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P1254 Differences between early and late prosthetic valve endocarditis in a series of 169 cases
Community-acquired bacterial infections P1254 Differences between early and late prosthetic valve endocarditis in a series of 169 cases A. Plata, J.M. Reguera, A. Alarcon, J. Galvez, J. Ruiz, J. de la Torre, J.M. Lomas, C. Hidalgo-Tenorio, J.L. Haro, J.D. Colmenero for the Andalusian Group for the Study of Cardiovascular Infections Objectives: To determine the clinical, epidemiological, diagnostic, and therapeutic differences between early (EP) and late (LP) prosthetic valve endocarditis in a series of 169 cases of prosthetic valve endocarditis. Method: Descriptive study of 169 cases of prosthetic valve endocarditis from a series of 696 left-sided infectious endocarditis from six secondor third-level Andalusian hospitals from 1985 to 2005. Early prosthetic endocarditis was considered up to 12 months after surgery. Results: No major differences in age, gender or valve affected were found. Clinical presentation was more acute in EP (15.7±18 days) than in LP (41±107 days) and there were more congestive heart failure (NYHA III/IV: 22.7% vs 14.8%). Other clinical signs like fever, splenomegaly and constitutional syndrome were more frequent in LP than EP. Clinical complications (CNS affectation, systemic embolisms, ocular or skin involvement) were more frequently registered in LP, but the complications related to poorer prognosis (renal failure, septic shock or distress) were more frequent in EP. Microbiology: EP: S. coagulase negative (50%), S. aureus (13%). LP: S. coagulase negative (22.8%), S. viridans (20.8%). Vancomicin was needed in 63% of EP and 27.7% of LP. Transthoracic echocardiography reaveled diagnosis more frequently in EP than in LP (66.6% vs 41.2%) and so did transoesophageal echocardiography (91% vs 84.7%). 63.2% of the EP and “only” 41.6% of the LE needed surgery. The most frequent indication for surgery for both was right ventricular failure. The complications found in ultrasound or surgery (abscess, fistula, . . . ) were more frequent in EP (66%) than in LP (27.7%). Related mortality was 55.9% in EP versus 31.7% in LP. Conclusions: Attending the different physiopathology between EP and LP we have found the following differences: 1. LP is more insidiosus and needs more days of simptoms for its diagnosis. 2. Transoesophageal echocardiography is better than transthoracic echocardiography for the diagnosis in EP and LP. 3. S. coagulase negative is still the most frequent microrganism in EP and in LP the aetiology is similar to native endocarditis. 4. EP patients develop more complications (annular abscess, fistula, . . . ) leaving them in a worse basal situation (NYHA) and a greater need for surgery together with an increased mortality. P1255 Risk factors for polymicrobial blood stream infections of biliary origin M. Salvad´o, V. Arauzo, E. Calbo, P. Vazquez, N. Freixes, M. Riera, M. Xercavins, C. Nicol´as, J. Garau (Terrassa, ES) Introduction: Biliary tract infection is an important source of bacteraemia. Frequently, polymicrobial blood stream infections (BSI) are also of biliary origin. The aim of our study was to compare monomicrobial (M) with polymicrobial (P) BSIs of biliary origin in terms of epidemiology, aetiology, severity and outcome. Material and Methods: From Jan 2000 to June 2006, all adult cases of BSI from a biliary source were identified through records of the Clinical Microbiology Laboratory in a 450-bed acute care teaching hospital. Medical charts were retrospectively reviewed. Variables included demographics, aetiology, comorbidities, severity of disease, and mortality. Results: During the study period, a total of 2,260 BSI were recorded; of these, 106 (4.7%) were polymicrobial, and one third (31 episodes) of them were of biliary origin. These 31 episodes represent a 14.8% of all BSI of biliary origin seen during this period. Men (66% vs 45%; p = 0.028), older age (76 y vs 70 y; p = 0.019), and the presence of stones (41% vs 19.2%; p = 0.046) were more frequent in the M group.
S345 Comorbidities (Charlson score mean 3.3 vs 2.3; p = 0.039), CPR levels (198 vs 115; p = 0.008), the presence of biliary neoplasia (14.8% vs 4.2%; p = 0.005) or biliary prostheses (25% vs 6.3%; p = 0.006) were more frequent in the polymicrobial bacteraemia group. E. coli was the most frequently isolated microorganism in both groups. Previous surgery or endoscopic retrograde cholangiopancreatography were identified in 18.8% in the M group vs. 26.9% in P (NS), and in 35% in M vs. 22.2% in P (NS), respectively. Severity, defined by the presence of shock, ICU admission or vasoactive drugs requirement, was similar in both groups. Mortality was higher in the polymicrobial bacteraemia group [10% in M vs 19% in P; p = 0.217)]. Conclusions: Biliary tract infection is an important cause of polymicrobial bacteraemia, a third of all cases of polymicrobial bacteraemias seen during a six year period were of biliary origin. It is associated with higher co morbidity as compared with the cases of monomicrobial bacteraemia from the same source. Finally, biliary neoplasm and biliary prosthesis appear to be risk factors for polymicrobial bacteraemia among patients with BSI of biliary origin
P1256 Outbreaks of invasive meningococcal disease caused by Neisseria meningitidis group C in two regions of southern Poland A. Pisula, E. Janczewska-Kazek, A. Szczerba-Sachs, U. Posmyk, K. Kosciow (Chorzow, Katowice, Opole, PL) Neisseria meningitidis (Nm) is still an important cause of life-threatening infections. Infections with group B strains are the most common in Poland, but infections with group C strain are rare. Between June and November 2006 in two neighbouring regions, Silesia and Opole, 13 cases of invasive meningococcal disease (IMD) caused by Nm group C were noted. First cases were observed in Silesia region in 3 teenagers (all 16 years old, 1 male, 2 females) and 25-year old woman who meet together in the same discotheque. The IMD form in one woman and the man from this group was meningitis, but in 2 women it was sepsis with disseminated intravascular coagulation (DIC). The epidemiological investigation has shown the connection between sharing of glasses or intranasal inhalations of illegal drugs and IMD development in this group. Prevalence of Neisseria meningitidis group C carriage in nasopharyngeal cavity among habitual guests of the discotheque was 24%. One discotheque worker was also a Nm carrier. The next cases were noted among 3 children (5, 10 and 2 years old) from families living in the same house in poor household condition. Nobody from their environment was Nm carrier. In Opole region 4 cases of meningitis (3 men and 1 woman) and 2 cases of sepsis with disseminated intravascular coagulation (1 man, 1 woman) were noted in patients aged 16−57. One case of sepsis and one case of meningitis caused by C ST11 strain resulted in patients’ death. The epidemiological investigation has shown no connections between these patients and their environments. In 2 persons from these patients families carriage of Nm group C was confirmed. 86 persons from environment received the chemoprophylaxis (ciprofloxacin, rifampicin). There were no new infections till half of November 2006. Conclusions: (1) An important risk factor of invasive meningococcal disease is intranasal inhalation of illegal drugs using the same straw. (2) Vaccination against Neisseria meningitidis group C should be widely conducted in children and teenagers.
