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Hospital wastewater: A reservoir for carbapenmase producing enterobacteriaceae unrelated to clinical isolates.
Abstracts
MODIFICATION OF ADULT PNEUMOCOCCAL CARRIAGE BY VACCINATION: EFFECT OF 7CONJUGATE VACCINE ON CARRIAGE IN MALAWIAN ADULTS, RESULTS FROM A RANDOMISED CONTROLLED TRIAL. Jody Aberdein 1, Robert Heyderman 3,1, Stephen Gordon 1, Herbert Longwe 1, T Mdezo 1, Maaike Aleerts 1, Neil French 2,1 1
Malawi-Liverpool Wellcome Clinical Research Unit & University of Malawi College of Medicine, Blantyre, Malawi 2 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK 3 Division of Infection and Immunity, University College London, UK
Abstract Introduction: Conjugate pneumococcal vaccination has, in certain settings, reduced rates of invasive disease in unvaccinated individuals due to vaccine-serotype pneumococci. Such herd immunity results from reduced pneumococcal carriage amongst vaccine recipients. Rates of pneumococcal disease are high in Sub-Saharan Africa, particularly in HIV positive individuals, potentially due to high rates of carriage. Such enhanced carriage is not reduced by anti-retroviral treatment. We investigated if carriage in this group is reduced by vaccination. Methods: Naso-pharyngeal swabs from a randomised controlled trial (French et al, NEJM, 2010) that previously demonstrated 7-conjugate pneumococcal vaccine (PCV-7) efficacy against recurrent adult invasive pneumococcal disease were analysed for pneumococcal carriage by standard culture and molecular serotyping. Results: 491 individuals provided 3381 swabs, median 7 (5e9) per person, over median follow-up time of 554 (186e948) days. Per-swab pneumococcal carriage rate was 18%, with 61% of individuals carrying on at least one occasion. In a Cox shared frailty model receipt of PCV-7 did not alter vaccine-type pneumococcus carriage free survival. In the same model HIV infected individuals were more likely to acquire vaccine-type pneumococcus (HR 2.3 (1.07e4.56). Conclusions: PCV-7, whilst able to reduce recurrent invasive pneumococcal disease, does not reduce carriage. The study raises doubts as to the efficacy of this vaccine to prevent non-bacteraemia mucosal disease in the HIV infected. HIV infected individuals are more likely to acquire and carry pneumococcus which may explain their propensity to develop disease, and suggests they may constitute a disease reservoir in the community. http://dx.doi.org/10.1016/j.jinf.2015.09.030
687 1
Lancashire Teaching Hospitals NHS Trust, Preston, UK Antimicrobial Resistance and Healthcare Acquired Infections Reference Unit, London, UK
2
Abstract Introduction: Carbapenemase-producing Enterobacteriaceae (CPE) are a concern for hospitals across the UK due to resistance to the carbapenem antibiotics. Isolation of CPE may require use of toxic antibiotics, and poses a cross infection hazard. Current Public Health England guidelines recommend that hospitals undertake risk factor based patient isolation and faecal screening for CPE on admission to hospital. Patients lacking risk factors would remain undetected but may be excreting CPEs into the hospital wastewater. Testing wastewater may offer a supplement to screening small numbers and reassurance that unrecognised CPE carriers are not being missed. Method: In this study 16 wastewater samples were taken using a newly introduced tap in the pipework, between February and March 2014 and screened using two culture methods: chromIDÒ CARBA agar and chromIDÒCPS agar plus an ertapenem antibiotic disc. Results: Fifty five carbapenem resistant or intermediate isolates were recovered; six were confirmed as metallobeta-lacatmase (MBL) carbapenemase producers and 11 as guinea extended spectrum-5 (GES-5) carbapenemase producers. Discussion: Phenotypic methods used failed to identify GES-5 so there is uncertainty of whether routine confirmation methods would detect them, however isolates produced high level resistance so would have further testing carried out. GES-5 has not been detected in clinical or screening samples at this hospital which does not support a link, limiting the use of wastewater as a surveillance tool. However it is unknown whether these isolates are of environmental origin, or if undetected carriers are producing them, which will not be determined unless widespread screening is carried out. http://dx.doi.org/10.1016/j.jinf.2015.09.029
THE IMPACT OF HIV ON THE BURDEN AND SEVERITY OF INFLUENZA ILLNESS IN MALAWIAN ADULTS: THE BASH-FLU STUDY Antonia Ho 1,2, Stephen J Aston 1,3, Tamara Mitchell 1,2, Maaike Alaerts 1, Mavis Menyere 1, Jane Mallewa 1,4, Mulinda Nyirenda 5, Dean Everett 1,2, Robert S Heyderman 1,3, Neil French 2 1
HOSPITAL WASTEWATER: A RESERVOIR FOR CARBAPENMASE PRODUCING ENTEROBACTERIACEAE UNRELATED TO CLINICAL ISOLATES. Leila White 1, Katie Hopkins 2, Daniele Meunier 2, John Cheesbrough 1, Neil Woodford 2
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi 2 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK 3 Liverpool School of Tropical Medicine, Liverpool, UK 4 University of Malawi College of Medicine, Blantyre, Malawi 5 Queen Elizabeth Central Hospital, Blantyre, Malawi
