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P331 Endogenous endophthalmitis following Bacillus cereus catheter related blood stream infection
S146
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
globally, tigecycline was considered as the last resort to treat pandrugresistant bacteria. Though tigecycline non-susceptible K. pneumoniae isolates have been identified increasingly in recent years, the clinical information regarding bloodstream infection due to tigecycline nonsusceptible K. pneumoniae has never been reported. Objectives: The aim of this cohort study is to investigate the clinical and microbiological characteristics of tigecycline non-susceptible Klebsiella pneumoniae bacteremia in adult patients from a medical center in Taiwan. Methods: Patients with tigecycline non-susceptible K. pneumoniae bacteremia identified by E-test using FDA criteria were analyzed at a medical center in Taiwan between January 2010 and December 2012. Data on clinical features, therapy and outcomes of patients were collected from medical records. Genes for cabapenemases, plasmidic ampC -type, and extended-spectrum b-lactamases (EBSLs) were analyzed by polymerase chain reaction. Antimicrobial susceptibilities and pulsed-field gel electrophoresis (PFGE) results were determined among all the isolates. Results: A total of 36 patients with tigecycline non-susceptible K. pneumoniae bacteremia were identified. 29 patients had nosocomial bacteremia and 4 patients had healthcare-associated bacteremia. Only 13 patients had the exposure to tigecycline in the past 30 days. The overall 28-day mortality rate was 36.1%. The MIC50 and MIC90 of tigecycline were 6 and 8 mg/L, respectively. 8 isolates were ertapenem non-susceptible K. pneumoniae , including 2 isolates not susceptible to imipenem. 19 isolates were ESBL producers, and DHA-1 was detected in 18 isolates. No carbapenemase was detected among the 36 isolates. PFGE demonstrated that most isolates were epidemiologically unrelated. Conclusion: This study for the first time showed the distinct features of tigecycline non-susceptible K. pneumoniae causing bacteremia and the associated poor prognosis. More studies focusing on the risk factor and the resistance mechanisms of tigecycline non-susceptible K. pneumoniae bacteremia are necessary in Taiwan. P330 Antibiotic combination therapy and clinical outcome for multidrug-resistant Pseudomonas aeruginosa infections I. Nakamura1 *, T. Yamaguchi1 , H. Shimizu1 , S. Fukushima1 , Y. Mizuno1 , T. Matsumoto1 . 1 Department of Infection Control and Prevention, Tokyo Medical University, Tokyo, Japan E-mail address : [email protected] Objectives: Pseudomonas aeruginosa isolates which are resistant to all or almost all antibiotics have necessitated the use of antibiotic combinations consisting of some drugs to which the organism may be resistant. However, the clinical effectiveness of antibiotic combination therapy for multidrug-resistant P. aeruginosa (MDRP) infections is unclear. Methods: We evaluated the effectiveness of antibiotic combination therapy for multidrug-resistant strains of P. aeruginosa in clinical settings. In Tokyo Medical University Hospital, we selected MDRP infection cases treated by combination therapy of antipseudomonal antibiotics. Diagnosis of the infection, the components of the drug combination, duration of therapy, adverse events, and outcomes were evaluated. MDRP isolates were defined as having resistance to at least 2 of the following 3 drugs: imipenem (MIC 16 mg/mL), amikacin (MIC 32 mg/mL), and ciprofloxacin (MIC 4 mg/mL). Synergistic effects of the combination were checked by the break-point checkerboard plate method (Tateda K, et al. Scand J Infect Dis. 2006;38:268–72). This method uses designated combinations of 8 antibiotics (CAZ, PIPC, IPM, AZT, GM, CPFX, colistin, and RFP) and selects 2 concentrations of each antibiotic by considering their breakpoints, in addition to tissue and serum concentrations. Results: Eight cases of MDRP infection were treated by combination therapy of antipseudomonal antibiotics. The cases included pneumonia (2), UTI (2), abdominal abscess (1), vertebral osteomyelitis (1), and nasal abscess (1). The antibiotic combinations were: AZT+AMK (2), AZT+ABK (1), AZT+colistin (1), AZT+CPFX (1), PIPC/TAZ+AMK (1), MEPM+CPFX (1), and MEPM+TOB (1). At the end of combination therapy, 3 cases had renal dysfunction (> 0.3 mg/dL increase in serum creatinine after treatment). No auditory impairment occurred. The
