- Email: [email protected]
P8.04 Candidemia: A Retrospective Four Years Study in Our Hospital
S44
Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
presence of toxins A & B, binary toxin gene, variation in the tcdC regulator gene, and susceptibility to selected antibiotics. Results: 34 hospitals from 9 provinces participated from Nov. 1, 2004 to April 30, 2005. 1847 cases were identified. By May 1, 2006; 1285 non-random toxigenic isolates (56%) were analyzed: 386 (30%) were Bi+/tcdCdel+, 284 (22%) had NAP1 pattern In the 1285 patients, 106 (8%) had severe outcomes: 12 (1%) colectomies, 24 (2%) ICU admissions and 87 (7%) CDAD-related deaths (32 (2%) directly and 55 (5%) indirectly related). 110 (9%) patients’ deaths were unrelated to CDAD; 1069 (83%) cases had no severe outcomes. The presence of Bi+/tcdCdel+ was very highly significantly correlated with severe CDAD (51% vs. 29%, OR 2.6 95%CI 1.7–3.8). The major “NAP1” or “027” clone was found in 7 of 9 provinces. Conclusions: The presence of Bi+/tcdCdel+ in C. difficile is highly and significantly correlated with increased morbidity and mortality in multiple Canadian centers. The major clone of this “hyper-virulent” type is now in 7 Canadian provinces, but mostly in Quebec, British Columbia, and Ontario. P8.02 Central Catheter as the Potential Source for Candida Parapsilosis Bloodstream Infection M. Oliveira *, L. Miranda, A. Sousa, R. Sienra, E. Rodrigues, R. Lobo, S. Gobara, C. Santos, A. Levin. Hospital das Cl´ ınicas, Brazil Background: Candidiasis is an increasing nosocomial problem. Most of Candida infections are from an endogenous source, but there is growing evidence that some species are acquired from an exogenous source. Objective: To evaluate the potential source Candida parapsilosis isolated in nosocomial candidemia. Methods: Consecutive patients with nosocomial fungemia by C. parapsilosis admitted between May 2004 and October 2005 were included. Surveillance cultures for Candida were obtained from: urine; catheter tip; oral, nasal and skin samples. Isolation was made on media CHROMagar Candida and phenotypic identification by the commercial kit ID 32C. Electrophoretic karyotype was analyzed by pulsed-field gel electrophoresis. Isolates were considered the same if band patterns were identical and different if at least one band differed. Results: Twenty-two patients with C. parapsilosis fungemia were included. The mean age was 17 years (0 to 59) and 12 (55%) were neonates. Clinical conditions associated were: prematurity, diabetes mellitus, cancer, lupus and burn. Invasive procedures were: central catheter 20 (90%), total parenteral nutrition 15 (66%), surgery 6 (27%), urinary catheter 4 (18%) and hemodyalisis 1 (5%). Previous antibiotics used were: vancomycin 15 (68%), carbapenens 11 (50%), penicillin 8 (36%), aminoglycosides 8 (36%) and 3rd generation cephalosporin 5 (23%). The median interval between blood and surveillance cultures was 4 days, ranging from 3 to 8. Ten catheter tips were collected. The same phenotypic profile in blood and surveillance isolates was observed in 14 cases: 10 (45%) in catheter, 4 (18%) urine, 4 (18%) retal swab, 3 (14%) in skin swab and 2 (9%) in oral swab. However, by molecular typing, only catheters presented the same pattern as from the blood. The overall mortality was 50% and among newborns was 58%. Conclusion: Among C. parapsilosis bloodstream infections the only identified source was the central venous catheter, suggesting an exogenous source.
