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P1335 Antimicrobial resistance of Escherichia coli urinary isolates from primary care patients in Greece
Community-acquired genito-urinary tract infections
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screening, especially for our at risk patients. According to high resistant to erythromycin and clindamycin in our population we recommended that for allergic penicillin patients use of these antibiotics should be done after identifying of sensitivity in laboratory. P1332 Chlamydial infections of non-pregnant women in a gypsy population R. Zafirovska, G. Bosevska, S. Panev, S. Kuzmanovska (Skopje, MK) Objective: To assess the incidence of chlamydial infections among non-pregnant women with genital infections of gypsy population, as a part of the Program of Ministry of Health of R. Macedonia, for HIV/AIDS prevention supported by Grant of Global Fund to fight AIDS, Tuberculosis and Malaria. Material and Methods: During period of 1 April to 1 November 2006, from 471 gynecological examined non-pregnant women with STDs problems, age of 15 to 64 years, 325 cervical samples were tested for Chlamydia trachomatis infections with ELFA VIDAS bioM´erieux method. Results: See the Table. Age
<19 20−25 26−40 >40 Total
Gynecological Cervical
Chlamydia test
examined for STDs
samples
(+), 80
(+/−), (−), >60 <80 60
30(64%) 87 (18.5%) 218 (46.3%) 136 (28.8%) 471
20(6.1%) 67 (20.6%) 146 (44.9%) 92 (28.3%) 325
0 4 (6%) 6 (4.1%) 1 (1%) 11 (34%)
0 0 1 2 3
20 (100%) 63 (94%) 139 (96%) 89 (96.7%) 311 (95.6%)
Conclusion: Low incidence of detected genital chlamydial infections, probably is a result of low prevalence (25%) of adolescent group of women (up to 25 years of age) as a result of gypsy population tradition for early marriages, average 4 births and termination of reproduction around 25 years of age. P1333 Coinfection of genital mycoplasmas among men with gonococcal urethritis and their roles in post-gonococcal urethritis T. Deguchi, M. Yasuda, S. Maeda, M. Tamaki, S. Ito, M. Nakano, S. Yokoi (Gifu City, Toyota City, JP) Objectives: F We determined the prevalence of coinfection with genital mycoplasmas, including Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum, among men with gonococcal urethritis (GU) and analysed roles of the genital mycoplasmas in post-gonococcal urethritis (PGU). Methods: We examined first-voided urine samples from 390 men with gonococcal urethritis (GU) for the presence of C. trachomatis, M. genitalium, M. hominis, U. parvum and U. urealyticum, by polymerase chain reaction-based assays. The patients were treated with cefixime, ceftriaxne, or spectinomycin. PGU was judged to occur if, in spite of the eradication of Neisseria gonorrhoeae, the urethral smear showed significant numbers of polymorphonuclear leucocytes from 7 days to 14 days after treatment. Results: C. trachomatis and/or the genital mycoplasmas were coinfected in 132 (33.8) of 390 men with culture-confirmed N. gonorrhoeae. In 85 (21.8%), C. trachomatis was detected with or without the genital mycoplasmas. One or two species of the genital mycoplasmas were detected in 15 men coinfected with C. trachomatis (3.8%) and in 47 men without chlamydia cofinfection (12.1%). Of these 47 men, M. genitalium and U. urealyticum were detected in 12 and 23, respectively. In 291 men, the eradication of N. gonorrhoeae was confirmed by culture after treatment. Of these 291 men, 103 men (35.4%) were judged to have PGU. PGU occurred in 51 (77.3%) of 66 men with chlamydia-positive GU
and in 14 (46.7%) of 30 men with chlamydia-negative but mycoplasmaand/or ureaplasma-positive GU, whereas it was observed in 38 (19.5%) of 195 men with GU negative for all of C. trachomatis and the genital mycoplasmas. C. trachomatis, M. genitalium and U. urealyticum were significantly associated with PGU, but M. hominis or U. parvum was not. Conclusion: The prevalence of coinfection with C. trachomatis among men with GU was 21.8%, whereas that with the genital mycoplasmas was 15.9%. M. genitalium and U. urealyticum were associated with PGU as well as C. trachomatis. In clinical settings, the detection of genital mycoplasmas is frequently difficult so that men with NGU should be treated presumptively with antimicrobial agents active against C. trachomatis and genital mycoplasmas. P1334 Epidemiology of urinary pathogens in adults during 2005–2006 