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P303 A retrospective study of the prevalence of Panton-Valentine leukocidin (PVL) genes in methicillin-susceptible Staphylococcus aureus and the impact of PVL on clinical disease severity
Saturday, June 20, 2009 Conclusion: Topical antifungals can possibly better penetrate the nail palat. Fluconazole therapy is effective and safe alternative in treatment of onychomycosis due to Dermatophytes. P302 A study of complicated P. falciparum malaria and clinical efficacy of Alpha-Beta Arteether in complicated P. falciparum M. Sharma1 *. 1 WHO NPSP INDIA, Bikaner, India Aims and Objectives: 1. To evaluate the efficacy of AlphaBeta Arteether in the treatment of complicated malaria. 2. To analyse clinical presentation Design Prospective Setting Urban Private Hospital & Research Center. Material and Methods: The study was undertaken at Urban Private Hospital & Research Center. Out of 110 patients, 32 cases with complicated Falciparum malaria were taken for Alpha-Beta Arteether trial. After laboratory confirmation P. Falciparum a dose Alpha-Beta Arteether 1 amp once daily for three days. Results: The clinical symptoms pyrexia; headache 25%, icterus 40%, vomitting 45%, altered sensorium 30%, oligourea 10%, bleeding, bodyache, insomnia, loss of appetite. Splenomegaly 80%, hepatomegaly 72%, hepatic involvement serum bilirumin (73 mg%) and elevated SGOT, SGPT serum creatinine more than 3, blood urea more than 40 mg% renal failure severe anaemia jaundice and hepatic dysfunction 46.5%, cerebral malaria 31.2%, renal failure 12.4%. Severe anaemia with multisystemic involvement 9%. patients hospitalised for a seven days then evaluated weekly. study shows cerebral malaria 31.2%, clinical jaundice and hepatic dysfunction 46.5%, renal failure 12.4%, severe anaemia and other involvement 9%. level of consciousness started improving fully consciousness within 72 hours. Serumbilirubin and serum creatinine decreasing from 3 days and comes normal within 7 10 days. No Parasites in three days. Serum creatinine normal within 7 days in renal failure. Splenemegaly regressed in one month. Rapid parasite clearance with Alpha-Beta Arteether. Clinical infectious diseases: Other P303 A retrospective study of the prevalence of Panton-Valentine leukocidin (PVL) genes in methicillin-susceptible Staphylococcus aureus and the impact of PVL on clinical disease severity T. Musewe1 *, M. Alawi, K. Bondy2 , C. Rutherford1 , S. Dale1 , J. Xu, C. Main. 1 McMaster university’s, Hamilton, Canada, 2 Hamilton Regional Laboratory Medicine Program, Hamilton, Canada Objectives: Panton-Valentine Leukocidin (PVL) is a toxin produced by Staphylococcus aureus and has been implicated in severe clinical diseases including necrotizing skin infections and pneumonia. PVL has been well studied in methicillin-resistant Staphylococcus aureus (MRSA), however its prevalence in methicillin-susceptible S. aureus (MSSA), is less well established. This study will determine the prevalence of the PVL gene in bloodstream and wound infections caused by MSSA and will assess the potential clinical impact of this virulence factor on the population studied. Methods: This retrospective cohort study assessed wound (n = 181) and blood (n = 82) isolates of S. aureus isolated from patients 18 years or older with no history of MRSA colonization. Isolates were confirmed as S. aureus by conventional tests. PCR amplification was performed to identify the nuc, mec and PVL-encoding genes and antibiotic susceptibilities were determined. A chart review was conducted to review the clinical characteristics of cases, followed by a review of age and gender matched controls. PVL-positive strains will be typed using pulsed field gel electrophoresis to assess clonality. Results: Over a 4-month period, the prevalence of PVL genes in MSSA isolates collected from our laboratory was 2.7% (7/263). All PVLpositive MSSA isolates were isolated from wounds. No PVL-positive MSSA were isolated from blood cultures. The clinical diagnoses of these cases were osteomyelitis (1/7) abscesses (5/7), and a PEG
