P1131 Antimicrobial susceptibilities and prevalence of qnrA in UTI isolates from hospital and the community

In vitro antibacterial susceptibility P1131 Antimicrobial susceptibilities and prevalence of qnrA in UTI isolates from hospital and the community P.G. Higgins, M. Lohr, F. Wisplinghoff, H. Seifert, H. Wisplinghoff (Cologne, DE) Objectives: To determine the prevalence of the quinolone resistance gene qnrA and to compare species distribution and antimicrobial susceptibility of nosocomial and community acquired urinary tract infections. Methods: Over a three-month period, isolates were prospectively collected from hospitals and private practices in the Cologne metropolitan area. 557 Gram-negative isolates were included in the study. Species identification and antimicrobial susceptibility testing were performed using the VITEK Two and the MicroScan-Walkaway system. Presence of qnrA was investigated by PCR. Results: E. coli was most the commonly isolated organism, accounting for 59% of all isolates, followed by Klebsiella spp. and Pseudomonas aeruginosa (13% and 8% respectively). Species distribution was similar in nosocomial and community acquired UTI, except for Klebsiella spp. and Morganella morganii that were more commonly seen in nosocomial UTI, while E. coli was more frequently observed in community acquired UTI. Prevalence of qnrA was low; the gene was detected in 2 Enterobacter cloacae isolates, both from nosocomial UTIs. One of these strains showed intermediate resistance to ciprofloxacin while the other was fully susceptible. Nosocomial isolates were in general more resistant to the antimicrobial agents than the community isolates. For example, 90% of P. aeruginosa from the community were susceptible to ceftazidime and imipenem compared to 83% and 71% respectively of the hospital isolates. Also 93% of community E. coli were susceptible to cefuroxime compared to 78% of hospital isolates. Of note, 88% of nosocomial Proteus species were susceptible to ciprofloxacin compared to only 59% in community isolates. Conclusions: As expected, nosocomial Gram-negative UTI pathogens are less susceptible to antimicrobials compared to those that are community acquired. However, the notable exception to this is ciprofloxacin activity against Proteus species. The qnrA gene is still rarely found in Germany and to date has not been found in community isolates. P1132 Occurrence and susceptibility rates among urinary tract infection pathogens from Europe: a seven-year report from the SENTRY Antimicrobial Surveillance Program (1997–2000, 2003) G. Moet, M. Stilwell, R. Jones (North Liberty, US) Objectives: To report the occurrence and susceptibility (S) rates for pathogens causing urinary tract infection (UTI) isolated from medical centres in Europe, Turkey, and Israel. The S rates were compared by CLSI and EUCAST breakpoints. The SENTRY Antimicrobial Surveillance Program was utilised as the platform for collecting urine culture isolates during 5 years out of 10 year period that the programme has been in existence. Methods: A total of 4,507 strains (50 consecutive, non-duplicate per site) were collected from 42 medical centres in 19 countries in Europe, Turkey and Israel (1997–2000, 2003). During the 5 years 31 locations participated in 3 or more years. All isolate identifications were confirmed and S testing performed in a central laboratory using reference broth microdilution methods (M7-A7) and interpretive criteria of CLSI and EUCAST (2006). ESBL phenotype rates were as determined by CLSI criteria. Results: The 5 most frequent pathogens accounted for 83.3% of the total CA-UTI and the top 7 for 90.0%. These 7 pathogens displayed little change in occurrence rates over the 7 year period. Escherichia coli remained the dominant UTI pathogen at nearly 50% while enterococci showed a slight decrease from 11.7 to 10.1%. Variations in 1999 were greater due to only 9 participating sites (small sample size). Among commonly isolated Enterobacteriaceae, carbapenems were the most active agents ranging from 99.1% to 100.0% S; lower S was

S307 noted for ciprofloxacin (77−89%) and trimethoprim/sulfamethoxazole (T/S; 63−78%). Ceftazidime S rates for Klebsiella, E. coli, and Proteus mirabilis were 80.7, 97.2, 95.5% (CLSI) and lower at 76.9, 94.7, 92.5% (EUCAST), respectively. ESBL phenotype rates were 24.0, 5.3, and 7.2% for the same organism groups. Polymyxin B was active against Pseudomonas aeruginosa at 99% S, followed by carbapenems and piperacillin/tazobactam at 84% and amikacin at 83%. Vancomycin, teicoplanin, and linezolid remained active against enterococci (99% S). Variation of rank order in SENTRY Program UTI pathogens by year for Europe Rank