I. Apostolidou, M. Zoumberi, K. Papaefstathiou, E. Koloka, G. Kouppari (Athens, GR) Objectives: To find out the frequency and antimicrobial susceptibility of urinary tract pathogens during 2005–2006. Methods: 10,323 urine samples were examined from 9,399 patients with median age 75 years. The identification of the isolated bacteria was performed by standard methods and the API systems (bioM´erieux). The antimicrobial susceptibility testing was carried out by disk diffusion method and interpreted according to NCCLS and the MIC with E-test when was needed. Results: Positive urine cultures were found in 2,183 patients (23.2%). The microbial strains most frequently isolated from the positive urine cultures were: Escherichia coli (52.6%), Enterococcus spp. (11.1%), Pseudomonas aeruginosa (8.8%), Candida spp. (8.6%), Proteus mirabilis (6.3%), Klebsiella pneumoniae (4.6%), others (7.9%). Of Escherichia coli isolates 54.6% were resistant to ampicillin, 19.3% to amoxicillin+clavulanic acid, 25% to co-trimoxazole, 13.1% to cefaclor, 4.4% to cefotaxime, 4.8% to gentamicin, 8.9% to norfloxacin, 0% to imipenem and 13 (0.9%) produced ESBL. Of Enterococcus spp. isolates 9.7% were resistant to vancomycin and teicoplanin (VanA). In 43 patients the same strain was isolated and from blood culture (2%). Conclusions: The most common pathogen among isolates from positive urine cultures was E. coli followed by Enterococcus spp. and Pseudomonas aeruginosa. Of E. coli isolates 0.9% produced ESBL. In 2% of the patients with urine infection there was bacteraemia and the same strain was isolated in both urine and blood cultures. Of Enterococcus spp. isolates 29 (9.7%) were resistant to vancomycin and teicoplanin (VanA). P1335 Antimicrobial resistance of Escherichia coli urinary isolates from primary care patients in Greece M.E. Falagas, M. Polemis, V.G. Alexiou, I. Sarantou, J. Kremastinou, A.C. Vatopoulos (Athens, Kyparissia, GR) Objective: Most of antimicrobial susceptibility surveillance studies focus on isolates from hospitalised patients. We performed a retrospective analysis of microbiological data of the antimicrobial susceptibility of Escherichia coli urinary isolates from primary care patients in Greece. Methods: The in vitro susceptibility to ampicillin, amoxicillin/ clavulanate, cefaclor, cefprozil, trimethoprim-sulfamethoxazole (cotrimoxazole), amikacin, and norfloxacin of 2,460 E. coli isolates (01/2005−06/2005) from the urine specimens of patients tested at the laboratories of 3 Greek primary care diagnostic centres were analysed. Only the first isolates per patient (2,074 females and 386 males) were included in the analysis. Results: The proportion of E. coli urinary isolates that were resistant to cotrimoxazole was 20.8% and 26.4% for females and males, respectively. There were noteworthy differences between age groups; 37.8% isolates from females <15 years old were resistant to cotrimoxazole compared to 21.9% and 16.7% for >45 years old and 15−45 years old females,
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17th ECCMID / 25th ICC, Posters
respectively (P < 0.001). The proportion of isolates resistant to ampicillin was very high (from 32.5% to 43.3% and 31% to 63% for urinary isolates from females and males, respectively, in the different age groups examined) while it was relatively low for amikacin (up to 4.8%); 17.8% and 5.5% of the isolates from males and females, respectively, were resistant to norfloxacin (20.7% for males >45 years). Conclusions: These findings offer help to clinicians in deciding the appropriate empirical treatment for primary care patients with urinary tract infection and emphasize the increasing problem of antimicrobial resistance in the primary care setting in Greece.
oral hypoglycaemic medication (odds ratio [OR]: 2.1; 95% CI: 1.2−3.5), insulin (3.0; 1.7−5.1), who had >5 years diabetes (2.9; 1.9−4.4) and who had retinopathy (4.1;1.9−9.1). A similar pattern of antibiotics was prescribed in women with and without diabetes, both for one episode of UTI and for relapses and recurrences. Conclusions: Women with diabetes of longer duration, on treatment and with retinopathy have an elevated risk for a recurrent episode of acute symptomatic UTI’s, but this does not evoke difference in the pattern of antibiotic prescriptions. Research focussing on preventive and antibiotic management of UTI is needed in women with DM.