clinical cure rate was 87.5% (7/8 cases). The synergistic effect of combination regimens was observed in 6 cases by the break-point checkerboard plate method. Conclusion: The effectiveness of antibiotic combination therapy for MDRP infections may be indicated in clinical settings. The breakpoint checkerboard plate method for antibiotic combination therapy can be used routinely in clinical microbiology laboratories. AZT and aminoglycoside antibiotics were the combinations with the most demonstrated synergistic effect. Our findings have important clinical implications for the therapeutic management of MDRP infections. P331 Endogenous endophthalmitis following Bacillus cereus catheter related blood stream infection G. Ohji1 *, H. Matsuo1 , K. Iwata1 . 1 Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan E-mail address : [email protected] Introduction: A 65-year-old man who had liver cirrhosis was transferred to the university hospital due to massive hematemesis. He had been performed emergency esophagogastroduodenoscopy (EGD), diagnosed as rupture of esophageal varices and performed endoscopic variceal band ligation (EVBL). Simultaneously he was administered intravenous normal saline and received blood transfusion. After the procedure his vital sign became stable. He received nothing per mouth and was given peripheral parenteral nutrition by high-dose aminoacid containing fluid. Six days after admission he became febrile and complained blurred vision in left eye. Physician diagnosed as catheter related blood steam infection and gave cefotiam, however his left eye vision was almost lost on the next day. Seven days after admission two set blood cultures revealed Bacillus cereus , then antibiotics was changed to vancomycin. Patient was referred to ophthalmologist and diagnosed as endoopthalmitis. Immediate vitrectomy was done, however his left eye vision was completely lost. Culture from vitreous humor also revealed Bacillus cereus . Although antibiotics was changed to vancomycin, blood culture was still positive on the next day. After one week administration of vancomycin blood culture became negative. Vancomycin, was continued for two weeks and followed by 8 weeks parenteral and oral fluoroqinolone. B. cereus bacteremia does not recur after one year. Bacillus cereus is a particularly virulent causative organism of endophthalmitis. Most B. cereus endophthalmitis cases were exogenous ones following to trauma or cornel ulcer. Endogenous endophthalmitis in intravenous drug abuse had been also reported. To our knowledge our case is the first endogenous endopthalmitis following to catheter related blood stream infection (CRBSI). CRBSI can be a cause of endogenous B. cereus endopthalmitis. Part of this work has been presented at the Local Meeting of the Japanese association for the Infectious Diseases, Kyoto, 2010. P332 A retrospective study of bloodstream infections caused by Klebsiella pneumoniae in a university hospital in Japan N. Shimono1,2 *, R. Nishida2 , M. Kadowaki3 , M. Kiyosuke3 , M. Murata4 , T. Yamada5 , S. Yasunaga1 , T. Gondo1 , K. Toyoda1,4 , T. Hoshina1,6 , J. Hayashi1,4 . 1 Center for the Study of Global Infection, 2 Departmnet of Clinical Immunology and Rheumatology/Infectious Disease, 3 Department of Clinical and Laboratory Medicine, 4 Department of General Internal Medicine, 5 Department of Pharmacy, 6 Department of Pediatrics, Kyushu University Hospital, Fukuoka, Japan E-mail address : [email protected] Introduction: Klebsiella pneumoniae is a type of Gram-negative bacteria belonging to Enterobacteriaceae, which can cause severe necrotizing pneumonia, urinary tract infections, biliary tract infections, and bloodstream infections (BSIs). K. pneumoniae infection occurs not only in community but also in hospital or health care environments. Some strains of K. pneumoniae have become resistant to various kinds of antibiotics, including cephalosporins and carbapenems. Besides the number of Extended-spectrum-betalactamase (ESBL) producing strains are increasing, carbapenemase
