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P3.02 Antimicrobial Resistance and Prevalence of Serogroups of Pseudomonas aeruginosa in a Lithuanian University Hospital
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Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
Aims: A better analysis of behavioral, organizational and structural circumstances of exposures. Method: Introduction of a new reporting form for exposures collected at the emergency department, entailing self-reported description of exposures, the involved instruments and body part, followed by additional medical care including Post Exposure Prophylaxis (PEP) for HIV or HBV. Results: 471 exposures were reported 2004/2005 (69% women). 51.2% were nurses, midwives and theatre nurse, 39.3% doctors (surgeons, internists, anaesthiologists). Percutaneous exposures compromised of 86.9% of all reported accidents. 40.5% exposures occurred in the OT, of which half occurred during surgical procedures and 16% in passing instruments. The predominately involved body parts were Dig II (16.9%) and Dig I (12%), left hand. 23.6% of the accidents happened in patients rooms, of which 46% occurred during disposal, 10.8% while recapping, 10.8% during blood drawing. 5.3% of the tested index patients were HIV positive, 1.7% HBsAg positive and 8.7% HCV positive. 26 of the 143 initiated HIV PEP finished the 4 weeks course (18%). 97% of all exposed HCW had Hepatitis B vaccination coverage. Conclusions: Our novel reporting system allows a more precise analysis of the type and location of reported exposures. It allows also to determine the specific department and ward involved (OT, ICU etc.) combined with the type of exposure (needlestick, failure of safety equipment etc.). Subsequently, targeted preventative measures can be taken, involving teaching of staff, feedback of results and preparation of recommendation for organizational and structural changes. P3.01 Prevalence of non-fermenting Gram-negative rods in clinical specimens from surgical patients M. Wroblewska1 *, H. Marchel2 , D. Bienko2 , M. Luczak1 . 1 Department of Medical Microbiology, Medical University of Warsaw, Poland, 2 Microbiology Laboratory, Central Clinical Hospital, Medical University of Warsaw, Poland Background: Gram-negative non-fermenting rods are emerging as important nosocomial pathogens, with increasing resistance to available antimicrobial agents. Objective: Analysis of prevalence of Gram-negative non-fermenting rods in clinical specimens from surgical patients hospitalised in a universityaffiliated hospital (1200 beds) over a period of one year (2005). Material and methods: Cultures of blood were done using a computerised BacT/Alert system (bioMerieux). Peritoneal swabs, drains, wound swabs, pleural fluid, bronchial aspirates, bile, intubation and tracheostomy tubes, as well as other clinical samples were processed with standard microbiological techniques. Identification of the isolates was done with API or VITEK tests (bioMerieux). Results: In total 5587 cultures were performed – 2894 (51.8%) were negative and 2693 (48.2%) were positive. Gram-negative non-fermenting rods (GN-NFR) comprised 444 strains (16.5% of all isolates). Most strains of GN-NFR were cultured from wound swabs – 196 (44.14%), followed by peritoneal swabs – 63 (14.19%), intubation/tracheostomy tubes – 40 (9.01%), blood – 32 (7.21%) and bile samples – 29 (6.53%). Isolates of GN-NFR constituted 12.16% of all strains cultured from the blood. Predominated strains of Pseudomonas aeruginosa – 204 (45.95%), Acinetobacter baumannii – 146 (32.88%) and Stenotrophomonas maltophilia – 54 (12.16%). A. baumannii was the most common species of GN-NFR isolated from blood, drains, bronchial washings and intubation/tracheostomy tubes. A great variation in frequency of GN-NFR isolation was observed between different surgical wards, depending on the profile of performed surgical procedures. Conclusions: 1. Gram-negative non-fermenting rods (GN-NFR) comprised over 16% of all bacterial isolates from surgical patients. 2. These bacteria appear to be particularly important
pathogens in patients undergoing abdominal surgery. 3. Strains of A. baumannii predominate over other species of GN-NFR in the cultures of blood, drains and bronchial washings of surgical patients. P3.02 Antimicrobial Resistance and Prevalence of Serogroups of Pseudomonas aeruginosa in a Lithuanian University Hospital G. Gailiene *, A. Pavilonis, V. Kareiviene. Kaunas University of Medicine, Lithuania Background: Pseudomonas aeruginosa is one of the common non-fermenting aerobic gram – negative microorganisms identified from clinical specimens of hospitalized patients. The emergence of multi-drug resistant (MDR) P.aeruginosa strains is a growing concern in hospital-acquired infections. The aim of this study was to investigate antimicrobial resistance and prevalence of serogroups of P. aeruginosa isolated at Kaunas Medical University Hospital, Lithuania. Methods: Minimum inhibitory concentrations of 609 Pseudomonas aeruginosa strains recovered various clinical sources between 11/2001 and 11/2002 were determinated against 11 antibiotics by microdilution method in Mueller–Hinton agar using NCCLS interpretative guidelines. References strains P.aeruginosa ATCC 27853 were used for quality control. Serogroups of P. aeruginosa strains were established using serums of Seiken Co. Ltd (Tokyo, Japan), containing antibodies against antigens of O-group P. aeruginosa. Results: P. aeruginosa strains were the most sensitive to ceftazidime (78.9%), imipenem (73.6%), meropenem (70.9%), the most resistant to gentamicin (54.1%) and ciprofloxacin (52.5%). 