P1336 A meta-analysis of risk factors for mortality in patients with emphysematous pyelonephritis
Epidemiology of multi-drug resistant Gram-negative organisms
M.E. Falagas, V.G. Alexiou, K.P. Giannopoulou, I.I. Siempos (Athens, GR) Objectives: Emphysematous pyelonephritis (EPN), an infection most commonly seen in patients with diabetes mellitus, is associated with considerable case fatality. We sought to identify the factors associated with mortality in patients with EPN and estimate the magnitude of the associations. Methods: Pub Med was searched to identify studies reporting on risk factors of mortality in patients with EPN. A meta-analysis of the eligible studies was performed. Results: Seven study cohorts, representing 175 patients with EPN, were included in the meta-analysis. The overall mortality was 25%, ranging from 11% to 42%. Conservative treatment alone [odds ratio (OR) = 2.85, 95% confidence interval (CI): 1.19–6.81), bilateral EPN (OR = 5.36, 95% CI: 1.41–20.33), type I EPN (OR = 2.53, 95% CI: 1.13–5.65), and thrombocytopenia (OR = 22.68, 95% CI: 4.4–116.32) were associated with increased mortality. Systolic blood pressure <90 mmHg, serum creatinine >2.5 mg/dl, and disturbance of consciousness were also found to be associated with increased mortality, based however on limited data. On the other hand, there was no association between mortality and diabetes mellitus (OR = 0.32, 95% CI: 0.05–1.99) in patients with EPN. Conclusion: Based on the available evidence, conservative treatment, type I EPN, bilateral EPN and thrombocytopenia are significant risk factors for mortality in patients with EPN. These data may be taken under consideration when managing patient with devastating infection. P1337 Diabetes increases relapses and recurrences of acute urinary tract infections in adult women but does not evoke a difference in the pattern of antibiotic prescriptions in primary care K.J. Gorter, D. van Oostveen, E. Hak, N.P.A. Zuithoff, A.I.M. Hoepelman, G.E.H.M. Rutten (Utrecht, NL) Objective: Women with diabetes (DM) have an increased risk for urinary tract infections (UTI). Aim was to assess diabetes care associated risks of recurrent episodes of UTI in adult women with diabetes (DM) in primary care and the pattern of prescribed antibiotics. Design: Retrospective study. Setting: All women of 30 years or over registered in two primary healthcare centres (n = 22,000 patients) during a period of 43 months (1998–2001). Patients: We compared incidence rates of single and recurrent urinary tract infections (UTI) in women with diabetes (n = 340) and women without diabetes (n = 6,618). Main outcome measures: Independent risk of diabetes characteristics, indicators of care and complications for relapsed and recurrent UTI; odds ratio with 95% confidence interval [OR; 95% CI]. The diabetes– no-diabetes associated pattern of antibiotic prescriptions. Results: Of the women with diabetes and those without diabetes relapses and (recurrences) were reported in 7.1 (16.9%) and 2.0 (4.2%) respectively. After adjustments in a multivariate logistic regression analysis for age, socio-economic status and history of vaginitis, the risk of a recurrent episode was 2.0 times higher in women with diabetes than in controls (95% CI: 1.4−2.9). Risks were higher in women who used
P1338 Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in a university hospital, Split, Croatia I. Goic-Barisic, B. Bedenic, M. Tonkic, S. Katic, A. Novak, S. Kalenic, V. Punda-Polic (Split, Zagreb, HR) Objectives: Acinetobacter baumannii is an opportunistic pathogen that is frequently involved in outbreaks of infection, occurring mostly in intensive care units. Carbapenem resistance is now being reported increasingly in A. baumannii isolates in association with the production of carbapenem-hydrolysing class D b-lactamases or oxacillinases that have now emerged worldwide. The aim of the present study was to analyse and compare genotypes of clinical isolates of carbapenem resistant Acinetobacter baumannii collected from three different Intensive Care Units in University Hospital Split, Croatia. Methods: During 2004, twenty-two non-repetitive A. baumannii isolates with an unusual resistance profile were obtained from patients hospitalised at