Organism

All years

1997

1998

1999

2000

2003

1 2 3 4 5 6 7 Total

E. coli Enterococci Klebsiella spp. P. aeruginosa P. mirabilis Enterobacter spp. Indole + Proteus spp.

2,175(48.3) 510(11.3) 445(9.9) 355(7.9) 265(5.9) 194(4.3) 109(2.4) 4,507

505(51.0) 116(11.7) 83(8.4) 65(6.6) 52(5.2) 49(4.9) 21(2.1) 991

548(48.0) 127(11.1) 120(10.5) 91(8.0) 70(6.1) 36(3.2) 31(2.7) 1,142

68(39.5) 23(13.4) 25(11.6) 16(9.3) 3(1.7) 11(6.4) 5(2.9) 172a

361(46.1) 100(12.8) 69(8.8) 71(9.1) 56(7.2) 33(4.2) 27(3.1) 783

693(48.8) 144(10.1) 153(10.8) 112(7.9) 84(5.9) 65(4.6) 28(2.0) 1,419

a Small sample.

Conclusions: This comprehensive report from the SENTRY Program covering 7 years of UTI sampling in Europe, reports minor variation in the most common pathogens between the sample intervals but with significant S differences noted among monitored countries. Emerging resistance is limiting the usefulness of commonly prescribed UTI agents including T/S and FQ, forcing reliance on more potent parenteral broadspectrum agents and the additional problems inherent in their use.

P1133 Increasing ciprofloxacine resistance in the bacteria isolated from urine samples: 1999–2004 O. Alici, Z. Acikgoz, S. Gocer, S. Gamberzade, M. Karahocagil (Ankara, TR) Purpose: The aim of the study was to determine the ciprofloxacin resistance of various bacterial species responsible for UTIs according to IDSA guidelines for UTIs between 1999 and 2004, retrospectively. Materials and Methods: Overall 3,520 unduplicated urinary isolates were screened for their ciprofloxacin resistance between 1999 and 2004, retrospectively. Of the isolates 3,276 (93.1%) were from outpatients and 244 (6.9%) from the hospitalised ones. The screening was made regardless of age, gender and other demographic parameters. The isolates were identified by using conventional biochemical tests and the semi automated API systems (bioM´erieux, France) when it was required. Antimicrobial susceptibility assays were performed using the disc diffusion method according to the recommendations of Clinical and Laboratory Standards Institute (CLSI) criteria. The data were analysed by Chi-square test in SPSS 10.0 programme and p values lower than 0.05 were considered significant. Results: Of the screened isolates 3,216 (91.4%) were Gram negative bacilli and 304 (8.6%) were Gram positive cocci. Totally 29.9% (73/244) of in-patients isolates and 11.8% (281/2,376) of outpatient isolates had ciprofloxacin resistance. Out-patient and in-patient distributions of the resistant isolates according to main microorganism groups were as follows: For Gram positives 34.7% (n.8) and 65.3% (n.15); for Gram negatives 19.6% (n.65) and 80.4% (n.266), respectively. While there was no statistically significant difference between Gram positive and Gram negative microorganisms in terms of ciprofloxacin resistance (p > .05), the resistance rates of isolates from in-patients and out-patients differed significantly (p < 0.001). Ciprofloxacin resistance rates over the six years (1999–2004) were: 3.3% (17/509), 4.2 (33/551), 6.7 (40/593), 13% (102/786), 16.1% (124/768) and 15.3% (48/313) respectively. the differences between 1999 and 2001, 1999 and 2002, 2000 and 2001, 2000 and 2002 and 2001 and 2002 were significant (p < 0.05). Conclusions: We concluded that a prominent increase in ciprofloxacin resistance has emerged in bacteria isolated as UTI agents, especially in E. coli. This problem of resistance is a considerable issue for in-patients and has the potential to affect out-patients in long term periods.