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
globally, tigecycline was considered as the last resort to treat pandrugresistant bacteria. Though tigecycline non-susceptible K. pneumoniae isolates have been identified increasingly in recent years, the clinical information regarding bloodstream infection due to tigecycline nonsusceptible K. pneumoniae has never been reported. Objectives: The aim of this cohort study is to investigate the clinical and microbiological characteristics of tigecycline non-susceptible Klebsiella pneumoniae bacteremia in adult patients from a medical center in Taiwan. Methods: Patients with tigecycline non-susceptible K. pneumoniae bacteremia identified by E-test using FDA criteria were analyzed at a medical center in Taiwan between January 2010 and December 2012. Data on clinical features, therapy and outcomes of patients were collected from medical records. Genes for cabapenemases, plasmidic ampC -type, and extended-spectrum b-lactamases (EBSLs) were analyzed by polymerase chain reaction. Antimicrobial susceptibilities and pulsed-field gel electrophoresis (PFGE) results were determined among all the isolates. Results: A total of 36 patients with tigecycline non-susceptible K. pneumoniae bacteremia were identified. 29 patients had nosocomial bacteremia and 4 patients had healthcare-associated bacteremia. Only 13 patients had the exposure to tigecycline in the past 30 days. The overall 28-day mortality rate was 36.1%. The MIC50 and MIC90 of tigecycline were 6 and 8 mg/L, respectively. 8 isolates were ertapenem non-susceptible K. pneumoniae , including 2 isolates not susceptible to imipenem. 19 isolates were ESBL producers, and DHA-1 was detected in 18 isolates. No carbapenemase was detected among the 36 isolates. PFGE demonstrated that most isolates were epidemiologically unrelated. Conclusion: This study for the first time showed the distinct features of tigecycline non-susceptible K. pneumoniae causing bacteremia and the associated poor prognosis. More studies focusing on the risk factor and the resistance mechanisms of tigecycline non-susceptible K. pneumoniae bacteremia are necessary in Taiwan. P330 Antibiotic combination therapy and clinical outcome for multidrug-resistant Pseudomonas aeruginosa infections I. Nakamura1 *, T. Yamaguchi1 , H. Shimizu1 , S. Fukushima1 , Y. Mizuno1 , T. Matsumoto1 . 1 Department of Infection Control and Prevention, Tokyo Medical University, Tokyo, Japan E-mail address : [email protected] Objectives: Pseudomonas aeruginosa isolates which are resistant to all or almost all antibiotics have necessitated the use of antibiotic combinations consisting of some drugs to which the organism may be resistant. However, the clinical effectiveness of antibiotic combination therapy for multidrug-resistant P. aeruginosa (MDRP) infections is unclear. Methods: We evaluated the effectiveness of antibiotic combination therapy for multidrug-resistant strains of P. aeruginosa in clinical settings. In Tokyo Medical University Hospital, we selected MDRP infection cases treated by combination therapy of antipseudomonal antibiotics. Diagnosis of the infection, the components of the drug combination, duration of therapy, adverse events, and outcomes were evaluated. MDRP isolates were defined as having resistance to at least 2 of the following 3 drugs: imipenem (MIC 16 mg/mL), amikacin (MIC 32 mg/mL), and ciprofloxacin (MIC 4 mg/mL). Synergistic effects of the combination were checked by the break-point checkerboard plate method (Tateda K, et al. Scand J Infect Dis. 2006;38:268–72). This method uses designated combinations of 8 antibiotics (CAZ, PIPC, IPM, AZT, GM, CPFX, colistin, and RFP) and selects 2 concentrations of each antibiotic by considering their breakpoints, in addition to tissue and serum concentrations. Results: Eight cases of MDRP infection were treated by combination therapy of antipseudomonal antibiotics. The cases included pneumonia (2), UTI (2), abdominal abscess (1), vertebral osteomyelitis (1), and nasal abscess (1). The antibiotic combinations were: AZT+AMK (2), AZT+ABK (1), AZT+colistin (1), AZT+CPFX (1), PIPC/TAZ+AMK (1), MEPM+CPFX (1), and MEPM+TOB (1). At the end of combination therapy, 3 cases had renal dysfunction (> 0.3 mg/dL increase in serum creatinine after treatment). No auditory impairment occurred. The
