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P305 Pulmonary tuberculosis in household contact of patients with active tuberculosis in Ahvaz, Iran (2003–2005)
S122
Poster Presentations
inadequate treatment, underlying diseases, severity of sepsis, UBC, IVL, previous invasive procedures, ventilation and neutropenia. Conclusions: The prevalence of MRSA is high and rapidly increasing at Patras University Hospital, as it is globally. Strict and continuous control measures to prevent the spread of MRSA should maintain with strengthening of sanitary preventative measures and expansion of strategies to hamper the indiscriminative use of antibiotics. P305 Pulmonary tuberculosis in household contact of patients with active tuberculosis in Ahvaz, Iran (2003 2005) S. Alavi1 . 1 Joundishapour University of Medical Sciences, Ahvaz, Iran Objectives: To determine the prevalence of tuberculosis (TB) among the household contacts. Methodology: It is a retrospective descriptive study conducted in Ahvaz a city in the southwest of Iran, between October and February 2007. Medical files and epidemiological forms of documented TB cases and their contacts in Ahvaz Health Center over the three years period from 2003 to 2005 were reviewed. An index case (IC) was defined as the first TB case identified in the household. A household contact (HC) was defined as an individual who had resided in the household for at least 30 days prior to the diagnosis of tuberculosis in the index case. Secondary cases were defined as TB cases among contacts of the IC. Results: We found 69 patients as IC of TB. Secondary TB in HC and community contacts (CC) was 64 and 15 cases respectively. The studied contact population of 1293 individuals included 352 HC and 941 CC. The prevalence rate of TB for HC and CC was 18.2% and 1.5% respectively (p < 0.05). The prevalence rate of TB from IC with smear positive pulmonary tuberculosis (SPPTB) and smear negative pulmonary tuberculosis (SNPTB) for HC and CC was 23.1%, 11.7% and 2.3%, 0.8% respectively (p < 0.05). More than 95% of patients with TB in HC were middle aged or elderly. HIV seropositivity and history of IDU addiction was detected in 18.7% of HC with tuberculosis (p < 0.05). Conclusion: Tuberculosis is common among household contacts of index cases in Ahvaz (Iran), especially among middle aged/elderly, HIVinfected and IDU addict contacts. P306 Investigating the colonization of Staphylococcus aureus among patients admitted to the infectious diseases ward of Imam Reza’s hospital in 1386 A. Hydari1 , V. Poriazadeh1 , M. Naderinasab2 *. 1 Infection Deasese, Mashhad, Iran, 2 Medical School of Mashhad University, Mashhad, Iran Background: Staphylococcus aureus is one of the most common human pathogens. Colonization with staphylococus is known as one of the most important risk factors for subsequent infections with this microorganism. Studies have demonstrated that anterior nares are the most common loci for the colonization of Staphylococcus aureus and the source of the spread to other parts of the body. Considering the variety of patients admitted to infectious ward, a high proportion of them may be carriers of Staphylococcus aureus particularly the methicillin-resistant strains and function as a reservoir for theirselves, other patients and hospital staff. Materials and method: This was a cross-sectional study peformed on 600 patients recently admitted in the infectious ward of Imam Reza’s hospital. Sampling was performed on all patients in less than 20 hours, from both nostrils and by sterile swab. The culture media were rapidly transferred to microbiology laboratory and after final identification of the bacteria, susceptibility of the bacteria to methicillin was evaluated and the results recorded. Results: Colonization with Staphylococcus aureus at admission was found in 239 patients (39.8%) among them, 98 (41%) were methicillinsusceptible and 141 (59%) methicillin-resistant. On the third admission day, 57 patients (15.8%) were found to become colonized, among them, 7 (12.3%) were methicillin-susceptible and 50 (87.7%) were methicillin-resistant. On the seventh day of admission, colonization was demonstrated in 32 patients (13%), of which, 3 (9.4%) were
susceptible and 29 (90.6%) resistant. At discharge, 13 patients (8.2%) were found colonized, of which, 1 (7.7%) person was susceptible and 12 (92.3%) were resistant. Conclusion: Most patients admitted in infectious ward have risk factors and a significant proportion are colonized with Staphylococcus aureus at admission. Carriers of Staphylococcus aureus at admission are mostly carrying the methicillin-resistant strains and this rate increases with time. The most common risk factors for carriage of methicillinresistant Staphylococcus aureus were a history of antibiotic use, prior admission and injection drug use. P307 Dramatic onset of acquired red cell spherocytosis in a febrile diabetic patient: clues from the blood film J. Kanji1 *, S. Chopra1 , J. Anderson1 , M. O’Donnell1 . 