- Email: [email protected]
P1930 A nosocomial outbreak due to Serratia marcescens in a West-Tallinn hospital
S554 address modifications of surgical access, graft materials, and whether the decision for an intervention in earlier stages of peripheral vascular disease would prevent surgical site infections. P1929 Joint implant infections in a general hospital F. Moreno, J. Aguilar, M. Noureddine, J. De la Torre, J.L. Prada, A. Del Arco, L. Merida, J.D. Ruiz-Mesa (Marbella, ES) Objectives: to analyse features and sources of joint implant (JI) infections and the medical and surgical treatment in our hospital. Method: Retrospective study of patients admitted suffrering from JI infections from 1997 to 2005. Hospital data base and discharge reports were used. Results: 89 patients were admitted. 15 had 2 admissions and 8 three admisions with a total of 121 cases of JI infection. The mean-age was 73 ± 12.39 years. 64% were female. 22% were diabetic, 25% heart patients and 11% COAF patients. In 57% artrosis was the cause of JI indication, and 32% by fracture. 60% were hips (96% by fracture), and 38% from knee (63% by artrosis). 85% were the first JI: 81% complete/16% parcial. In 45% first symptom started in first month after surgery, 34% between 1 month and 2 years and 20% more than 2 years after surgery. Only 20% had risk factors for infection, 10% surgical wound infection and 10% haemorrhage and haematoma. The more recurrent symptoms were local inflamation or wound drainage in 50%, joint pain in 31% and fever in 14%, a fistula in 8% and in 2% joint effusion. Bacteria were isolated in 57%, in 36% from fistula or injure 9% from joint fluid and the others from surgical samples or blood stream. Only a bacteria was isolated in 82%. In 12% were 2 bacterias and in 6% more than 2. In 57% Staphylococcus was isolated (37% S. aureus, and 20% S. coagulase negative), in 19% Bacillus Gram-negatives (P. aeruginosa and E. coli), and 14% Streptococcus (beta-haemolytic streptococcus, viridans and enterococcus), and 6% were with more than 2. About therapy, surgical cleaned and antibiotical treatments were performed in 66%. JI was removed in 15% with reinstatement of a new JI. JI removed without a new implant and antibiotics in 9%. In the others, parcial JI were removed, cronic antibiotical treatment was indicated or amputation was made. The mean length of stay was 24 days (TD 19.33). Only 2 died. The common antibiotical combination was aminoglicosides plus cloxacilin or cefazoline, vancomycin or ciprofloxacin (44%), and cocktail with ciprofloxacin plus cloxacilin, rifampicin or vancomycin (16%). One case was treated only with one antibiotic. Ciprofloxacin was the wide used (12%). After discharged therapy was prolonged between 3 and 16 weeks with a mean of 7 weeks. Conclusions: More than 50% were late JI infections but in less than 50% JI was removed. In the causes, S. aureus is the main bacteria followed by Staph coagulase negatives and Gram-negatives. P1930 A nosocomial outbreak due to Serratia marcescens in a West-Tallinn hospital I. Zolotuhhina, R. Voiko, P. Albri, V. Adamson, K. Allik (Tallinn, Tartu, EE) Objectives: A nosocomial outbreak due to S. marcescens in neonatal unit of West-Tallinn Central Hospital involving 7 neonate patients was investigated. Materials and Methods: During 2005 and 2006 total of 1796 specimens (369 blood cultures and 1427 swabs taken from nasopharynx, eyes, ears and umbilical wounds) from patients with clinical signs of infection were examined. First isolation of S. marcescens from blood of twins, one of whom developed meningitis (S. marcescens was also isolated from the cerebrospinal fluid) and another sepsis was registered in November 2005. 6 following isolates were obtained in the period from April to May 2006 from 5 patients – 2 from blood cultures and 4 from nasopharyngeal swabs. All these patients manifestated clinical symptoms of true infection (purulent rhinitis, sepsis). A nosocomial infection was suspected. The epidemiological investigation included the review of medical records and of medical and nursing practices in the department.
17th ECCMID / 25th ICC, Posters 40 environmental samples from surfaces and medical equipment were examined. All cultures were identified initially by BBL Crystal and confirmed by other biochemical tests. Susceptibility of all strains against 6 antibiotics was determined by the CLSI agar dilution method. Pulsefield gel electrophoresis (PFGE) was used for genotyping of 6 strains. Results: During epidemiological investigations a single S. marcescens strain was isolated from the inner surface of the bottle with 0.05% xylomethazoline drops used for the patients with nasal congestion. The bottle had been in use during several months. All investigated strains of S. marcescens had similar antibiotic susceptibility profiles. 6 cultures recovered from clinical material and from the bottle showed indistinguishable PFGE patterns. This led to conclusion that the bottle with nasal drops contaminated with S. marcescens was the likely reservoir from which the spread of infection occurred. The bottle was eliminated and that put a rapid end to the outbreak. No new recovery of S. marcescens from patients and unit environment has been registered since May 2006. Conclusions: The outbreak was related to the bottle with nasal drops contaminated with S. marcescens. From November 2005 till May 2006 7 neonates in the unit developed clinical manifestations of true S. marcescens infection. The outbreak stopped after the elimination of the bottle. The importance of following good medical practice and standard hygienic precautions should be stressed out. P1931 Microbiological epidemiology of infections related to pace-makers and indwelling cardiac defibrillator C. Tascini, M. Bongiorni, G. Gemignani, E. Soldati, A. Leonildi, G. Arena, S. Capolupo, F. Menichetti (Pisa, IT) Background: The cardiology Unit at Cisanello Hospital in Pisa is the Italian reference centre for non invasive, transvenous removal of infected pace-makers (PM) or indwelling cardiac defibrillator (ICD). The aim of the study is to review microbiological findings of PM and ICD infections observed at this Unit in five years period (2000–2005). Materials and Methods: Retrospective observational study on consecutive patients. All patients with clinically documented PM or ICD infections were enrolled in the study. To define the aetiology of the infections. Catheter leads and/or the infected material from the pocket upon removal were cultured in aerobic and anaerobic solid media. Results: In the study period PM and ICD leads and generators were removed transvenously from 602 patients. Microbiological documentation was obtained from 451 patients (75%) and 560 different microorganisms were isolated; therefore we had negative culture in 151 patients. In 99 patients infections were polymicrobial. Staphylococci were the most frequently isolated pathogens (474/560−84%). The coagulase-negative staphylococci (CNS) resulted the first pathogen (380) followed by S. aureus (94), methicillin-resistant strains, among staphylococci, were 123/474 (26%). Gram negative rods and fungi are relatively rare. Overall susceptibility were also studied; the classes of antibiotic with good activity were newer quinolones (moxifloxacin and levofloxacin followed by aminoglycosides and glycopeptides).