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tube site infection (1/7). None of the patients had systemic signs or symptoms of infection, however, one died during the study period secondary to a pulmonary embolism. The PVL positive organisms were susceptibile to cefazolin, ciprofloxacin, clindamycin, erythromycin, rifampin, tetracycline and trimethoprim-sulfamethoxazole by VITEK 2 susceptibility testing. Three of the isolates were resistant to fluoroquinolones (43%) and one was resistant to both clindamycin and erythromycin (14%). Data on the genetic relatedness of these isolates and the clinical course of cases compared to matched controls will be presented. Conclusions: Our preliminary data indicate that PVL-encoding genes are present in 2.7% of MSSA causing wound infections in the Hamilton area. PVL-positive MSSA infections were more likely to manifest as purulent wounds and abscess, whereas no PVL-positive MSSA were isolated from bloodstream infections. P304 Methicillin-resistant Staphylococcus aureus (MRSA): one year study in a Greek university hospital I. Starakis1 *, M. Lagadinou1 , H. Bassaris1 , C. Gogos1 . 1 Patras University Hospital, Patras, Greece Aim: To portray the prevalence, demography and clinical characteristics of patients who suffered from methicillin-resistant Staphylococcus aureus (MRSA) infection in 2006 at Patras University hospital, RionPatras, Greece. Patients and Methods: All MRSA-positive cultures of various clinical samplings attained as a part of the diagnostic process in the evaluation of patients with a suspected infection were recovered from the Microbiology department of our hospital. The patients’ medical records were fully reassessed for the collection of demographic information, severity of illness categorized as sepsis, severe sepsis, or septic shock. Underlying diseases and their severity according to the McCabe and Jackson groups, the presence of intravenous lines (IVL) or central venous catheters (CVC), urinary bladder catheter (UBC), mechanical ventilation, and neutropenia if they were present at the time of infection, invasive medical procedures including surgery if they were performed in the three days prior to the bacteraemic incident, previous antimicrobial therapy at least two weeks prior to the event, and inadequate treatment if the patient did not receive appropriate antibiotic for at least 7 days, were also recorded. Results: Four hundred sixty one S. aureus isolates were identified and of them 207 (44.9%) strains were MRSA, or 4.3 MRSA isolates/1000 admissions, which represented an increase of 6.9% over MRSA prevalence in the last trimester of 2005 (38.0%). Thirteen (6.3%) out of 207 isolates represented colonization and 194 (93.7%) out of 207 isolates caused frank infection. Community and hospital-acquired strains represented the 23.6% and 73. 7% of these isolates, respectively. There were 107 (55.2%) male and 87 (44. 8%) female patients, with a mean age 51.1±22.3 years. Older patients (65 years old) were mostly affected (57.8%). Ten patients (5.1%) were less than one month old. Eighty seven (44.8%) out of 194 patients had at least one comorbidity. The highest prevalence was noted in the overcrowded internal medicine wards (47.4%), followed by the nephrology (11.4%), the paediatrics and the adult surgical wards (10.8% each), the neonatal and the adult intensive care unit (5.1% each), the orthopaedics (4.7%), the emergency (2.6%) and the ophthalmology departments (2.1%). Skin wounds (35.1%), surgical site infections (18.5%), intraabdominal infections (12.4%) and lower respiratory tract infections (10.3%), represented the most frequent infection sites. Primary bacteraemia, including patients with an intravascular device-related infection, was noticed in 13.4% of the patients. Local signs (70.2.9%) and fever (67.9%) were the most common clinical manifestations. Severe sepsis and septic shock occurred in 55.8% and 5.1% of cases, accordingly. Overall mortality of patients with MRSA infection was 34.0%. As far as the CA incidents are concerned, mortality was significantly linked to neutropenia, previous invasive procedures, inadequate treatment, ventilation, underlying diseases, severity of sepsis, CVC, UBC and IVL. In nosocomial bacteraemias mortality was significantly correlated to previous antibiotic use and
