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P1365 Dissemination of a VIM-positive Pseudomonas aeruginosa clone in a university hospital, Ankara, Turkey
S378 Conclusion: MBL-producing isolates are prevalent among MDR P. aeruginosa clinical isolates in our Hospital. Phenotypic tests may not be entirely accurate, but are indicative enough for the presence of MBL production. We found that imipenem/EDTA combined synergy test is more sensitive in indicating MBL (+) isolates. The high incidence of MBL-producing strains among non-ICU patients is of great concern, and measures should be taken to avoid dissemination of these MDR strains in the community. P1362 The first isolation of PER-1-producing Pseudomonas aeruginosa and Acinetobacter baumanii strains in Hungary D. Szab´o, L. R´okusz, Z. Juh´asz, J. Szentandr´assy, K. Katona, K. Nagy (Budapest, HU) Objectives: A 45-year-old Hungarian tourist injured in terror-attack was transferred with serious burn injury from Egypt to the Central Military Hospital, Budapest, Hungary. Our aim was to characterise the ß-lactamases produced by the Gram-negative bacteria isolated from the patient. Methods: The identification and the antimicrobial susceptibility profile of the Gram-negative bacteria were evaluated using a VITEK 2 system. The isolates were screened for extended-spectrum ß-lactamase (ESBL) and metallo-ß-lactamase (MBL) production. The minimal inhibitory concantrations (MICs) were determined using E-test according to Clinical and Laboratory Standards Institute (CLSI) recommendations. Isoelectric focusing was performed using crude ß-lactamase extracts in polyacrylamide gels containing ampholines with a pH range of 3.5 to 9.5. Pulsed-field gel electrophoresis (PFGE) was done with SpeI enzyme to compare the isolates. DNA amplification by PCR was carried out using primers specific to the blaTEM gene, the blaSHV gene, the blaPER gene and the blaVIM gene. Both strands of the amplification products were sequenced by the standard Sanger dideoxynucleotide method. Results: The ESBL phenotype was detected in Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and Enterobacter cloacae strains. The PER-1-producing (pI:5.3) P. aeruginosa and A. baumannii strains were isolated from the bloodculture and the wound of the pateint on the admission day suggesting that these strains were transported from Egypt. The PER-1 producing A. baumanii also produced TEM-1 enzyme. The PER-1 producing P. aeruginosa and A. baumannii were resistant to the ceftazidime, cefotaxime, cefepime, aztreonam, but were sensitive to imipenem, meropenem. On the first day TEM-1 and SHV-type ESBL-producing K. pneumoniae strain was also isolated. MBL phenotype was also detected in a P. aeruginosa strain. This VIM-2 producing P. aeruginosa showed resistance to almost all ß-lactam antibiotics, including penicillins, cephalosporins, and carbapenems, but it was sensitive to colistin. The PER-1 producing P. aeruginosa and the VIM-2 producing P. aeruginosa strains were unrelated as determined by PFGE. Conclusion: This is the first report of the PER-1 and VIM-2-producing P. aeruginosa and PER-1 producing A. baumannii strains from Hungary. This work illustrates the inter-country and the inter-continent spread of PER-1-producing P. aeruginosa and A. baumannii isolates. Supported by OTKA F048410. P1363 Carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates in an Iranian 1,000-bed hospital M. Rahbar, P. Islami, S. Molanaee, M. Deldari (Tehran, IR) Objective: Carbapenems, including imipenem and meropenem, are b-lactam antibiotics which widely are used recently in our country. The aim of this study was to determine resistance of P. aeruginosa, A. baumannii and Klebsiella pneumoniae to carbapenems in our hospital. Methods: From April 2006 to October 2006 one hundred nosocomial isolates including 29 strains of P. aeruginosa, 27 Acinetobacter baumannii and 44 isolates of Klebsiella pneumoniae were collected from specimens obtained from hospitalised patients. The MIC f of meropenem