MODIFICATION OF ADULT PNEUMOCOCCAL CARRIAGE BY VACCINATION: EFFECT OF 7CONJUGATE VACCINE ON CARRIAGE IN MALAWIAN ADULTS, RESULTS FROM A RANDOMISED CONTROLLED TRIAL. Jody Aberdein 1, Robert Heyderman 3,1, Stephen Gordon 1, Herbert Longwe 1, T Mdezo 1, Maaike Aleerts 1, Neil French 2,1 1
Malawi-Liverpool Wellcome Clinical Research Unit & University of Malawi College of Medicine, Blantyre, Malawi 2 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK 3 Division of Infection and Immunity, University College London, UK
Abstract Introduction: Conjugate pneumococcal vaccination has, in certain settings, reduced rates of invasive disease in unvaccinated individuals due to vaccine-serotype pneumococci. Such herd immunity results from reduced pneumococcal carriage amongst vaccine recipients. Rates of pneumococcal disease are high in Sub-Saharan Africa, particularly in HIV positive individuals, potentially due to high rates of carriage. Such enhanced carriage is not reduced by anti-retroviral treatment. We investigated if carriage in this group is reduced by vaccination. Methods: Naso-pharyngeal swabs from a randomised controlled trial (French et al, NEJM, 2010) that previously demonstrated 7-conjugate pneumococcal vaccine (PCV-7) efficacy against recurrent adult invasive pneumococcal disease were analysed for pneumococcal carriage by standard culture and molecular serotyping. Results: 491 individuals provided 3381 swabs, median 7 (5e9) per person, over median follow-up time of 554 (186e948) days. Per-swab pneumococcal carriage rate was 18%, with 61% of individuals carrying on at least one occasion. In a Cox shared frailty model receipt of PCV-7 did not alter vaccine-type pneumococcus carriage free survival. In the same model HIV infected individuals were more likely to acquire vaccine-type pneumococcus (HR 2.3 (1.07e4.56). Conclusions: PCV-7, whilst able to reduce recurrent invasive pneumococcal disease, does not reduce carriage. The study raises doubts as to the efficacy of this vaccine to prevent non-bacteraemia mucosal disease in the HIV infected. HIV infected individuals are more likely to acquire and carry pneumococcus which may explain their propensity to develop disease, and suggests they may constitute a disease reservoir in the community. http://dx.doi.org/10.1016/j.jinf.2015.09.030
687 1
Lancashire Teaching Hospitals NHS Trust, Preston, UK Antimicrobial Resistance and Healthcare Acquired Infections Reference Unit, London, UK
2
Abstract Introduction: Carbapenemase-producing Enterobacteriaceae (CPE) are a concern for hospitals across the UK due to resistance to the carbapenem antibiotics. Isolation of CPE may require use of toxic antibiotics, and poses a cross infection hazard. Current Public Health England guidelines recommend that hospitals undertake risk factor based patient isolation and faecal screening for CPE on admission to hospital. Patients lacking risk factors would remain undetected but may be excreting CPEs into the hospital wastewater. Testing wastewater may offer a supplement to screening small numbers and reassurance that unrecognised CPE carriers are not being missed. Method: In this study 16 wastewater samples were taken using a newly introduced tap in the pipework, between February and March 2014 and screened using two culture methods: chromIDÒ CARBA agar and chromIDÒCPS agar plus an ertapenem antibiotic disc. Results: Fifty five carbapenem resistant or intermediate isolates were recovered; six were confirmed as metallobeta-lacatmase (MBL) carbapenemase producers and 11 as guinea extended spectrum-5 (GES-5) carbapenemase producers. Discussion: Phenotypic methods used failed to identify GES-5 so there is uncertainty of whether routine confirmation methods would detect them, however isolates produced high level resistance so would have further testing carried out. GES-5 has not been detected in clinical or screening samples at this hospital which does not support a link, limiting the use of wastewater as a surveillance tool. However it is unknown whether these isolates are of environmental origin, or if undetected carriers are producing them, which will not be determined unless widespread screening is carried out. http://dx.doi.org/10.1016/j.jinf.2015.09.029
THE IMPACT OF HIV ON THE BURDEN AND SEVERITY OF INFLUENZA ILLNESS IN MALAWIAN ADULTS: THE BASH-FLU STUDY Antonia Ho 1,2, Stephen J Aston 1,3, Tamara Mitchell 1,2, Maaike Alaerts 1, Mavis Menyere 1, Jane Mallewa 1,4, Mulinda Nyirenda 5, Dean Everett 1,2, Robert S Heyderman 1,3, Neil French 2 1
HOSPITAL WASTEWATER: A RESERVOIR FOR CARBAPENMASE PRODUCING ENTEROBACTERIACEAE UNRELATED TO CLINICAL ISOLATES. Leila White 1, Katie Hopkins 2, Daniele Meunier 2, John Cheesbrough 1, Neil Woodford 2
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi 2 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK 3 Liverpool School of Tropical Medicine, Liverpool, UK 4 University of Malawi College of Medicine, Blantyre, Malawi 5 Queen Elizabeth Central Hospital, Blantyre, Malawi