P8.03 Meeting the Enemy Head on: Responding to the Emergence of a Virulent Strain of Clostridium difficile in an Elective Orthopaedic Hospital E. Finerty *, P. Shea, S. Goldberg. Hospital for Special Surgery, USA Background: Clostridium difficile associated diarrhea (CDAD) is an uncomfortable and problematic experience for the patient undergoing orthopaedic surgery. The emergence of a virulent strain of CDAD in three patients at an orthopaedic specialty hospital during 2004–2005 necessitated a specific Infection Control action plan. Aim: To promote patient safety and prevent the spread of CDAD in patients and health care workers (HCW). Methods: Current standards and protocols regarding care of patients with CDAD were reviewed by the hospital Infection Control Committee. Recommended Infection Control protocols included placement of patients with diarrhea in a single room on Contact Precautions (gown and gloves) with dedicated patient care equipment, HCW hand hygiene with soap and water when caring for patients with diarrhea, and terminal cleaning of CDAD patient rooms with a sodium hypochlorite (bleach) solution upon discharge. Laboratory processing of CDAD specimens, surveillance activities, and monitoring of hand hygiene were increased. Round the clock education sessions were conducted for nursing staff regarding communication of early signs and symptoms of CDAD in the post-operative patient including increased abdominal pain and/or abdominal distention. CDAD has been added to the orientation and annual education module for all HCW with direct patient care responsibility. Results: No infection clusters were observed during this study period. No secondary transmission to HCW was observed. No additional cases of virulent CDAD have been reported in six months. Conclusion: Implementing a comprehensive approach to combat CDAD which combines intensive education, adherence to Infection Control protocols, and strict attention to environmental cleanliness may be effective in preventing transmission of CDAD in the elective orthopedic surgery setting. P8.04 Candidemia: A Retrospective Four Years Study in Our Hospital A. Tsiringa *, A. Xanthaki, X. Trelogianni, V. Skandami, P. Fostira, M. Toutouza. General Hospital Hippokratio, Greece Background: Candida species are responsible for causing serious infections, particularly bloodstream infections among hospitalized patients. Aim/objective: To investigate the frequency of isolation of Candida spp in blood cultures and to evaluate the antifungal susceptibility in our hospital. Methods: We retrospectively examined all cases of candidemia during four years period (10/2001–10/2005). We used the BACTEC 9240 (Becton–Dickinson) blood culture system. Positive blood cultures were examined microscopically directly for yeasts or pseudohyphae and subcultured on Sabouraud agar (Difco). The identification of yeasts was done by VITEK 2 SYSTEM ID-YST (BIOMERIEUX). Antifungal profile was determined by measurement of MIC with E-test (Biodisk) on RPMI-2% Glucose agar for the following anifungals: Amphotericin B (AB), keto conazole (KE), 5-fluorocytosin (FC), itraconazole (IT) and fluconazole (FL). Results: A total of 64 (0.8%) yeasts isolates was found out of 8640 positive blood cultures in the study period. We found 27 Candida albicans (42%), 15 Candida parapsilosis (23%), 8 Candida glabrata (12%), 7 Candida tropicalis (11%),
Poster Presentations 2 Candida krusei (3.1%), 1 Candida famata (1.5%), 2 Candida lusitaniae (3.1%) and 3 Candida spp (4.3%). Candida showed different anifungal profile to antifungal agents. For C. albicans the sensitivity was: 60% to FC, 100% to KE-IT-FL-AB. For C. parapsilosis 50% to FC, 80% to IT, 90% to KE, 100% to FL-AB. For C. krusei 0% to FC-FL and 100% to AB-IT-KE. For C. glabrata 50% to FC and 100% to KE-FL-IT-AB. Conclusion: The first yeast in candidemia was C. albicans ˆ he frequency of candidemia due with second C. parapsilosis O to Candida non albicans (58%) is higher than candidemia due to C.albicans. The highest degree of resistance was to 5-fluorocytosin. Early identification and antifungal susceptibility are important on Candida bloodstream infections. P8.05 Outbreak of Vancomycin Resistant Enterococci Among Immunocompromized Patients in a Region with a Very Low Endemic VRE-Rate in Recent Years K. Weist1 *, C. Brandt2 , D. Jonas3 , M. Schmidt-Hieber4 , H. R¨ uden1 , T. Eckmanns1 . 