17th ECCMID / 25th ICC, Posters for all isolates was determined by E-test (AB/Bio disk Sweden). Susceptibility to other antibiotics including Pipracillin/Tazobactam, Cefepime Ciprofloxacin, Amikacin, Imipenem and Ceftazidim were performed by disk diffusion method as recommended by Clinical Laboratory Standards institute (CLSI). Results: MIC for meropenem by E-test ranged from 0.25 mg/mL to 32 mg/mL. Of 29 isolates of P. aeruginosa, 7 (24%) were resistant to meropenem (MIC > 32 mg/mL). These isolates also were resistant to imipenem. In Acinetobacter baumannii, of 27 isolates 8 (27%) were resistant to meropenem. All isolates of K. pneumoniae were susceptible to meropenem and imipenem. Only one strain had intermediate resistance (MIC = 6 mg/mL). Resistance to other tested antibiotics was very high and more than 80% of organisms were resistant to Piperacillin/ Tazobactam, Cefepime, Ciprofloxacin, Amikacin, and Ceftazidim. All isolates of Klebsiella pneumoniae were resistant to Ceftazidim. Conclusion: These studies showed that nearly one fourth of nonfermenter tested organisms in our study were resistant to carbapenems. However resistance of K. pneumoniae to carbapenem is not a serious problem already in our hospital.
P1364 The first metallo-b-lactamase producing clinical isolate of Pseudomonas aeruginosa in Norway Ø. Samuelsen, M.A. Toleman, N.O. Hermansen, B. Aasnæs, B. Haldorsen, A. Sundsfjord, T.R. Walsh (Tromsø, NO; Cardiff, UK; Oslo, NO) Objectives: MBL are of great clinical significance as they are able to hydrolyse virtually all b-lactams limiting therapeutic options. Here we describe the first clinical isolate of MBL-producing Pseudomonas aeruginosa in Norway and its subsequent genetic characterisation. Methods: A clinical isolate of P. aeruginosa (K34−7) was recovered from a patient recently admitted from an African country with a high-level resistance to carbapenems and was examined for MBL production. Susceptibility testing was performed using disc diffusion, VITEK and Etest. The presence of MBL was confirmed by PCR (custom oligonucleotides for all major blaMBL genes) and by spectrophotometric analysis of crude cell extracts (with and without EDTA – 25mM for 1 hr) for the ability to hydrolyse imipenem. Characterisation of the MBL gene and its genetic support was evaluated by its association with integrons, transposons and insertion elements (ISCR) using PCR and sequencing. Results: Susceptibility testing showed that P. aeruginosa K34−7 was multi-drug resistant, highly resistant to imipenem and meropenem (MIC > 32 mg/L) and positive on the MBL Etest (ratio MIC imipenem/imipenem + EDTA 8). MBL production was also verified by hydrolysis/inhibition assays on crude cell extracts ± EDTA. Sequencing analysis of the positive blaVIM amplicon revealed it was 100% identical to blaVIM-2. PCR and sequencing analysis revealed that K34−7 contained 2 very different integrons. The class 1 integron contains 4 antibiotic resistant genes including blaOXA31 and genes encoding novel multi-drug resistant pumps and aminoglycoside modifying enzymes. The second integron contained TniCR at the 3 end instead of qac/sul and the gene cassette sequence: aacA7-blaVIM-2-aacA5. Although standard transposons was not detected adjacent to the integrons, we detected a new ISCR element, designated ISCR10, and the first to be found in P. aeruginosa. Conclusion: This is the first report of an MBL-producing P. aeruginosa identified in Norway. Genetic analysis revealed the “new” TniCR integron associated with the blaVIM-2 MBL gene and the first ISCR10 found in P. aeruginosa.
P1365 Dissemination of a VIM-positive Pseudomonas aeruginosa clone in a university hospital, Ankara, Turkey N. Gurkan Aydin, G. Metan, B. Altun, P. Zarakolu (Ankara, Kayseri, TR) Objectives: The aim of this study was to report the dissemination of a VIM-positive Pseudomonas aeruginosa clone in Hacettepe University Hospital in Ankara, Turkey.