1 McMaster University, Hamilton, Canada Objective: Massive intravascular hemolysis (MIH) is a rare complication of Clostridium perfringens septicemia with a high mortality. Clues to the diagnosis can be obtained from the blood film and other simple tests which are easily carried out in the hematology lab, even before blood and tissue cultures become positive. The authors describe a case of a diabetic woman who presented with confusion and hip pain after local trauma and developed MIH within hours of presentation. To our knowledge, this is the first case of spontaneous Clostridium perfringens associated MIH with metastatic bone infection (primary ankle osteomyelitis spreading to the hip causing myonecrosis) with no documentation of prior hepatobiliary or colonic disease. Important clinical and laboratory features of MIH, comment on the differential diagnosis, and important hematological features of the condition are discussed. Clinical Presentation: A 61 year old female presented after a fall onto her left hip. She had seen her family physician several weeks prior for right ankle pain, which had been treated with narcotic analgesia. Physical exam revealed her to be febrile (39.6ºC), hypoxic (85% on ambient air), able to weight bear, with palpable right hip pain and a swollen erythematous right heel with purulent drainage from a 2 mm open skin lesion overlying it. Within 12 hours, the patient’s hemoglobin fell from 144 to 60 g/L. Due to the absence of identifiable bleeding, the hematologist reviewed her blood film and commented on the striking appearance of numerous small spherocytes and toxic granulation of neutrophils. A direct Coomb’s test was negative on two occasions. Review of the patient’s ankle xray revealed calcaneal fragmentation, intraosseous gas lucencies, and changes suggestive of anaerobic osteomyelitis. Xrays of the left hip revealed overlying subcutaneous emphysema. The hematologist made a diagnostic phone call! Conclusion: This case highlights the importance of close liason between the hematology laboratory and the clinician in the early recognition of this pathogen. Basic inexpensive hematological tests can elucidate the development of acute intravascular hemolysis and Coomb’s negative spherocytosis both grave indicators of prognosis in Clostridium septicemia. P308 Empiric antimicrobial therapy of extended-spectrum beta-lactamase producing Enterobacteriaceae bacteremias and effect on outcome V. Chaubey1 *, B. Dalton1 , T. Ross1 , J. Pitout1 , D. Church2 , D. Gregson1 , K. Laupland1 . 1 University of Calgary, Calgary, Canada, 2 University of Calgary and Calgary Laboratory Services, Calgary, Canada Objective: Prompt administration of adequate empiric antimicrobial therapy is a major determinant influencing the outcome of serious infections. The objective of this study was to describe empiric antimicrobial therapy employed and assess its effect on the outcome of patients bacteremic with extended-spectrum beta-lactamase (ESBL) producing Enterobacteraciae.
Poster Presentations
inadequate treatment, underlying diseases, severity of sepsis, UBC, IVL, previous invasive procedures, ventilation and neutropenia. Conclusions: The prevalence of MRSA is high and rapidly increasing at Patras University Hospital, as it is globally. Strict and continuous control measures to prevent the spread of MRSA should maintain with strengthening of sanitary preventative measures and expansion of strategies to hamper the indiscriminative use of antibiotics. P305 Pulmonary tuberculosis in household contact of patients with active tuberculosis in Ahvaz, Iran (2003 2005) S. Alavi1 . 1 Joundishapour University of Medical Sciences, Ahvaz, Iran Objectives: To determine the prevalence of tuberculosis (TB) among the household contacts. Methodology: It is a retrospective descriptive study conducted in Ahvaz a city in the southwest of Iran, between October and February 2007. Medical files and epidemiological forms of documented TB cases and their contacts in Ahvaz Health Center over the three years period from 2003 to 2005 were reviewed. An index case (IC) was defined as the first TB case identified in the household. A household contact (HC) was defined as an individual who had resided in the household for at least 30 days prior to the diagnosis of tuberculosis in the index case. Secondary cases were defined as TB cases among contacts of the IC. Results: We found 69 patients as IC of TB. Secondary TB in HC and community contacts (CC) was 64 and 15 cases respectively. The studied contact population of 1293 individuals included 352 HC and 941 CC. The prevalence rate of TB for HC and CC was 18.2% and 1.5% respectively (p < 0.05). The prevalence rate of TB from IC with smear positive pulmonary tuberculosis (SPPTB) and smear negative pulmonary tuberculosis (SNPTB) for HC and CC was 23.1%, 11.7% and 2.3%, 0.8% respectively (p < 0.05). More than 95% of patients with TB in HC were middle aged or elderly. HIV seropositivity and history of IDU addiction was detected in 18.7% of HC with tuberculosis (p < 0.05). Conclusion: Tuberculosis is common among household contacts of index cases in Ahvaz (Iran), especially among middle aged/elderly, HIVinfected and IDU addict contacts. P306 Investigating the colonization of Staphylococcus aureus among patients admitted to the infectious diseases ward of Imam Reza’s hospital in 1386 A. Hydari1 , V. Poriazadeh1 , M. Naderinasab2 *. 