1 Institute of Hygiene and Environmental Medicine, Charit´ e – Universit¨ atsmedizin Berlin, Germany, 2 Institute of Medical Microbiology and Hygiene, Wolfgang Goethe University, Frankfurt, Germany, 3 Institute of Environmental Medicine and Hospital Hygiene, University Freiburg, Germany, 4 Medical Clinic III, Charite – Universit¨ atsmedizin Berlin, Germany Background: Vancomycin resistant enterococci (VRE) are increasingly reported in immunocompromized patients in recent years and associated with an increased mortality. Objective: To describe the outbreak and infection control measures to stop the outbreak. Methods: The outbreak occurred in 2005 in a hematology/ oncology clinic of a 1,100 beds university hospital while in 2003 to 2004 no clinical isolates of VRE had been detected. Following infection control measures were implemented to abandon the outbreak: VRE-screening at the patient’s admission followed by quarantine and segregation accordingly the VRE status; weekly surveillances cultures; environmental screening cultures; a separated VRE-ward, contact isolation and intensified staff training. All VRE isolates were genotyped by amplified fragment length polymorphism technique and multiple-locus variablenumber tandem repeat analysis (MLVA). Results: From August 2005 to April 2006, 47 patients with vanA gene positive E. faecium VRE were detected (3 nosocomial infections, 1 fatal septicemia). The outbreak strain (MLVA type 7) belonged to an endemic group of strains (MLST clonal complex CC17) which have been identified Europe wide in recent outbreaks. Intensified infection control measures including a quarantine and cohorting system of VRE positive patients resulted in a control of this outbreak within 2 months. However, subsequent withdrawal of these infection control measures resulted in reoccurrence of VRE spread. After reinforcing the compliance to those measures the outbreak stopped in April, 2005 without having been transmitted to other wards of the hospital. Conclusion: We conclude that VRE outbreaks may be timely manageable by intensive infection control strategies even concerning VRE strains with high epidemic potential on “high risk wards” (e.g. hematological/oncological units). Premature withdrawal of infection control measures may again result in uncontrolled VRE spread.
S45 P8.06 Infection Control of Tuberculosis in a Japanese Emergency Hospital Without a Ward for Tuberculosis Y. Shibuya *, T. Hatakeyama, A. Yamagata, K. Ekuni, S. Yamaki, R. Mogi, S. Koyama. Tokyo Metropolitan Horoo General Hospital, Japan Background and Aim: Tokyo Metropolitan Hiroo General Hospital (our hospital) is a 500-bed emergency hospital in the heart of the Tokyo metropolitan area, providing primary, secondary and tertiary emergency services 24 hours a day to patients with various nationalities and backgrounds. We report the status of infection control at our hospital. Methods: A total of 40 patients reported between 1999 and 2005 to the Infection Control Committee of our hospital as positive for Mycobacterium infection were evaluated retrospectively. Results: The number of acid-fast bacterium infectious disease cases was 3 in 1999, 5 in 2000, 2 in 2001, 5 in 2002, 8 in 2003, 12 in 2004, and 5 in 2005. Of the 40 cases, 33 were from wards and 7 from the outpatient clinic. The majority (27 patients) were patients of the respiratory medicine department and the rest were patients of many departments. Three out of 7 patients in the tertiary care division were smear positive, and two were transferred to another hospital with a ward for tuberculosis. Another patient was a foreign woman who came because of hemoptysis with cardiopulmonary arrest. Discussion and Conclusions: 1. The importance of infection control for tuberculosis has been accepted since 2003 and infection control for tuberculosis has been practiced throughout our hospital particularly in outpatient clinics and the emergency division. 2. Rapid detection with acid-fast staining was deemed quite useful for infection control for tuberculosis because it shortened the period between admission and isolation or transfer to high-level emergency areas of the hospital. 3. The triage of ambulant tuberculosis patients is indispensable in an emergency hospital that does not have a tuberculosis ward. As for emergency visits, safety measures such as the wearing of masks is especially necessary in primary care settings. 4. But patient transfer may be difficult. Thus, a regional network of emergency hospitals for patients with tuberculosis must be established. P8.07 Epidemiological Trends in Micobacterial Isolated in a Tertiary Care Hospital M.J. Unzaga1 *, I. Gerediaga1 , J.L. Barrios2 , C. Ezpeleta2 , J.A. Alava2 , R. Cisterna2 . 