three different Intensive Care Units (two adults ICU and one children ICU) inside University Hospital Split. All collected isolates of A. baumannii displayed intermediate (MIC > 8 mg/L) or resistant (MIC > 16 mg/L) profile to imipenem and/or meropenem. Minimum inhibitory concentrations were also determined for ceftazidime, cefepime, ceftriaxone, amikacin, gentamicin, ciprofloxacin and piperacillin-tazobactam by broth microdilution according to CLSI (formerly NCCLS) recommendation. All isolates were multidrugresistant exhibiting high resistance to tested antimicrobials. The isolates of A. baumannii were genetically characterised using pulsed-field gel electrophoresis (PFGE). Strain typing was performed by macrorestriction analysis of chromosomal DNA by use of PFGE (Apa I enzyme, in a CHEF DR III drive module). Results: We report the clonal dissemination of pulsotype A between two different adult intensive care units in University Hospital Split, belonging to the same pulsed-field gel electrophoresis (PFGE) profile, probably by hospital staff during medical procedures. The strain characterised as pulsotype B was the only strain isolated from children intensive care unit without expanding inside the hospital. Conclusion: The infection control team of the hospital implemented restriction of carbapenem usage and strict antiseptic techniques, which included the rigorous use of alcohol-clorhexidine solutions before and between patient and equipment contact and before leaving the units. Consequently, incidence and spread of multidrug-resistant A. baumannii nosocomial infections suggest the necessity of a surveillance programme and enforcing adequate control measures in different hospital settings. P1339 Molecular characterisation of carbapenem-resistant Acinetobacter baumannii isolated in two Turkish medical centres in 2006: report from the SENTRY Antimicrobial Surveillance Program L. Deshpande, H. Sader, D. Gur, V. Korten, G. Soyletir, R. Jones (North Liberty, US; Ankara, Istanbul, TR) Objectives: To evaluate the mechanisms of resistance (R) to carbapenems (CARB) and the epidemiologic typing of CARB-R Acinetobacter
S369
screening, especially for our at risk patients. According to high resistant to erythromycin and clindamycin in our population we recommended that for allergic penicillin patients use of these antibiotics should be done after identifying of sensitivity in laboratory. P1332 Chlamydial infections of non-pregnant women in a gypsy population R. Zafirovska, G. Bosevska, S. Panev, S. Kuzmanovska (Skopje, MK) Objective: To assess the incidence of chlamydial infections among non-pregnant women with genital infections of gypsy population, as a part of the Program of Ministry of Health of R. Macedonia, for HIV/AIDS prevention supported by Grant of Global Fund to fight AIDS, Tuberculosis and Malaria. Material and Methods: During period of 1 April to 1 November 2006, from 471 gynecological examined non-pregnant women with STDs problems, age of 15 to 64 years, 325 cervical samples were tested for Chlamydia trachomatis infections with ELFA VIDAS bioM´erieux method. Results: See the Table. Age
<19 20−25 26−40 >40 Total
Gynecological Cervical
Chlamydia test
examined for STDs
samples
(+), 80
(+/−), (−), >60 <80 60
30(64%) 87 (18.5%) 218 (46.3%) 136 (28.8%) 471
20(6.1%) 67 (20.6%) 146 (44.9%) 92 (28.3%) 325
0 4 (6%) 6 (4.1%) 1 (1%) 11 (34%)
0 0 1 2 3
20 (100%) 63 (94%) 139 (96%) 89 (96.7%) 311 (95.6%)
Conclusion: Low incidence of detected genital chlamydial infections, probably is a result of low prevalence (25%) of adolescent group of women (up to 25 years of age) as a result of gypsy population tradition for early marriages, average 4 births and termination of reproduction around 25 years of age. P1333 Coinfection of genital mycoplasmas among men with gonococcal urethritis and their roles in post-gonococcal urethritis T. Deguchi, M. Yasuda, S. Maeda, M. Tamaki, S. Ito, M. Nakano, S. Yokoi (Gifu City, Toyota City, JP) Objectives: F We determined the prevalence of coinfection with genital mycoplasmas, including Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum, among men with gonococcal urethritis (GU) and analysed roles of the genital mycoplasmas in post-gonococcal urethritis (PGU). Methods: We