Epidemiology of multi-drug resistant Gram-negative organisms Methods: P. aeruginosa strains (n = 26) isolated from various clinical specimens (4 blood, 7 urine, 12 pus, 1 cerebrospinal fluid, 1 bronchoalveolar lavage, 1 sputum) of patients with nosocomial infections in Hacettepe University Adult Hospital during January and July 2005 were included in the study. The isolates were identified by Phoenix System (Becton Dickinson, USA) and the antimicrobial susceptibility testing was performed by Etest (AB Biodisk, Sweden) method according to CLSI criteria. All the isolates were screened for carbapenem hydrolysing metallo-b-lactamase activity by imipenem-EDTA disk method phenotypically and genotypic detection was performed by PCR with bla-IMP and bla-VIM primers. Clonal diversity was examined by PFGE of SpeI-digested genomic DNA. Results: The antimicrobial resistance of the isolates to ceftazidime was 27% where as 31% to piperacillin-tazobactam, 35% to imipenem, 38% to meropenem, 46% to tobramycin, 58% to ciprofloxacin. All the isolates were carrying the blaVIM gene and the blaIMP gene was not detected in any of them. However, only 8 (31%) were phenotypically positive for metallo-b-lactamase activity. There were 3 clones with one dominant clone (n = 22). Conclusion: P. aeruginosa is a multidrug resistant pathogen of nosocomial infections. Although metallo-b-lactamase activity as a resistance mechanism has been reported increasingly worldwide, there are few reports from Turkey. Our finding of dissemination of this clone is pointing out the emergence of this resistance pattern in our country. P1366 Multiresistant Pseudomonas aeruginosa serogroup O:12 outbreak in an intensive care unit R. Rodr´ıguez, M.M. Gallardo, M.V. Garc´ıa, A. Vindel, E. Granados, F. Ropero, I. Viciana, A. Pinedo (M´alaga, Madrid, ES) Objective: Research on an multirresistant P. aeruginosa outbreak among patients hospitalised in the Intensive Care Unit. Methods: A retrospective study was carried out where the clinical reports of those patients with a presence of P. aeruginosa of the same resistant phenotype, were revised. Antimicrobial suceptibilities were carried out by the MicroScan automised system and by disk difussion test and E-test. The results interpretation were according NCCLS guidelines. The epidemiological characterisation by serotyping was analysed using an agglutination technique with the antisueros of the IATS. Clonal relationship of strains were carried out with Pulse Field Gel Elctrophoresis (PFGE) of the restriction fragments obtained with XbaI and PCR for blaVIM for the detection of metallo-b-lactamases. Results: Between September 2002 and February 2003, 45 P. aeruginosa serotype O:12 were isolated with identical resistant phenotype only sensitive to amikacin. These 45 strains were obtained from 13 patients out of which 10 (76.9%) were men and 3 (23.07%) were woman with an average age of 60 years old. Isolates were produced in two intensive care units from different hospital areas: General Intensive Care Unit (ICU) and Anaesthesia Intensive Care Unit (recovery). 9 patients were admitted in ICU, 3 in recovery and one in both wards. Average hospitalisation days were 49.23 days. 76.9% of the patients were smoker and the base pathology most frequently found were cardiopathy, diabetes mellitus and hypertension (46.2%). Mostly of patients were no fatal underlying condition (76.9%). Samples where P. aeruginosa was isolated more frequently were blood in 37.7% of the cases followed by bronchial aspirations (26.6%). Index case was a patient hospitalised in ICU for 49 days. The last 4 cases were recovery patients, one of them had been admitted previously in ICU. Bronchial aspiration had been done in all of them as well as mechanical ventilation and SNG. Mortality was of 46.15% and the mortality attributable was of 23.1%. Restriction patterns obtained through PFGE were identical in all strains confirming isolation clonal relationships. PCR blaVIM for carbapenemas detection was negative in all cases. Conclusions: Antibiotic pressure to which these patients are submitted plus the control measures relaxation of healthcare workers, probably are the cause of the outbreak appearance and dissemination. Molecular characterisation is an useful tool for epidemiologic surveillance programmes.