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tube site infection (1/7). None of the patients had systemic signs or symptoms of infection, however, one died during the study period secondary to a pulmonary embolism. The PVL positive organisms were susceptibile to cefazolin, ciprofloxacin, clindamycin, erythromycin, rifampin, tetracycline and trimethoprim-sulfamethoxazole by VITEK 2 susceptibility testing. Three of the isolates were resistant to fluoroquinolones (43%) and one was resistant to both clindamycin and erythromycin (14%). Data on the genetic relatedness of these isolates and the clinical course of cases compared to matched controls will be presented. Conclusions: Our preliminary data indicate that PVL-encoding genes are present in 2.7% of MSSA causing wound infections in the Hamilton area. PVL-positive MSSA infections were more likely to manifest as purulent wounds and abscess, whereas no PVL-positive MSSA were isolated from bloodstream infections. P304 Methicillin-resistant Staphylococcus aureus (MRSA): one year study in a Greek university hospital I. Starakis1 *, M. Lagadinou1 , H. Bassaris1 , C. Gogos1 . 1 Patras University Hospital, Patras, Greece Aim: To portray the prevalence, demography and clinical characteristics of patients who suffered from methicillin-resistant Staphylococcus aureus (MRSA) infection in 2006 at Patras University hospital, RionPatras, Greece. Patients and Methods: All MRSA-positive cultures of various clinical samplings attained as a part of the diagnostic process in the evaluation of patients with a suspected infection were recovered from the Microbiology department of our hospital. The patients’ medical records were fully reassessed for the collection of demographic information, severity of illness categorized as sepsis, severe sepsis, or septic shock. Underlying diseases and their severity according to the McCabe and Jackson groups, the presence of intravenous lines (IVL) or central venous catheters (CVC), urinary bladder catheter (UBC), mechanical ventilation, and neutropenia if they were present at the time of infection, invasive medical procedures including surgery if they were performed in the three days prior to the bacteraemic incident, previous antimicrobial therapy at least two weeks prior to the event, and inadequate treatment if the patient did not receive appropriate antibiotic for at least 7 days, were also recorded. Results: Four hundred sixty one S. aureus isolates were identified and of them 207 (44.9%) strains were MRSA, or 4.3 MRSA isolates/1000 admissions, which represented an increase of 6.9% over MRSA prevalence in the last trimester of 2005 (38.0%). Thirteen (6.3%) out of 207 isolates represented colonization and 194 (93.7%) out of 207 isolates caused frank infection. Community and hospital-acquired strains represented the 23.6% and 73. 7% of these isolates, respectively. There were 107 (55.2%) male and 87 (44. 8%) female patients, with a mean age 51.1±22.3 years. Older patients (65 years old) were mostly affected (57.8%). Ten patients (5.1%) were less than one month old. Eighty seven (44.8%) out of 194 patients had at least one comorbidity. The highest prevalence was noted in the overcrowded internal medicine wards (47.4%), followed by the nephrology (11.4%), the paediatrics and the adult surgical wards (10.8% each), the neonatal and the adult intensive care unit (5.1% each), the orthopaedics (4.7%), the emergency (2.6%) and the ophthalmology departments (2.1%). Skin wounds (35.1%), surgical site infections (18.5%), intraabdominal infections (12.4%) and lower respiratory tract infections (10.3%), represented the most frequent infection sites. Primary bacteraemia, including patients with an intravascular device-related infection, was noticed in 13.4% of the patients. Local signs (70.2.9%) and fever (67.9%) were the most common clinical manifestations. Severe sepsis and septic shock occurred in 55.8% and 5.1% of cases, accordingly. Overall mortality of patients with MRSA infection was 34.0%. As far as the CA incidents are concerned, mortality was significantly linked to neutropenia, previous invasive procedures, inadequate treatment, ventilation, underlying diseases, severity of sepsis, CVC, UBC and IVL. In nosocomial bacteraemias mortality was significantly correlated to previous antibiotic use and