examined first-voided urine samples from 390 men with gonococcal urethritis (GU) for the presence of C. trachomatis, M. genitalium, M. hominis, U. parvum and U. urealyticum, by polymerase chain reaction-based assays. The patients were treated with cefixime, ceftriaxne, or spectinomycin. PGU was judged to occur if, in spite of the eradication of Neisseria gonorrhoeae, the urethral smear showed significant numbers of polymorphonuclear leucocytes from 7 days to 14 days after treatment. Results: C. trachomatis and/or the genital mycoplasmas were coinfected in 132 (33.8) of 390 men with culture-confirmed N. gonorrhoeae. In 85 (21.8%), C. trachomatis was detected with or without the genital mycoplasmas. One or two species of the genital mycoplasmas were detected in 15 men coinfected with C. trachomatis (3.8%) and in 47 men without chlamydia cofinfection (12.1%). Of these 47 men, M. genitalium and U. urealyticum were detected in 12 and 23, respectively. In 291 men, the eradication of N. gonorrhoeae was confirmed by culture after treatment. Of these 291 men, 103 men (35.4%) were judged to have PGU. PGU occurred in 51 (77.3%) of 66 men with chlamydia-positive GU
and in 14 (46.7%) of 30 men with chlamydia-negative but mycoplasmaand/or ureaplasma-positive GU, whereas it was observed in 38 (19.5%) of 195 men with GU negative for all of C. trachomatis and the genital mycoplasmas. C. trachomatis, M. genitalium and U. urealyticum were significantly associated with PGU, but M. hominis or U. parvum was not. Conclusion: The prevalence of coinfection with C. trachomatis among men with GU was 21.8%, whereas that with the genital mycoplasmas was 15.9%. M. genitalium and U. urealyticum were associated with PGU as well as C. trachomatis. In clinical settings, the detection of genital mycoplasmas is frequently difficult so that men with NGU should be treated presumptively with antimicrobial agents active against C. trachomatis and genital mycoplasmas. P1334 Epidemiology of urinary pathogens in adults during 2005–2006 I. Apostolidou, M. Zoumberi, K. Papaefstathiou, E. Koloka, G. Kouppari (Athens, GR) Objectives: To find out the frequency and antimicrobial susceptibility of urinary tract pathogens during 2005–2006. Methods: 10,323 urine samples were examined from 9,399 patients with median age 75 years. The identification of the isolated bacteria was performed by standard methods and the API systems (bioM´erieux). The antimicrobial susceptibility testing was carried out by disk diffusion method and interpreted according to NCCLS and the MIC with E-test when was needed. Results: Positive urine cultures were found in 2,183 patients (23.2%). The microbial strains most frequently isolated from the positive urine cultures were: Escherichia coli (52.6%), Enterococcus spp. (11.1%), Pseudomonas aeruginosa (8.8%), Candida spp. (8.6%), Proteus mirabilis (6.3%), Klebsiella pneumoniae (4.6%), others (7.9%). Of Escherichia coli isolates 54.6% were resistant to ampicillin, 19.3% to amoxicillin+clavulanic acid, 25% to co-trimoxazole, 13.1% to cefaclor, 4.4% to cefotaxime, 4.8% to gentamicin, 8.9% to norfloxacin, 0% to imipenem and 13 (0.9%) produced ESBL. Of Enterococcus spp. isolates 9.7% were resistant to vancomycin and teicoplanin (VanA). In 43 patients the same strain was isolated and from blood culture (2%). Conclusions: The most common pathogen among isolates from positive urine cultures was E. coli followed by Enterococcus spp. and Pseudomonas aeruginosa. Of E. coli isolates 0.9% produced ESBL. In 2% of the patients with urine infection there was bacteraemia and the same strain was isolated in both urine and blood cultures. Of Enterococcus spp. isolates 29 (9.7%) were resistant to vancomycin and teicoplanin (VanA). P1335 Antimicrobial resistance of Escherichia coli urinary isolates from primary care patients in Greece M.E. Falagas, M. Polemis, V.G. Alexiou, I. Sarantou, J. Kremastinou, A.C. Vatopoulos (Athens, Kyparissia, GR) Objective: Most of antimicrobial susceptibility surveillance studies focus on isolates from hospitalised patients. We performed a retrospective analysis of microbiological data of the antimicrobial susceptibility of Escherichia coli urinary isolates from primary care patients in Greece. Methods: The in