clinical cure rate was 87.5% (7/8 cases). The synergistic effect of combination regimens was observed in 6 cases by the break-point checkerboard plate method. Conclusion: The effectiveness of antibiotic combination therapy for MDRP infections may be indicated in clinical settings. The breakpoint checkerboard plate method for antibiotic combination therapy can be used routinely in clinical microbiology laboratories. AZT and aminoglycoside antibiotics were the combinations with the most demonstrated synergistic effect. Our findings have important clinical implications for the therapeutic management of MDRP infections. P331 Endogenous endophthalmitis following Bacillus cereus catheter related blood stream infection G. Ohji1 *, H. Matsuo1 , K. Iwata1 . 1 Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan E-mail address : [email protected] Introduction: A 65-year-old man who had liver cirrhosis was transferred to the university hospital due to massive hematemesis. He had been performed emergency esophagogastroduodenoscopy (EGD), diagnosed as rupture of esophageal varices and performed endoscopic variceal band ligation (EVBL). Simultaneously he was administered intravenous normal saline and received blood transfusion. After the procedure his vital sign became stable. He received nothing per mouth and was given peripheral parenteral nutrition by high-dose aminoacid containing fluid. Six days after admission he became febrile and complained blurred vision in left eye. Physician diagnosed as catheter related blood steam infection and gave cefotiam, however his left eye vision was almost lost on the next day. Seven days after admission two set blood cultures revealed Bacillus cereus , then antibiotics was changed to vancomycin. Patient was referred to ophthalmologist and diagnosed as endoopthalmitis. Immediate vitrectomy was done, however his left eye vision was completely lost. Culture from vitreous humor also revealed Bacillus cereus . Although antibiotics was changed to vancomycin, blood culture was still positive on the next day. After one week administration of vancomycin blood culture became negative. Vancomycin, was continued for two weeks and followed by 8 weeks parenteral and oral fluoroqinolone. B. cereus bacteremia does not recur after one year. Bacillus cereus is a particularly virulent causative organism of endophthalmitis. Most B. cereus endophthalmitis cases were exogenous ones following to trauma or cornel ulcer. Endogenous endophthalmitis in intravenous drug abuse had been also reported. To our knowledge our case is the first endogenous endopthalmitis following to catheter related blood stream infection (CRBSI). CRBSI can be a cause of endogenous B. cereus endopthalmitis. Part of this work has been presented at the Local Meeting of the Japanese association for the Infectious Diseases, Kyoto, 2010. P332 A retrospective study of bloodstream infections caused by Klebsiella pneumoniae in a university hospital in Japan N. Shimono1,2 *, R. Nishida2 , M. Kadowaki3 , M. Kiyosuke3 , M. Murata4 , T. Yamada5 , S. Yasunaga1 , T. Gondo1 , K. Toyoda1,4 , T. Hoshina1,6 , J. Hayashi1,4 . 1 Center for the Study of Global Infection, 2 Departmnet of Clinical Immunology and Rheumatology/Infectious Disease, 3 Department of Clinical and Laboratory Medicine, 4 Department of General Internal Medicine, 5 Department of Pharmacy, 6 Department of Pediatrics, Kyushu University Hospital, Fukuoka, Japan E-mail address : [email protected] Introduction: Klebsiella pneumoniae is a type of Gram-negative bacteria belonging to Enterobacteriaceae, which can cause severe necrotizing pneumonia, urinary tract infections, biliary tract infections, and bloodstream infections (BSIs). K. pneumoniae infection occurs not only in community but also in hospital or health care environments. Some strains of K. pneumoniae have become resistant to various kinds of antibiotics, including cephalosporins and carbapenems. Besides the number of Extended-spectrum-betalactamase (ESBL) producing strains are increasing, carbapenemase