S379 P1367 Epidemiological and clinical investigation of Gram-negative anaerobic infections in Greece A. Katsandri, A. Avlamis, N.J. Legakis, G.L. Petrikkos, A. Pantazatou, J. Papaparaskevas for The Hellenic Study Group for Gram-Negative Anaerobic Bacteria* Objective: Epidemiological and clinical investigation of Gram(−) anaerobic infections. Materials and Methods: A prospective multicentre study of 206 Gram(−) anaerobic infections was conducted during the period 2003– 2006. Data collected included gender, age, ward type, duration of hospitalisation, underlying disease, clinical manifestation, outcome, prior antimicrobial therapy, infection treatment, and microbiological data (clinical specimen, species identification, other pathogens from the same specimen). Analysis was performed with the STATA 6.0 programme. Results: Bacteroides spp. isolates were more frequent in intra-abdominal infections (p < 0.001). Infections due to B. fragilis compared to other species of the B. fragilis group were more frequent in surgical ward patients (p = 0.008), and those who received treatment with second generation cephalosporins (p = 0.017). In bacteraemic cases, Bacteroides non-fragilis spp. were more frequent than B. fragilis group spp. (p = 0.02). B. fragilis group spp. were isolated more frequently than Bacteroides non-fragilis spp. in polymicrobial infections (p = 0.05), and younger patients (p = 0.049, for median ages of 47.4 and 61.3 years). Prevotella spp. strains were more frequent in pulmonary infections compared to bacteraemias, soft tissue, or intrabdominal infections (p < 0.001), from outpatients than inpatients (p < 0.05), and from patients with shorter hospitalisation duration (p = 0.033). Fusobacterium spp. were isolated more frequently from patients with lung abscess (p = 0.038), and from those that did not receive any form of antimicrobial therapy (p = 0.024). Mortality was higher among bacteraemic patients (p < 0.001), those that were hospitalised in internal medicine dpts. or ICU (p = 0.001), or those that were treated with aminoglycosides (p = 0.008). Among polymicrobial infections an association was detected between Staphylococcus and Prevotella spp. (p = 0.006), and between Enterobacteriaeae and Bacteroides spp. (p = 0.007). Conclusions: Epidemiological and clinical differences were detected among cases of infections due to different Gram(−) anaerobic species, differences that provide useful information for optimisation of the respective empirical treatment guidelines. Acknowledgements: The study was funded by European Social Fund and National Resources (grant EPEAEK II–Pythagoras II). *Drs M. Foustoukou, M. Kanellopoulou, C. Koutsia-Karouzou, H. Malamou-Ladas, A. Pangalis, E. Papafrangas, M. Toutouza, E. TrikaGrafakos, and A. Vogiatzi. P1368 Correlation between colonisation and infection with antibiotic-resistant Gram-negative bacilli in the neonatal intensive care unit A. Dedeic Ljubovic, D. Bekic, M. Hukic (Sarajevo, BA) Objectives: Infection due to Gram-negative bacilli which are often resistant to multiple antibiotics usually occurs in neonates already colonised in the pharynx or intestine. We studied bacterial colonisation in the intestinal and nasopharyngeal flora and development of severe infection (septicaemia and meningitis) in colonised neonates admitted to a neonatal intensive care unit. Methods: The study included 255 neonates admitted to a neonatal intensive care unit at Clinical Center University of Sarajevo in a sixmonth period. Cultures of nose, throat and stool were obtained on admission and once weekly if the lenght of stay was more than seven days. A total of 923 nose and throat cultures and 450 stool cultures were performed. Antibiotic sensitivity pattern and ESBL production were determined with disc-diffusion methods and E test (AB Biodisk, Solna Sweden) according to the NCCLS. Results: 85% (217/255) of patients became colonised in throat/intestine with antibiotic-resistant Gram-negative bacilli. 37.3% (81/217) of