vitro susceptibility to ampicillin, amoxicillin/ clavulanate, cefaclor, cefprozil, trimethoprim-sulfamethoxazole (cotrimoxazole), amikacin, and norfloxacin of 2,460 E. coli isolates (01/2005−06/2005) from the urine specimens of patients tested at the laboratories of 3 Greek primary care diagnostic centres were analysed. Only the first isolates per patient (2,074 females and 386 males) were included in the analysis. Results: The proportion of E. coli urinary isolates that were resistant to cotrimoxazole was 20.8% and 26.4% for females and males, respectively. There were noteworthy differences between age groups; 37.8% isolates from females <15 years old were resistant to cotrimoxazole compared to 21.9% and 16.7% for >45 years old and 15−45 years old females,
S370
17th ECCMID / 25th ICC, Posters
respectively (P < 0.001). The proportion of isolates resistant to ampicillin was very high (from 32.5% to 43.3% and 31% to 63% for urinary isolates from females and males, respectively, in the different age groups examined) while it was relatively low for amikacin (up to 4.8%); 17.8% and 5.5% of the isolates from males and females, respectively, were resistant to norfloxacin (20.7% for males >45 years). Conclusions: These findings offer help to clinicians in deciding the appropriate empirical treatment for primary care patients with urinary tract infection and emphasize the increasing problem of antimicrobial resistance in the primary care setting in Greece.
oral hypoglycaemic medication (odds ratio [OR]: 2.1; 95% CI: 1.2−3.5), insulin (3.0; 1.7−5.1), who had >5 years diabetes (2.9; 1.9−4.4) and who had retinopathy (4.1;1.9−9.1). A similar pattern of antibiotics was prescribed in women with and without diabetes, both for one episode of UTI and for relapses and recurrences. Conclusions: Women with diabetes of longer duration, on treatment and with retinopathy have an elevated risk for a recurrent episode of acute symptomatic UTI’s, but this does not evoke difference in the pattern of antibiotic prescriptions. Research focussing on preventive and antibiotic management of UTI is needed in women with DM.
P1336 A meta-analysis of risk factors for mortality in patients with emphysematous pyelonephritis
Epidemiology of multi-drug resistant Gram-negative organisms
M.E. Falagas, V.G. Alexiou, K.P. Giannopoulou, I.I. Siempos (Athens, GR) Objectives: Emphysematous pyelonephritis (EPN), an infection most commonly seen in patients with diabetes mellitus, is associated with considerable case fatality. We sought to identify the factors associated with mortality in patients with EPN and estimate the magnitude of the associations. Methods: Pub Med was searched to identify studies reporting on risk factors of mortality in patients with EPN. A meta-analysis of the eligible studies was performed. Results: Seven study cohorts, representing 175 patients with EPN, were included in the meta-analysis. The overall mortality was 25%, ranging from 11% to 42%. Conservative treatment alone [odds ratio (OR) = 2.85, 95% confidence interval (CI): 1.19–6.81), bilateral EPN (OR = 5.36, 95% CI: 1.41–20.33), type I EPN (OR = 2.53, 95% CI: 1.13–5.65), and thrombocytopenia (OR = 22.68, 95% CI: 4.4–116.32) were associated with increased mortality. Systolic blood pressure <90 mmHg, serum creatinine >2.5 mg/dl, and disturbance of consciousness were also found to be associated with increased mortality, based however on limited data. On the other hand, there was no association between mortality and diabetes mellitus (OR = 0.32, 95% CI: 0.05–1.99) in patients with EPN. Conclusion: Based on the available evidence, conservative treatment, type I EPN, bilateral EPN and thrombocytopenia are significant risk factors for mortality in patients with EPN. These data may be taken under consideration when managing patient with devastating infection. P1337 Diabetes increases relapses and recurrences of acute urinary tract infections in adult women but does not evoke a difference in the pattern of antibiotic prescriptions in primary care K.J. Gorter, D. van Oostveen, E. Hak, N.P.A. Zuithoff, A.I.M. Hoepelman, G.E.H.M. Rutten (Utrecht, NL) Objective: Women with diabetes (DM) have an increased risk for urinary tract infections (UTI). Aim was to assess diabetes care