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P1936 Assessment of the risk factors for mortality in hospital-acquired Acinetobacter baumannii infections in a teaching hospital
S556 Objective: In recent years, the Hospital dos Capuchos, a hospital located in Lisbon, has increasingly observed the isolation of resistant A. baumannii. The main goal was to study the epidemiology of A. baumannii infection during 2004–2006 and to determine whether the European clone II strain was, at present, endemic. Methods: During the period of December 2003 until September 2006, 49 non-duplicate A. baumannii isolates were collected. Antibiotic susceptibility was determined by VITEK 2 Advanced Expert System. Clinical epidemiologic study of A. baumannii isolates was performed by combination of antibiotyping and randomly amplified polymorphic DNA analysis (RAPD). Results and Conclusions: Isolates were more frequently recovered from older patients (55 to 70 years old, 26.5%; 71 and more, 55%). Fifty seven per cent of the isolates were collected from intensive care units samples, 32.7% from Medicine wards, 8.2% from Surgery wards and 2% from Haematology. They were isolated mainly from bronchial secretions (40.8%), urine (24.5%) and blood (22.4%). Ten different antibiotypes were found, according to antibiotic susceptibility profiles. The majority of isolates collected since January 2004 showed multidrug-resistance. Only one isolate from January 2004 showed a susceptibility profile, with a unique DNA fingerprint. During 2004, it was observed an increasingly higher genetic diversity (five genotypes), replaced at the end of the year, and subsequent years, by two major clusters. Both were multidrug resistant, including resistance to carbapenems and quinolones. Cluster A isolates were consistently susceptible to gentamycin and amikacin, showing intermediate susceptibility to ceftazidime, while isolates from cluster B were resistant to all antibiotics except to tobramycin and amikacin (variable susceptibility). Phenotypic and genotypic profiles of cluster B isolates were compatible with those of European clone II strain. At our knowledge, cluster A is found for the first time in Portugal in this hospital. Although, considering antibiogram and DNA fingerprinting, it cannot be considered as a clone. It is possible that these isolates may have evolved independently from a common ancestor, forming a recent lineage. The study shows that several multidrug-resistant clusters of EU clone II can coexist endemically for several years.
P1936 Assessment of the risk factors for mortality in hospital-acquired Acinetobacter baumannii infections in a teaching hospital C. Bulut, M.A. Yetkin, F.S. Erdinc, C. Ataman Hatipoglu, U. Onde, E.A. Karakoc, N. T¨ulek (Ankara, Samsun, TR) Objectives: Acinetobacters are increasingly involved as aetiological agents of hospital acquired infections in seriously ill patients, in recent years. The aim of this study was to evaluate the hospital acquired Acinetobacter baumannii infections and to assess the risk factors associated with mortality. Methods: Prospective laboratory based active surveillance has been performed in our hospital between January 2000 and December 2004. Hospital acquired infections were diagnosed according to the CDC criterias. Conventional methods were used for the identification of Acinetobacter isolates. Disc diffusion method was used for antimicrobial susceptibility test of the microorganisms. Results: Hospital acquired Acinetobacter baumannii infections were detected in 95 male and 71 woman patients. The mean age of the patients were 58.0±17.8 years. Acinetobacter baumannii was isolated mainly from the ICU patients (32.5%), from the patients on the orthopaedy wards (16.3%) and on the neurology ward (11.4%) consecutively. Predisposing factors detected in the patients infected with Acinetobacter baumannii were urinary catheter insertion (81.3%), mechanical ventilation (25.3%) and central venous catheter (21.1%) consecutively. The mean duration of time between hospitalisation and occurrence of infection were 17.2±14.8 days. Urinary tract infection, surgical site infection, primary bloodstream infection and hospital acquired meningitis were the most common infections and existed in 30.1%, 29.5%, 17.5% and 7.3% of patients respectively. Carbapenems and netilmicin were the most effective antimicrobials agents against