17th ECCMID / 25th ICC, Posters for all isolates was determined by E-test (AB/Bio disk Sweden). Susceptibility to other antibiotics including Pipracillin/Tazobactam, Cefepime Ciprofloxacin, Amikacin, Imipenem and Ceftazidim were performed by disk diffusion method as recommended by Clinical Laboratory Standards institute (CLSI). Results: MIC for meropenem by E-test ranged from 0.25 mg/mL to 32 mg/mL. Of 29 isolates of P. aeruginosa, 7 (24%) were resistant to meropenem (MIC > 32 mg/mL). These isolates also were resistant to imipenem. In Acinetobacter baumannii, of 27 isolates 8 (27%) were resistant to meropenem. All isolates of K. pneumoniae were susceptible to meropenem and imipenem. Only one strain had intermediate resistance (MIC = 6 mg/mL). Resistance to other tested antibiotics was very high and more than 80% of organisms were resistant to Piperacillin/ Tazobactam, Cefepime, Ciprofloxacin, Amikacin, and Ceftazidim. All isolates of Klebsiella pneumoniae were resistant to Ceftazidim. Conclusion: These studies showed that nearly one fourth of nonfermenter tested organisms in our study were resistant to carbapenems. However resistance of K. pneumoniae to carbapenem is not a serious problem already in our hospital.
P1364 The first metallo-b-lactamase producing clinical isolate of Pseudomonas aeruginosa in Norway Ø. Samuelsen, M.A. Toleman, N.O. Hermansen, B. Aasnæs, B. Haldorsen, A. Sundsfjord, T.R. Walsh (Tromsø, NO; Cardiff, UK; Oslo, NO) Objectives: MBL are of great clinical significance as they are able to hydrolyse virtually all b-lactams limiting therapeutic options. Here we describe the first clinical isolate of MBL-producing Pseudomonas aeruginosa in Norway and its subsequent genetic characterisation. Methods: A clinical isolate of P. aeruginosa (K34−7) was recovered from a patient recently admitted from an African country with a high-level resistance to carbapenems and was examined for MBL production. Susceptibility testing was performed using disc diffusion, VITEK and Etest. The presence of MBL was confirmed by PCR (custom oligonucleotides for all major blaMBL genes) and by spectrophotometric analysis of crude cell extracts (with and without EDTA – 25mM for 1 hr) for the ability to hydrolyse imipenem. Characterisation of the MBL gene and its genetic support was evaluated by its association with integrons, transposons and insertion elements (ISCR) using PCR and sequencing. Results: Susceptibility testing showed that P. aeruginosa K34−7 was multi-drug resistant, highly resistant to imipenem and meropenem (MIC > 32 mg/L) and positive on the MBL Etest (ratio MIC imipenem/imipenem + EDTA 8). MBL production was also verified by hydrolysis/inhibition assays on crude cell extracts ± EDTA. Sequencing analysis of the positive blaVIM amplicon revealed it was 100% identical to blaVIM-2. PCR and sequencing analysis revealed that K34−7 contained 2 very different integrons. The class 1 integron contains 4 antibiotic resistant genes including blaOXA31 and genes encoding novel multi-drug resistant pumps and aminoglycoside modifying enzymes. The second integron contained TniCR at the 3 end instead of qac/sul and the gene cassette sequence: aacA7-blaVIM-2-aacA5. Although standard transposons was not detected adjacent to the integrons, we detected a new ISCR element, designated ISCR10, and the first to be found in P. aeruginosa. Conclusion: This is the first report of an MBL-producing P. aeruginosa identified in Norway. Genetic analysis revealed the “new” TniCR integron associated with the blaVIM-2 MBL gene and the first ISCR10 found in P. aeruginosa.
P1365 Dissemination of a VIM-positive Pseudomonas aeruginosa clone in a university hospital, Ankara, Turkey N. Gurkan Aydin, G. Metan, B. Altun, P. Zarakolu (Ankara, Kayseri, TR) Objectives: The aim of this study was to report the dissemination of a VIM-positive Pseudomonas aeruginosa clone in Hacettepe University Hospital in Ankara, Turkey.