1 Hospital de Basurto, Spain, 2 Hospital Basurto, Spain Background: The incidence of tuberculosis (tbc) is changing, decreases and resurgences. Objectives: The purpose of this study was to describe epidemiological features of tbc cases identified in our 800-bed general teaching hospital, which provides care to the urban area of Bilbao. Material and Methods: We performed a retrospective evaluation of patients who had diagnosed of active tbc (microbiological results positive) during January 1994–December 2005. Results: Mycobacterias were isolated in 1174 patients with estimated incidence in health areas the past year of 15.8 cases per 100,000 habitants. The distribution of the isolates was as follow: 861 (73.3%) M tuberculosis (mytu), 229 (19.5%) M kansasii (myka), 75 (6.4%) M avium (myai), and 9 (0.8%) other non tuberculous mycobacteria. The trends in myai isolates were to decrease along the time. On the other hand myka isolates were increasing since 1994 (6.5%) to 1999 year (34.1%) and declined to 7.9% in 2005. While myka was increasing, the number of mytu isolates were decreasing (81% in 1994 to 63% in 2000) and we experienced a resurgence of mytu when myka declined although the overall number of mytu isolates nowadays
Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
presence of toxins A & B, binary toxin gene, variation in the tcdC regulator gene, and susceptibility to selected antibiotics. Results: 34 hospitals from 9 provinces participated from Nov. 1, 2004 to April 30, 2005. 1847 cases were identified. By May 1, 2006; 1285 non-random toxigenic isolates (56%) were analyzed: 386 (30%) were Bi+/tcdCdel+, 284 (22%) had NAP1 pattern In the 1285 patients, 106 (8%) had severe outcomes: 12 (1%) colectomies, 24 (2%) ICU admissions and 87 (7%) CDAD-related deaths (32 (2%) directly and 55 (5%) indirectly related). 110 (9%) patients’ deaths were unrelated to CDAD; 1069 (83%) cases had no severe outcomes. The presence of Bi+/tcdCdel+ was very highly significantly correlated with severe CDAD (51% vs. 29%, OR 2.6 95%CI 1.7–3.8). The major “NAP1” or “027” clone was found in 7 of 9 provinces. Conclusions: The presence of Bi+/tcdCdel+ in C. difficile is highly and significantly correlated with increased morbidity and mortality in multiple Canadian centers. The major clone of this “hyper-virulent” type is now in 7 Canadian provinces, but mostly in Quebec, British Columbia, and Ontario. P8.02 Central Catheter as the Potential Source for Candida Parapsilosis Bloodstream Infection M. Oliveira *, L. Miranda, A. Sousa, R. Sienra, E. Rodrigues, R. Lobo, S. Gobara, C. Santos, A. Levin. Hospital das Cl´ ınicas, Brazil Background: Candidiasis is an increasing nosocomial problem. Most of Candida infections are from an endogenous source, but there is growing evidence that some species are acquired from an exogenous source. Objective: To evaluate the potential source Candida parapsilosis isolated in nosocomial candidemia. Methods: Consecutive patients with nosocomial fungemia by C. parapsilosis admitted between May 2004 and October 2005 were included. Surveillance cultures for Candida were obtained from: urine; catheter tip; oral, nasal and skin samples. Isolation was made on media CHROMagar Candida and phenotypic identification by the commercial kit ID 32C. Electrophoretic karyotype was analyzed by pulsed-field gel electrophoresis. Isolates were considered the same if band patterns were identical and different if at least one band differed. Results: Twenty-two patients with C. parapsilosis fungemia were included. The mean age was 17 years (0 to 59) and 12 (55%) were neonates. Clinical conditions associated were: prematurity, diabetes mellitus, cancer, lupus and burn. Invasive procedures were: central catheter 20 (90%), total parenteral nutrition 15 (66%), surgery 6 (27%), urinary catheter 4 (18%) and hemodyalisis 1 (5%). Previous antibiotics used were: vancomycin 15 (68%), carbapenens 11 (50%), penicillin 8 (36%), aminoglycosides 8 (36%) and 3rd generation cephalosporin 5 (23%). The median interval between blood and surveillance cultures was 4 days, ranging from 3 to 8. Ten catheter tips were collected. The same phenotypic profile in blood and surveillance isolates was observed in 14 cases: 10 (45%) in catheter, 4 (18%) urine, 4 (18%) retal swab, 3 (14%) in skin swab and 2 (9%) in oral swab. However, by molecular typing, only catheters presented the same pattern as from the blood. The overall mortality was 50% and among newborns was 58%. Conclusion: Among C. parapsilosis bloodstream infections the only identified source was the central venous catheter, suggesting an exogenous source.