9.85% of investigated P. aeruginosa were MDR strains. MDR P. aeruginosa strains were 1.5–3.5 times more resistant to antibiotics in comparison with non-MDR strains, except amikacin: MDR strains are more sensitive (81.7%), than nonMDR P. aeruginosa strains (61.0%). The most frequently were observed O:E (34.7%) and O:B (29.0%) P. aeruginosa serogroups followed in order by O:I (11.4%), O:A (10.1%) serogroups. Among MDR strains dominate P. aeruginosa of O:E serogroup (48.3%). Conclusions: Our results show that serogroup O:E was the most prevalent P.aeruginosa serogroup in our hospital and that its antibiotic resistance was the highest. Identifying the serogroups of these bacteria is informative as an initial screening procedure in epidemiological studies. P3.03 Prognostic Factors for Infections Caused by ImipenemResistant Acinetobacter Spp.: Effect of Treatment Choice M. Oliveira1 *, S. Costa1 , G. Prado1 , R. Grinbaum2 , A. Levin1 . das Cl´ ınicas da Universidade de S˜ ao Paulo, Brazil, 2 Hospital do Servidor P´ ublico Estadual, Brazil 1 Hospital
Background: Acinetobacter spp. resistant to imipenem has emerged as a significant nosocomial pathogen and mortality associated with these infections is high. Objective: Evaluate prognostic factors for infections caused by imipenem-resistant Acinetobacter spp. Methods: We reviewed charts of patients with nosocomial infections caused by imipenem-resistant Acinetobacter from 1996 to 2004 from 2 hospitals. Data obtained: demographics; underlying diseases; severity of condition; admission at ICU; invasive devices; surgery; time to beginning treatment; infectious diagnosis; presence of bacteremia; treatment regimen; mechanical ventilation and hemodynamic instability. Only isolates obtained from usually sterile sites and from quantitative bronchoalveolar lavage (>104 ufc/mL) were included. Eightyfive patients used ampicillin-sulbactam (A/S) and 80 received polymyxin. The outcome variables studied were death until the end of treatment and death until the end of hospitalization.
Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
Aims: A better analysis of behavioral, organizational and structural circumstances of exposures. Method: Introduction of a new reporting form for exposures collected at the emergency department, entailing self-reported description of exposures, the involved instruments and body part, followed by additional medical care including Post Exposure Prophylaxis (PEP) for HIV or HBV. Results: 471 exposures were reported 2004/2005 (69% women). 51.2% were nurses, midwives and theatre nurse, 39.3% doctors (surgeons, internists, anaesthiologists). Percutaneous exposures compromised of 86.9% of all reported accidents. 40.5% exposures occurred in the OT, of which half occurred during surgical procedures and 16% in passing instruments. The predominately involved body parts were Dig II (16.9%) and Dig I (12%), left hand. 23.6% of the accidents happened in patients rooms, of which 46% occurred during disposal, 10.8% while recapping, 10.8% during blood drawing. 5.3% of the tested index patients were HIV positive, 1.7% HBsAg positive and 8.7% HCV positive. 26 of the 143 initiated HIV PEP finished the 4 weeks course (18%). 97% of all exposed HCW had Hepatitis B vaccination coverage. Conclusions: Our novel reporting system allows a more precise analysis of the type and location of reported exposures. It allows also to determine the specific department and ward involved (OT, ICU etc.) combined with the type of exposure (needlestick, failure of safety equipment etc.). Subsequently, targeted preventative measures can be taken, involving teaching of staff, feedback of results and preparation of recommendation for organizational and structural changes. P3.01 Prevalence of non-fermenting Gram-negative rods in clinical specimens from surgical patients M. Wroblewska1 *, H. Marchel2 , D. Bienko2 , M. Luczak1 . 