P1257 Assessment of risk factors in continuous ambulatory peritoneal dialysis-related peritonitis attacks G.R. Yilmaz, R. Ozturk, C. Bulut, H. Parpucu, H. Irmak, S. Kinikli, M. Duranay, A.P. Demiroz (Ankara, TR) Objectives: Peritonitis is a common clinical problem that occurs in patients with end stage renal disease and treated by peritoneal dialysis. The aim of this study was to evaluate the potential risk factors for continuous ambulatory peritoneal dialysis (CAPD) related peritonitis
S345 Comorbidities (Charlson score mean 3.3 vs 2.3; p = 0.039), CPR levels (198 vs 115; p = 0.008), the presence of biliary neoplasia (14.8% vs 4.2%; p = 0.005) or biliary prostheses (25% vs 6.3%; p = 0.006) were more frequent in the polymicrobial bacteraemia group. E. coli was the most frequently isolated microorganism in both groups. Previous surgery or endoscopic retrograde cholangiopancreatography were identified in 18.8% in the M group vs. 26.9% in P (NS), and in 35% in M vs. 22.2% in P (NS), respectively. Severity, defined by the presence of shock, ICU admission or vasoactive drugs requirement, was similar in both groups. Mortality was higher in the polymicrobial bacteraemia group [10% in M vs 19% in P; p = 0.217)]. Conclusions: Biliary tract infection is an important cause of polymicrobial bacteraemia, a third of all cases of polymicrobial bacteraemias seen during a six year period were of biliary origin. It is associated with higher co morbidity as compared with the cases of monomicrobial bacteraemia from the same source. Finally, biliary neoplasm and biliary prosthesis appear to be risk factors for polymicrobial bacteraemia among patients with BSI of biliary origin
P1256 Outbreaks of invasive meningococcal disease caused by Neisseria meningitidis group C in two regions of southern Poland A. Pisula, E. Janczewska-Kazek, A. Szczerba-Sachs, U. Posmyk, K. Kosciow (Chorzow, Katowice, Opole, PL) Neisseria meningitidis (Nm) is still an important cause of life-threatening infections. Infections with group B strains are the most common in Poland, but infections with group C strain are rare. Between June and November 2006 in two neighbouring regions, Silesia and Opole, 13 cases of invasive meningococcal disease (IMD) caused by Nm group C were noted. First cases were observed in Silesia region in 3 teenagers (all 16 years old, 1 male, 2 females) and 25-year old woman who meet together in the same discotheque. The IMD form in one woman and the man from this group was meningitis, but in 2 women it was sepsis with disseminated intravascular coagulation (DIC). The epidemiological investigation has shown the connection between sharing of glasses or intranasal inhalations of illegal drugs and IMD development in this group. Prevalence of Neisseria meningitidis group C carriage in nasopharyngeal cavity among habitual guests of the discotheque was 24%. One discotheque worker was also a Nm carrier. The next cases were noted among 3 children (5, 10 and 2 years old) from families living in the same house in poor household condition. Nobody from their environment was Nm carrier. In Opole region 4 cases of meningitis (3 men and 1 woman) and 2 cases of sepsis with disseminated intravascular coagulation (1 man, 1 woman) were noted in patients aged 16−57. One case of sepsis and one case of meningitis caused by C ST11 strain resulted in patients’ death. The epidemiological investigation has shown no connections between these patients and their environments. In 2 persons from these patients families carriage of Nm group C was confirmed. 86 persons from environment received the chemoprophylaxis (ciprofloxacin, rifampicin). There were no new infections till half of November 2006. Conclusions: (1) An important risk factor of invasive meningococcal disease is intranasal inhalation of illegal drugs using the same straw. (2) Vaccination against Neisseria meningitidis group C should be widely conducted in children and teenagers.
P1257 Assessment of risk factors in continuous ambulatory peritoneal dialysis-related peritonitis attacks G.R. Yilmaz, R. Ozturk, C. Bulut, H. Parpucu, H. Irmak, S. Kinikli, M. Duranay, A.P. Demiroz (Ankara, TR) Objectives: Peritonitis is a common clinical problem that occurs in patients with end stage renal disease and treated by peritoneal dialysis. The aim of this study was to evaluate the potential risk factors for continuous ambulatory peritoneal dialysis (CAPD) related peritonitis