17th ECCMID / 25th ICC, Posters Acinetobacter isolates and an evident decrease in amicasin resistance was detected overall the five year period. Crude mortality rate was 36.5%. Older age (60 years), mechanical ventilation, presence of central venous catheter, tracheostomy, being an ICU patient, presence of coma and having a carbapenem resistance were found to be associated with mortality due to A baumannii infection by univariate analysis. Of these factors older age ( 60 years), mechanical ventilation, presence of coma and being an ICU patient were independently associated with mortality on multivariate analysis (p < 0.05). Conclusion: These data suggest that, clinical efforts aimed at the improvements in the medical management of ICU patients with severe A. baumannii infection especially those who need mechanical ventilation, are required for further improvement in patient outcome. P1937 Multidrug-resistant Acinetobacter baumannii in a surgical intensive care unit J.M. Sahuquillo Arce, E. Colombo Gainza, A. Gil Brusola, P. Ramirez Galleymore, M. Bosch Alepuz, J. Cordoba, M. Gobernado (Valencia, ES) Objective: To study the changes in the population of Acinetobacter baumannii in a period of two years (2003–2005) in an endemic situation of a surgical ICU. Materials and Methods: We contrasted the antibiotic susceptibility (Rosco Disk diffusion and bioM´erieux VITEK 2) and the genetic polymorphism (Amersham Biosciences Random Amplified Polymorphic DNA [RAPD]) data of two environmental studies conducted in February 2003 and January 2005 in a surgical ICU to determine the colonisation pressure of multidrug-resistant A. baumannii. The antibiotic consumption of this department and the percentage of patients who suffered a bacteraemia by this microorganism were analysed as well. Results: Nineteen strains of A. baumannii were isolated in the first study, this represented 20% of all the samples included. They were classified into three different clones by the RAPD: clone 1 (5 isolates) was susceptible to sulbactam/ampicillin (SAMP), colistin (CS), sulfamethoxazole trimethoprim (SXT), and two of the isolates were also susceptible to amikacin (AMK); clone 2 (13 isolates) was susceptible to SAMP, CS, AMK, and five isolates were intermediate to cefepime (CEFP); clone 3 (1 isolate) was only susceptible to CS. Thirty seven strains of A. baumannii were isolated in the second study, this meant 31% of all the samples included. They were classified into the three original clones by the RAPD: clone 1 (18 isolates) was susceptible to SAMP, CS, SXT and two of these were also susceptible to AMK; clone 2 (3 isolates) was susceptible to CL, AMK, intermediate to CEFP and SAMP; clone 3 (16 isolate) was only susceptible to CS. The consumption of SXT during that period of time did not vary, while that of CEFP decreased to half its previous value. On the other hand, the use of SAMP and AMK reached three times its initial level. Bacteraemia by A. baumannii increased constantly from 2.8% to 4%. Conclusions: A population of multidrug-resistant A. baumannii has settled at our surgical ICU. Three different clones comprise all the isolates found in both studies with a two-year delay, which points to an endemic colonisation. The antibiotic pressure over this population due to the increased use of AMK and SAMP favoured the expansion of clones 1 and 3, whereas clone 2 almost disappeared. An extensive use of antibiotics against this microorganism did not improve the situation, moreover, the number of bacteraemia cases augmented and the treatment options dimished. P1938 Use of nested PCR for evaluation of Helicobacter pylori transmission by endoscopies H. Mikkelsen, L.P. Andersen (Copenhagen, DK) Objective: Helicobacter pylori colonise the gastric mucosa of almost half the world population and have been recognized as the main cause of gastritis. Additionally, it is considered to play a major role in development of duodenal ulcers, gastric ulcers and gastric lymphoma
P1936 Assessment of the risk factors for mortality in hospital-acquired Acinetobacter baumannii infections in a teaching hospital C. Bulut, M.A. Yetkin, F.S. Erdinc, C. Ataman Hatipoglu, U. Onde, E.A. Karakoc, N. T¨ulek (Ankara, Samsun, TR) Objectives: Acinetobacters are increasingly involved as aetiological agents of hospital acquired infections in seriously ill patients, in recent years. The aim of this study was to evaluate the hospital acquired Acinetobacter baumannii infections and to assess the risk factors associated with mortality. Methods: Prospective laboratory based active surveillance has been performed in our hospital between January 2000 and December 2004. Hospital acquired infections were diagnosed according to the CDC criterias. Conventional methods were used for the identification of Acinetobacter isolates. Disc diffusion method was used for antimicrobial susceptibility test of the microorganisms. Results: Hospital acquired Acinetobacter baumannii infections were detected in 95 male and 71 woman patients. The mean age of the patients were 58.0±17.8 years. Acinetobacter