1 Department of Medical Microbiology, Medical University of Warsaw, Poland, 2 Microbiology Laboratory, Central Clinical Hospital, Medical University of Warsaw, Poland Background: Gram-negative non-fermenting rods are emerging as important nosocomial pathogens, with increasing resistance to available antimicrobial agents. Objective: Analysis of prevalence of Gram-negative non-fermenting rods in clinical specimens from surgical patients hospitalised in a universityaffiliated hospital (1200 beds) over a period of one year (2005). Material and methods: Cultures of blood were done using a computerised BacT/Alert system (bioMerieux). Peritoneal swabs, drains, wound swabs, pleural fluid, bronchial aspirates, bile, intubation and tracheostomy tubes, as well as other clinical samples were processed with standard microbiological techniques. Identification of the isolates was done with API or VITEK tests (bioMerieux). Results: In total 5587 cultures were performed – 2894 (51.8%) were negative and 2693 (48.2%) were positive. Gram-negative non-fermenting rods (GN-NFR) comprised 444 strains (16.5% of all isolates). Most strains of GN-NFR were cultured from wound swabs – 196 (44.14%), followed by peritoneal swabs – 63 (14.19%), intubation/tracheostomy tubes – 40 (9.01%), blood – 32 (7.21%) and bile samples – 29 (6.53%). Isolates of GN-NFR constituted 12.16% of all strains cultured from the blood. Predominated strains of Pseudomonas aeruginosa – 204 (45.95%), Acinetobacter baumannii – 146 (32.88%) and Stenotrophomonas maltophilia – 54 (12.16%). A. baumannii was the most common species of GN-NFR isolated from blood, drains, bronchial washings and intubation/tracheostomy tubes. A great variation in frequency of GN-NFR isolation was observed between different surgical wards, depending on the profile of performed surgical procedures. Conclusions: 1. Gram-negative non-fermenting rods (GN-NFR) comprised over 16% of all bacterial isolates from surgical patients. 2. These bacteria appear to be particularly important
pathogens in patients undergoing abdominal surgery. 3. Strains of A. baumannii predominate over other species of GN-NFR in the cultures of blood, drains and bronchial washings of surgical patients. P3.02 Antimicrobial Resistance and Prevalence of Serogroups of Pseudomonas aeruginosa in a Lithuanian University Hospital G. Gailiene *, A. Pavilonis, V. Kareiviene. Kaunas University of Medicine, Lithuania Background: Pseudomonas aeruginosa is one of the common non-fermenting aerobic gram – negative microorganisms identified from clinical specimens of hospitalized patients. The emergence of multi-drug resistant (MDR) P.aeruginosa strains is a growing concern in hospital-acquired infections. The aim of this study was to investigate antimicrobial resistance and prevalence of serogroups of P. aeruginosa isolated at Kaunas Medical University Hospital, Lithuania. Methods: Minimum inhibitory concentrations of 609 Pseudomonas aeruginosa strains recovered various clinical sources between 11/2001 and 11/2002 were determinated against 11 antibiotics by microdilution method in Mueller–Hinton agar using NCCLS interpretative guidelines. References strains P.aeruginosa ATCC 27853 were used for quality control. Serogroups of P. aeruginosa strains were established using serums of Seiken Co. Ltd (Tokyo, Japan), containing antibodies against antigens of O-group P. aeruginosa. Results: P. aeruginosa strains were the most sensitive to ceftazidime (78.9%), imipenem (73.6%), meropenem (70.9%), the most resistant to gentamicin (54.1%) and ciprofloxacin (52.5%). 9.85% of investigated P. aeruginosa were MDR strains. MDR P. aeruginosa strains were 1.5–3.5 times more resistant to antibiotics in comparison with non-MDR strains, except amikacin: MDR strains are more sensitive (81.7%), than nonMDR P. aeruginosa strains (61.0%). The most frequently were observed O:E (34.7%) and O:B (29.0%) P. aeruginosa serogroups followed in order by O:I (11.4%), O:A (10.1%) serogroups. Among MDR strains dominate P. aeruginosa of O:E serogroup (48.3%). Conclusions: Our results show that serogroup O:E was the most prevalent P.aeruginosa serogroup in our hospital and that its antibiotic resistance was the highest. Identifying the serogroups of these bacteria is informative as an initial screening procedure in epidemiological studies. P3.03 Prognostic Factors for Infections Caused by ImipenemResistant Acinetobacter Spp.: Effect of Treatment Choice M. Oliveira1 *, S. Costa1 , G. Prado1 , R. Grinbaum2 , A. Levin1 . das Cl´ ınicas da Universidade de S˜ ao Paulo, Brazil, 2 Hospital do Servidor P´ ublico Estadual, Brazil 1 Hospital
Background: Acinetobacter spp. resistant to imipenem has emerged as a significant nosocomial pathogen and mortality associated with these infections is high. Objective: Evaluate prognostic factors for infections caused by imipenem-resistant Acinetobacter spp. Methods: We reviewed charts of patients with nosocomial infections caused by imipenem-resistant Acinetobacter from 1996 to 2004 from 2 hospitals. Data obtained: demographics; underlying diseases; severity of condition; admission at ICU; invasive devices; surgery; time to beginning treatment; infectious diagnosis; presence of bacteremia; treatment regimen; mechanical ventilation and hemodynamic instability. Only isolates obtained from usually sterile sites and from quantitative bronchoalveolar lavage (>104 ufc/mL) were included. Eightyfive patients used ampicillin-sulbactam (A/S) and 80 received polymyxin. The outcome variables studied were death until the end of treatment and death until the end of hospitalization.