associated risks of recurrent episodes of UTI in adult women with diabetes (DM) in primary care and the pattern of prescribed antibiotics. Design: Retrospective study. Setting: All women of 30 years or over registered in two primary healthcare centres (n = 22,000 patients) during a period of 43 months (1998–2001). Patients: We compared incidence rates of single and recurrent urinary tract infections (UTI) in women with diabetes (n = 340) and women without diabetes (n = 6,618). Main outcome measures: Independent risk of diabetes characteristics, indicators of care and complications for relapsed and recurrent UTI; odds ratio with 95% confidence interval [OR; 95% CI]. The diabetes– no-diabetes associated pattern of antibiotic prescriptions. Results: Of the women with diabetes and those without diabetes relapses and (recurrences) were reported in 7.1 (16.9%) and 2.0 (4.2%) respectively. After adjustments in a multivariate logistic regression analysis for age, socio-economic status and history of vaginitis, the risk of a recurrent episode was 2.0 times higher in women with diabetes than in controls (95% CI: 1.4−2.9). Risks were higher in women who used
P1338 Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in a university hospital, Split, Croatia I. Goic-Barisic, B. Bedenic, M. Tonkic, S. Katic, A. Novak, S. Kalenic, V. Punda-Polic (Split, Zagreb, HR) Objectives: Acinetobacter baumannii is an opportunistic pathogen that is frequently involved in outbreaks of infection, occurring mostly in intensive care units. Carbapenem resistance is now being reported increasingly in A. baumannii isolates in association with the production of carbapenem-hydrolysing class D b-lactamases or oxacillinases that have now emerged worldwide. The aim of the present study was to analyse and compare genotypes of clinical isolates of carbapenem resistant Acinetobacter baumannii collected from three different Intensive Care Units in University Hospital Split, Croatia. Methods: During 2004, twenty-two non-repetitive A. baumannii isolates with an unusual resistance profile were obtained from patients hospitalised at three different Intensive Care Units (two adults ICU and one children ICU) inside University Hospital Split. All collected isolates of A. baumannii displayed intermediate (MIC > 8 mg/L) or resistant (MIC > 16 mg/L) profile to imipenem and/or meropenem. Minimum inhibitory concentrations were also determined for ceftazidime, cefepime, ceftriaxone, amikacin, gentamicin, ciprofloxacin and piperacillin-tazobactam by broth microdilution according to CLSI (formerly NCCLS) recommendation. All isolates were multidrugresistant exhibiting high resistance to tested antimicrobials. The isolates of A. baumannii were genetically characterised using pulsed-field gel electrophoresis (PFGE). Strain typing was performed by macrorestriction analysis of chromosomal DNA by use of PFGE (Apa I enzyme, in a CHEF DR III drive module). Results: We report the clonal dissemination of pulsotype A between two different adult intensive care units in University Hospital Split, belonging to the same pulsed-field gel electrophoresis (PFGE) profile, probably by hospital staff during medical procedures. The strain characterised as pulsotype B was the only strain isolated from children intensive care unit without expanding inside the hospital. Conclusion: The infection control team of the hospital implemented restriction of carbapenem usage and strict antiseptic techniques, which included the rigorous use of alcohol-clorhexidine solutions before and between patient and equipment contact and before leaving the units. Consequently, incidence and spread of multidrug-resistant A. baumannii nosocomial infections suggest the necessity of a surveillance programme and enforcing adequate control measures in different hospital settings. P1339 Molecular characterisation of carbapenem-resistant Acinetobacter baumannii isolated in two Turkish medical centres in 2006: report from the SENTRY Antimicrobial Surveillance Program L. Deshpande, H. Sader, D. Gur, V. Korten, G. Soyletir, R. Jones (North Liberty, US; Ankara, Istanbul, TR) Objectives: To evaluate the mechanisms of resistance (R) to carbapenems (CARB) and the epidemiologic typing of CARB-R Acinetobacter