1 Infection Deasese, Mashhad, Iran, 2 Medical School of Mashhad University, Mashhad, Iran Background: Staphylococcus aureus is one of the most common human pathogens. Colonization with staphylococus is known as one of the most important risk factors for subsequent infections with this microorganism. Studies have demonstrated that anterior nares are the most common loci for the colonization of Staphylococcus aureus and the source of the spread to other parts of the body. Considering the variety of patients admitted to infectious ward, a high proportion of them may be carriers of Staphylococcus aureus particularly the methicillin-resistant strains and function as a reservoir for theirselves, other patients and hospital staff. Materials and method: This was a cross-sectional study peformed on 600 patients recently admitted in the infectious ward of Imam Reza’s hospital. Sampling was performed on all patients in less than 20 hours, from both nostrils and by sterile swab. The culture media were rapidly transferred to microbiology laboratory and after final identification of the bacteria, susceptibility of the bacteria to methicillin was evaluated and the results recorded. Results: Colonization with Staphylococcus aureus at admission was found in 239 patients (39.8%) among them, 98 (41%) were methicillinsusceptible and 141 (59%) methicillin-resistant. On the third admission day, 57 patients (15.8%) were found to become colonized, among them, 7 (12.3%) were methicillin-susceptible and 50 (87.7%) were methicillin-resistant. On the seventh day of admission, colonization was demonstrated in 32 patients (13%), of which, 3 (9.4%) were
susceptible and 29 (90.6%) resistant. At discharge, 13 patients (8.2%) were found colonized, of which, 1 (7.7%) person was susceptible and 12 (92.3%) were resistant. Conclusion: Most patients admitted in infectious ward have risk factors and a significant proportion are colonized with Staphylococcus aureus at admission. Carriers of Staphylococcus aureus at admission are mostly carrying the methicillin-resistant strains and this rate increases with time. The most common risk factors for carriage of methicillinresistant Staphylococcus aureus were a history of antibiotic use, prior admission and injection drug use. P307 Dramatic onset of acquired red cell spherocytosis in a febrile diabetic patient: clues from the blood film J. Kanji1 *, S. Chopra1 , J. Anderson1 , M. O’Donnell1 . 1 McMaster University, Hamilton, Canada Objective: Massive intravascular hemolysis (MIH) is a rare complication of Clostridium perfringens septicemia with a high mortality. Clues to the diagnosis can be obtained from the blood film and other simple tests which are easily carried out in the hematology lab, even before blood and tissue cultures become positive. The authors describe a case of a diabetic woman who presented with confusion and hip pain after local trauma and developed MIH within hours of presentation. To our knowledge, this is the first case of spontaneous Clostridium perfringens associated MIH with metastatic bone infection (primary ankle osteomyelitis spreading to the hip causing myonecrosis) with no documentation of prior hepatobiliary or colonic disease. Important clinical and laboratory features of MIH, comment on the differential diagnosis, and important hematological features of the condition are discussed. Clinical Presentation: A 61 year old female presented after a fall onto her left hip. She had seen her family physician several weeks prior for right ankle pain, which had been treated with narcotic analgesia. Physical exam revealed her to be febrile (39.6ºC), hypoxic (85% on ambient air), able to weight bear, with palpable right hip pain and a swollen erythematous right heel with purulent drainage from a 2 mm open skin lesion overlying it. Within 12 hours, the patient’s hemoglobin fell from 144 to 60 g/L. Due to the absence of identifiable bleeding, the hematologist reviewed her blood film and commented on the striking appearance of numerous small spherocytes and toxic granulation of neutrophils. A direct Coomb’s test was negative on two occasions. Review of the patient’s ankle xray revealed calcaneal fragmentation, intraosseous gas lucencies, and changes suggestive of anaerobic osteomyelitis. Xrays of the left hip revealed overlying subcutaneous emphysema. The hematologist made a diagnostic phone call! Conclusion: This case highlights the importance of close liason between the hematology laboratory and the clinician in the early recognition of this pathogen. Basic inexpensive hematological tests can elucidate the development of acute intravascular hemolysis and Coomb’s negative spherocytosis both grave indicators of prognosis in Clostridium septicemia. P308 Empiric antimicrobial therapy of extended-spectrum beta-lactamase producing Enterobacteriaceae bacteremias and effect on outcome V. Chaubey1 *, B. Dalton1 , T. Ross1 , J. Pitout1 , D. Church2 , D. Gregson1 , K. Laupland1 . 1 University of Calgary, Calgary, Canada, 2 University of Calgary and Calgary Laboratory Services, Calgary, Canada Objective: Prompt administration of adequate empiric antimicrobial therapy is a major determinant influencing the outcome of serious infections. The objective of this study was to describe empiric antimicrobial therapy employed and assess its effect on the outcome of patients bacteremic with extended-spectrum beta-lactamase (ESBL) producing Enterobacteraciae.