, David L. Paterson1,2 and Narelle M. George1 1Microbiology, Central Laboratory, Pathology Queensland, and 2The University of Queensland, UQ Centre of Clinical Research, Qld, Australia Background: The prevalence of carbapenemase producing enterobacteriaceae (CPE), particularly IMP producers (IMP), in Australia is increasing. Optimal methods for detection of IMP CPE are unknown. We compare six phenotypic methods to determine the most sensitive method for the detection of IMP CPE. Methods: We tested 25 molecularly confirmed IMP CPE producers, including 16 Enterobacter cloacae, collected from Queensland Health hospitals. The following methods were performed: disc susceptibility testing (DST), minimum inhibitory concentrations (MICs) by E-test, broth microdilution (BMD) and Vitek 2, modified hodge test (MHT) and Carba NP test. Results: Meropenem MIC range (MIC50/90) was 0.25–>32 (4/16), 0.25–32 (2/16), 1–16 (16/16) for BMD, E-test and Vitek 2, respectively. Seventeen percent of isolates had a Vitek 2 meropenem MIC between 1–2 mg/mL. Using EUCAST breakpoints, all isolates tested resistant by Ertapenem E-test and all except for one isolate was resistant by ertapenem DST. CLSI breakpoints increased detection of CPE with meropenem and imipenem. Carba NP test and MHT provided positive results for all isolates. Conclusion: Our results indicate that isolates with a Vitek 2 meropenem MIC of 1 mg/mL should undergo further phenotypic testing. Ertapenem DST, ertapenem E-test, Carba NP test and MHT are the most sensitive methods for detection of IMP CPE.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
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PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Pathology (2014), 46(S1)
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
in management changes. Similarly, call-backs were inappropriate when LPs were performed for non-infective indications. An algorithm for call-backs may be useful, however, this seems difficult to accomplish secondary to the variability in ordering practises. Further study is needed to determine if delay results in significant degradation in CSF parameters.
ACTINOBACULUM SCHAALII – A REVIEW OF CASES AND THE DEVELOPMENT OF A PHENOTYPIC SCREEN Robert Stevens and Peter Taylor SEALS Microbiology, Kogarah, NSW, Australia Introduction: Actinobaculum shaalii is an anaerobic and aerotolerant, non-motile, catalase negative, Gram positive bacillus increasingly recognised as a human pathogen. It is easily dismissed as a contaminant, and is difficult to identify. Aim: To determine the epidemiological and clinical characteristics of A. schaalii, develop and perform preliminary evaluation of a phenotypic screen. Methods: Patient demographics from all A. schaalii isolates from 10/05/2012–10/11/2013 were reviewed and clinical details extracted. Isolates were presumptively identified using urease activity and characteristic antibiogram. Isolate identity was confirmed using MALDI-TOF (Bruker) or 16S rRNA sequencing. Results: 20 isolates were identified over the time period. Mean age was 83.65 years (range 67–96, 70% female). The majority of isolates were from the urinary tract with one patient also bacteraemic. All isolates were urease negative, susceptible to penicillin, and resistant to trimethoprim and ciprofloxacin on CDS testing. This combination of tests had 100% sensitivity and specificity for presumptively identifying A. schaalii, proving more reliable than MALDI-TOF. Discussion: A. schaalii is an important but difficult to identify pathogen of the urinary tract in the elderly. Urease activity and antibiogram are highly sensitive and specific simple screening tools and warrant further evaluation prior to wider application to identify A. schaalii.
CD4 COUNTS IN HIV POSITIVE PATIENTS IN WEST TIMOR, INDONESIA – A SNAPSHOT Samson Ehe Teron1, Don Bosko Joni Dumbaris1, Rasvitri Utami2 and Smathi Chong3,4 1Department of Clinical Pathology, 2Department of Medicine, Prof. Johannes Hospital, Kupang, West Timor, Indonesia, 3Flinders Overseas Health Group, Australia, and 4Clinipath Pathology, Perth, WA, Australia Background: Data regarding HIV patients’ CD4 counts reported from Indonesia are scarce, especially from the outer islands. Until recently CD4 counts have only been available in large academic
S101
tertiary referral hospitals in Java or Bali. In 2013, the Alere Pima CD4 Analyser was rolled out across many sites in Indonesia including Prof. Johannes Hospital. Aims: To describe the CD4 count distributions of patients with HIV/AIDS at Prof. Johannes Hospital. This data will also serve as a baseline to monitor the HIV/AIDS program and as a basis for comparison when HIV viral load testing becomes available in the near future. Methods: This is a retrospective single centre study based at Prof. Johannes Hospital in Kupang involving analysis of routinely captured data from the laboratory CD4 count logbook. Patient files and pharmacy records will be reviewed to determine whether the patients were on anti-retrovirals. Results/Discussion: Results for 2013 will be presented. Preliminary analysis reveals that the majority of patients have CD4 counts eligible for starting anti-retroviral therapy. Public health and health personnel education needs to be improved to enable earlier diagnosis and initiation of anti-retrovirals and prophylaxis for opportunistic infections to eligible HIV patients to improve morbidity and mortality.
COMPARISON OF PHENOTYPIC METHODS FOR THE DETECTION OF IMP PRODUCING ENTEROBACTERIACEAE IN QUEENSLAND Nicola Townell1, Hanna E. Sidjabat2, Graeme Nimmo1, David L. Paterson1,2 and Narelle M. George1 1Microbiology, Central Laboratory, Pathology Queensland, and 2The University of Queensland, UQ Centre of Clinical Research, Qld, Australia Background: The prevalence of carbapenemase producing enterobacteriaceae (CPE), particularly IMP producers (IMP), in Australia is increasing. Optimal methods for detection of IMP CPE are unknown. We compare six phenotypic methods to determine the most sensitive method for the detection of IMP CPE. Methods: We tested 25 molecularly confirmed IMP CPE producers, including 16 Enterobacter cloacae, collected from Queensland Health hospitals. The following methods were performed: disc susceptibility testing (DST), minimum inhibitory concentrations (MICs) by E-test, broth microdilution (BMD) and Vitek 2, modified hodge test (MHT) and Carba NP test. Results: Meropenem MIC range (MIC50/90) was 0.25–>32 (4/16), 0.25–32 (2/16), 1–16 (16/16) for BMD, E-test and Vitek 2, respectively. Seventeen percent of isolates had a Vitek 2 meropenem MIC between 1–2 mg/mL. Using EUCAST breakpoints, all isolates tested resistant by Ertapenem E-test and all except for one isolate was resistant by ertapenem DST. CLSI breakpoints increased detection of CPE with meropenem and imipenem. Carba NP test and MHT provided positive results for all isolates. Conclusion: Our results indicate that isolates with a Vitek 2 meropenem MIC of 1 mg/mL should undergo further phenotypic testing. Ertapenem DST, ertapenem E-test, Carba NP test and MHT are the most sensitive methods for detection of IMP CPE.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
S102
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Pathology (2014), 46(S1)
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.