Patients Microrganisms isolated CNS S. aureus Total MR staphylococci Gram-negative rods Yeasts/moulds Others
Year 2000–2001 2002–2003 2004
2005
121 132 93 (70%) 19 (14%) 33 (29%) 16 1 4
127 120 81 (67%) 21 (18%) 25 (25%) 2 5 11
228 180 117 (65%) 35 (19%) 36 (30%) 14 4 10
136 128 89 (69%) 19 (15%) 29 (22%) 3 2 15
Total
602 560 380 (68%) 94 (17%) 123 (26%) 35 (6%) 12 (2%) 40 (8%)
Conclusions: In our experience PM and ICD infections were mainly caused by Staphylococci, especially CNS, other microorganisms (Gramnegative rods and fungi) were also documented in few cases. The
17th ECCMID / 25th ICC, Posters 40 environmental samples from surfaces and medical equipment were examined. All cultures were identified initially by BBL Crystal and confirmed by other biochemical tests. Susceptibility of all strains against 6 antibiotics was determined by the CLSI agar dilution method. Pulsefield gel electrophoresis (PFGE) was used for genotyping of 6 strains. Results: During epidemiological investigations a single S. marcescens strain was isolated from the inner surface of the bottle with 0.05% xylomethazoline drops used for the patients with nasal congestion. The bottle had been in use during several months. All investigated strains of S. marcescens had similar antibiotic susceptibility profiles. 6 cultures recovered from clinical material and from the bottle showed indistinguishable PFGE patterns. This led to conclusion that the bottle with nasal drops contaminated with S. marcescens was the likely reservoir from which the spread of infection occurred. The bottle was eliminated and that put a rapid end to the outbreak. No new recovery of S. marcescens from patients and unit environment has been registered since May 2006. Conclusions: The outbreak was related to the bottle with nasal drops contaminated with S. marcescens. From November 2005 till May 2006 7 neonates in the unit developed clinical manifestations of true S. marcescens infection. The outbreak stopped after the elimination of the bottle. The importance of following good medical practice and standard hygienic precautions should be stressed out. P1931 Microbiological epidemiology of infections related to pace-makers and indwelling cardiac defibrillator C. Tascini, M. Bongiorni, G. Gemignani, E. Soldati, A. Leonildi, G. Arena, S. Capolupo, F. Menichetti (Pisa, IT) Background: The cardiology Unit at Cisanello Hospital in Pisa is the Italian reference centre for non invasive, transvenous removal of infected pace-makers (PM) or indwelling cardiac defibrillator (ICD). The aim of the study is to review microbiological findings of PM and ICD infections observed at this Unit in five years period (2000–2005). Materials and Methods: Retrospective observational study on consecutive patients. All patients with clinically documented PM or ICD infections were enrolled in the study. To define the aetiology of the infections. Catheter leads and/or the infected material from the pocket upon removal were cultured in aerobic and anaerobic solid media. Results: In the study period PM and ICD leads and generators were removed transvenously from 602 patients. Microbiological documentation was obtained from 451 patients (75%) and 560 different microorganisms were isolated; therefore we had negative culture in 151 patients. In 99 patients infections were polymicrobial. Staphylococci were the most frequently isolated pathogens (474/560−84%). The coagulase-negative staphylococci (CNS) resulted the first pathogen (380) followed by S. aureus (94), methicillin-resistant strains, among staphylococci, were 123/474 (26%). Gram negative rods and fungi are relatively rare. Overall susceptibility were also studied; the classes of antibiotic with good activity were newer quinolones (moxifloxacin and levofloxacin followed by aminoglycosides and glycopeptides).
Patients Microrganisms isolated CNS S. aureus Total MR staphylococci Gram-negative rods Yeasts/moulds Others
Year 2000–2001 2002–2003 2004
2005
121 132 93 (70%) 19 (14%) 33 (29%) 16 1 4
127 120 81 (67%) 21 (18%) 25 (25%) 2 5 11
228 180 117 (65%) 35 (19%) 36 (30%) 14 4 10
136 128 89 (69%) 19 (15%) 29 (22%) 3 2 15
Total
602 560 380 (68%) 94 (17%) 123 (26%) 35 (6%) 12 (2%) 40 (8%)
Conclusions: In our experience PM and ICD infections were mainly caused by Staphylococci, especially CNS, other microorganisms (Gramnegative rods and fungi) were also documented in few cases. The