Epidemiology of multi-drug resistant Gram-negative organisms Methods: P. aeruginosa strains (n = 26) isolated from various clinical specimens (4 blood, 7 urine, 12 pus, 1 cerebrospinal fluid, 1 bronchoalveolar lavage, 1 sputum) of patients with nosocomial infections in Hacettepe University Adult Hospital during January and July 2005 were included in the study. The isolates were identified by Phoenix System (Becton Dickinson, USA) and the antimicrobial susceptibility testing was performed by Etest (AB Biodisk, Sweden) method according to CLSI criteria. All the isolates were screened for carbapenem hydrolysing metallo-b-lactamase activity by imipenem-EDTA disk method phenotypically and genotypic detection was performed by PCR with bla-IMP and bla-VIM primers. Clonal diversity was examined by PFGE of SpeI-digested genomic DNA. Results: The antimicrobial resistance of the isolates to ceftazidime was 27% where as 31% to piperacillin-tazobactam, 35% to imipenem, 38% to meropenem, 46% to tobramycin, 58% to ciprofloxacin. All the isolates were carrying the blaVIM gene and the blaIMP gene was not detected in any of them. However, only 8 (31%) were phenotypically positive for metallo-b-lactamase activity. There were 3 clones with one dominant clone (n = 22). Conclusion: P. aeruginosa is a multidrug resistant pathogen of nosocomial infections. Although metallo-b-lactamase activity as a resistance mechanism has been reported increasingly worldwide, there are few reports from Turkey. Our finding of dissemination of this clone is pointing out the emergence of this resistance pattern in our country. P1366 Multiresistant Pseudomonas aeruginosa serogroup O:12 outbreak in an intensive care unit R. Rodr´ıguez, M.M. Gallardo, M.V. Garc´ıa, A. Vindel, E. Granados, F. Ropero, I. Viciana, A. Pinedo (M´alaga, Madrid, ES) Objective: Research on an multirresistant P. aeruginosa outbreak among patients hospitalised in the Intensive Care Unit. Methods: A retrospective study was carried out where the clinical reports of those patients with a presence of P. aeruginosa of the same resistant phenotype, were revised. Antimicrobial suceptibilities were carried out by the MicroScan automised system and by disk difussion test and E-test. The results interpretation were according NCCLS guidelines. The epidemiological characterisation by serotyping was analysed using an agglutination technique with the antisueros of the IATS. Clonal relationship of strains were carried out with Pulse Field Gel Elctrophoresis (PFGE) of the restriction fragments obtained with XbaI and PCR for blaVIM for the detection of metallo-b-lactamases. Results: Between September 2002 and February 2003, 45 P. aeruginosa serotype O:12 were isolated with identical resistant phenotype only sensitive to amikacin. These 45 strains were obtained from 13 patients out of which 10 (76.9%) were men and 3 (23.07%) were woman with an average age of 60 years old. Isolates were produced in two intensive care units from different hospital areas: General Intensive Care Unit (ICU) and Anaesthesia Intensive Care Unit (recovery). 9 patients were admitted in ICU, 3 in recovery and one in both wards. Average hospitalisation days were 49.23 days. 76.9% of the patients were smoker and the base pathology most frequently found were cardiopathy, diabetes mellitus and hypertension (46.2%). Mostly of patients were no fatal underlying condition (76.9%). Samples where P. aeruginosa was isolated more frequently were blood in 37.7% of the cases followed by bronchial aspirations (26.6%). Index case was a patient hospitalised in ICU for 49 days. The last 4 cases were recovery patients, one of them had been admitted previously in ICU. Bronchial aspiration had been done in all of them as well as mechanical ventilation and SNG. Mortality was of 46.15% and the mortality attributable was of 23.1%. Restriction patterns obtained through PFGE were identical in all strains confirming isolation clonal relationships. PCR blaVIM for carbapenemas detection was negative in all cases. Conclusions: Antibiotic pressure to which these patients are submitted plus the control measures relaxation of healthcare workers, probably are the cause of the outbreak appearance and dissemination. Molecular characterisation is an useful tool for epidemiologic surveillance programmes.