baumannii was isolated mainly from the ICU patients (32.5%), from the patients on the orthopaedy wards (16.3%) and on the neurology ward (11.4%) consecutively. Predisposing factors detected in the patients infected with Acinetobacter baumannii were urinary catheter insertion (81.3%), mechanical ventilation (25.3%) and central venous catheter (21.1%) consecutively. The mean duration of time between hospitalisation and occurrence of infection were 17.2±14.8 days. Urinary tract infection, surgical site infection, primary bloodstream infection and hospital acquired meningitis were the most common infections and existed in 30.1%, 29.5%, 17.5% and 7.3% of patients respectively. Carbapenems and netilmicin were the most effective antimicrobials agents against
17th ECCMID / 25th ICC, Posters Acinetobacter isolates and an evident decrease in amicasin resistance was detected overall the five year period. Crude mortality rate was 36.5%. Older age (60 years), mechanical ventilation, presence of central venous catheter, tracheostomy, being an ICU patient, presence of coma and having a carbapenem resistance were found to be associated with mortality due to A baumannii infection by univariate analysis. Of these factors older age ( 60 years), mechanical ventilation, presence of coma and being an ICU patient were independently associated with mortality on multivariate analysis (p < 0.05). Conclusion: These data suggest that, clinical efforts aimed at the improvements in the medical management of ICU patients with severe A. baumannii infection especially those who need mechanical ventilation, are required for further improvement in patient outcome. P1937 Multidrug-resistant Acinetobacter baumannii in a surgical intensive care unit J.M. Sahuquillo Arce, E. Colombo Gainza, A. Gil Brusola, P. Ramirez Galleymore, M. Bosch Alepuz, J. Cordoba, M. Gobernado (Valencia, ES) Objective: To study the changes in the population of Acinetobacter baumannii in a period of two years (2003–2005) in an endemic situation of a surgical ICU. Materials and Methods: We contrasted the antibiotic susceptibility (Rosco Disk diffusion and bioM´erieux VITEK 2) and the genetic polymorphism (Amersham Biosciences Random Amplified Polymorphic DNA [RAPD]) data of two environmental studies conducted in February 2003 and January 2005 in a surgical ICU to determine the colonisation pressure of multidrug-resistant A. baumannii. The antibiotic consumption of this department and the percentage of patients who suffered a bacteraemia by this microorganism were analysed as well. Results: Nineteen strains of A. baumannii were isolated in the first study, this represented 20% of all the samples included. They were classified into three different clones by the RAPD: clone 1 (5 isolates) was susceptible to sulbactam/ampicillin (SAMP), colistin (CS), sulfamethoxazole trimethoprim (SXT), and two of the isolates were also susceptible to amikacin (AMK); clone 2 (13 isolates) was susceptible to SAMP, CS, AMK, and five isolates were intermediate to cefepime (CEFP); clone 3 (1 isolate) was only susceptible to CS. Thirty seven strains of A. baumannii were isolated in the second study, this meant 31% of all the samples included. They were classified into the three original clones by the RAPD: clone 1 (18 isolates) was susceptible to SAMP, CS, SXT and two of these were also susceptible to AMK; clone 2 (3 isolates) was susceptible to CL, AMK, intermediate to CEFP and SAMP; clone 3 (16 isolate) was only susceptible to CS. The consumption of SXT during that period of time did not vary, while that of CEFP decreased to half its previous value. On the other hand, the use of SAMP and AMK reached three times its initial level. Bacteraemia by A. baumannii increased constantly from 2.8% to 4%. Conclusions: A population of multidrug-resistant A. baumannii has settled at our surgical ICU. Three different clones comprise all the isolates found in both studies with a two-year delay, which points to an endemic colonisation. The antibiotic pressure over this population due to the increased use of AMK and SAMP favoured the expansion of clones 1 and 3, whereas clone 2 almost disappeared. An extensive use of antibiotics against this microorganism did not improve the situation, moreover, the number of bacteraemia cases augmented and the treatment options dimished. P1938 Use of nested PCR for evaluation of Helicobacter pylori transmission by endoscopies H. Mikkelsen, L.P. Andersen (Copenhagen, DK) Objective: Helicobacter pylori colonise the gastric mucosa of almost half the world population and have been recognized as the main cause of gastritis. Additionally, it is considered to play a major role in development of duodenal ulcers, gastric ulcers and gastric lymphoma