S379 P1367 Epidemiological and clinical investigation of Gram-negative anaerobic infections in Greece A. Katsandri, A. Avlamis, N.J. Legakis, G.L. Petrikkos, A. Pantazatou, J. Papaparaskevas for The Hellenic Study Group for Gram-Negative Anaerobic Bacteria* Objective: Epidemiological and clinical investigation of Gram(−) anaerobic infections. Materials and Methods: A prospective multicentre study of 206 Gram(−) anaerobic infections was conducted during the period 2003– 2006. Data collected included gender, age, ward type, duration of hospitalisation, underlying disease, clinical manifestation, outcome, prior antimicrobial therapy, infection treatment, and microbiological data (clinical specimen, species identification, other pathogens from the same specimen). Analysis was performed with the STATA 6.0 programme. Results: Bacteroides spp. isolates were more frequent in intra-abdominal infections (p < 0.001). Infections due to B. fragilis compared to other species of the B. fragilis group were more frequent in surgical ward patients (p = 0.008), and those who received treatment with second generation cephalosporins (p = 0.017). In bacteraemic cases, Bacteroides non-fragilis spp. were more frequent than B. fragilis group spp. (p = 0.02). B. fragilis group spp. were isolated more frequently than Bacteroides non-fragilis spp. in polymicrobial infections (p = 0.05), and younger patients (p = 0.049, for median ages of 47.4 and 61.3 years). Prevotella spp. strains were more frequent in pulmonary infections compared to bacteraemias, soft tissue, or intrabdominal infections (p < 0.001), from outpatients than inpatients (p < 0.05), and from patients with shorter hospitalisation duration (p = 0.033). Fusobacterium spp. were isolated more frequently from patients with lung abscess (p = 0.038), and from those that did not receive any form of antimicrobial therapy (p = 0.024). Mortality was higher among bacteraemic patients (p < 0.001), those that were hospitalised in internal medicine dpts. or ICU (p = 0.001), or those that were treated with aminoglycosides (p = 0.008). Among polymicrobial infections an association was detected between Staphylococcus and Prevotella spp. (p = 0.006), and between Enterobacteriaeae and Bacteroides spp. (p = 0.007). Conclusions: Epidemiological and clinical differences were detected among cases of infections due to different Gram(−) anaerobic species, differences that provide useful information for optimisation of the respective empirical treatment guidelines. Acknowledgements: The study was funded by European Social Fund and National Resources (grant EPEAEK II–Pythagoras II). *Drs M. Foustoukou, M. Kanellopoulou, C. Koutsia-Karouzou, H. Malamou-Ladas, A. Pangalis, E. Papafrangas, M. Toutouza, E. TrikaGrafakos, and A. Vogiatzi. P1368 Correlation between colonisation and infection with antibiotic-resistant Gram-negative bacilli in the neonatal intensive care unit A. Dedeic Ljubovic, D. Bekic, M. Hukic (Sarajevo, BA) Objectives: Infection due to Gram-negative bacilli which are often resistant to multiple antibiotics usually occurs in neonates already colonised in the pharynx or intestine. We studied bacterial colonisation in the intestinal and nasopharyngeal flora and development of severe infection (septicaemia and meningitis) in colonised neonates admitted to a neonatal intensive care unit. Methods: The study included 255 neonates admitted to a neonatal intensive care unit at Clinical Center University of Sarajevo in a sixmonth period. Cultures of nose, throat and stool were obtained on admission and once weekly if the lenght of stay was more than seven days. A total of 923 nose and throat cultures and 450 stool cultures were performed. Antibiotic sensitivity pattern and ESBL production were determined with disc-diffusion methods and E test (AB Biodisk, Solna Sweden) according to the NCCLS. Results: 85% (217/255) of patients became colonised in throat/intestine with antibiotic-resistant Gram-negative bacilli. 37.3% (81/217) of