P8.03 Meeting the Enemy Head on: Responding to the Emergence of a Virulent Strain of Clostridium difficile in an Elective Orthopaedic Hospital E. Finerty *, P. Shea, S. Goldberg. Hospital for Special Surgery, USA Background: Clostridium difficile associated diarrhea (CDAD) is an uncomfortable and problematic experience for the patient undergoing orthopaedic surgery. The emergence of a virulent strain of CDAD in three patients at an orthopaedic specialty hospital during 2004–2005 necessitated a specific Infection Control action plan. Aim: To promote patient safety and prevent the spread of CDAD in patients and health care workers (HCW). Methods: Current standards and protocols regarding care of patients with CDAD were reviewed by the hospital Infection Control Committee. Recommended Infection Control protocols included placement of patients with diarrhea in a single room on Contact Precautions (gown and gloves) with dedicated patient care equipment, HCW hand hygiene with soap and water when caring for patients with diarrhea, and terminal cleaning of CDAD patient rooms with a sodium hypochlorite (bleach) solution upon discharge. Laboratory processing of CDAD specimens, surveillance activities, and monitoring of hand hygiene were increased. Round the clock education sessions were conducted for nursing staff regarding communication of early signs and symptoms of CDAD in the post-operative patient including increased abdominal pain and/or abdominal distention. CDAD has been added to the orientation and annual education module for all HCW with direct patient care responsibility. Results: No infection clusters were observed during this study period. No secondary transmission to HCW was observed. No additional cases of virulent CDAD have been reported in six months. Conclusion: Implementing a comprehensive approach to combat CDAD which combines intensive education, adherence to Infection Control protocols, and strict attention to environmental cleanliness may be effective in preventing transmission of CDAD in the elective orthopedic surgery setting. P8.04 Candidemia: A Retrospective Four Years Study in Our Hospital A. Tsiringa *, A. Xanthaki, X. Trelogianni, V. Skandami, P. Fostira, M. Toutouza. General Hospital Hippokratio, Greece Background: Candida species are responsible for causing serious infections, particularly bloodstream infections among hospitalized patients. Aim/objective: To investigate the frequency of isolation of Candida spp in blood cultures and to evaluate the antifungal susceptibility in our hospital. Methods: We retrospectively examined all cases of candidemia during four years period (10/2001–10/2005). We used the BACTEC 9240 (Becton–Dickinson) blood culture system. Positive blood cultures were examined microscopically directly for yeasts or pseudohyphae and subcultured on Sabouraud agar (Difco). The identification of yeasts was done by VITEK 2 SYSTEM ID-YST (BIOMERIEUX). Antifungal profile was determined by measurement of MIC with E-test (Biodisk) on RPMI-2% Glucose agar for the following anifungals: Amphotericin B (AB), keto conazole (KE), 5-fluorocytosin (FC), itraconazole (IT) and fluconazole (FL). Results: A total of 64 (0.8%) yeasts isolates was found out of 8640 positive blood cultures in the study period. We found 27 Candida albicans (42%), 15 Candida parapsilosis (23%), 8 Candida glabrata (12%), 7 Candida tropicalis (11%),
Poster Presentations 2 Candida krusei (3.1%), 1 Candida famata (1.5%), 2 Candida lusitaniae (3.1%) and 3 Candida spp (4.3%). Candida showed different anifungal profile to antifungal agents. For C. albicans the sensitivity was: 60% to FC, 100% to KE-IT-FL-AB. For C. parapsilosis 50% to FC, 80% to IT, 90% to KE, 100% to FL-AB. For C. krusei 0% to FC-FL and 100% to AB-IT-KE. For C. glabrata 50% to FC and 100% to KE-FL-IT-AB. Conclusion: The first yeast in candidemia was C. albicans ˆ he frequency of candidemia due with second C. parapsilosis O to Candida non albicans (58%) is higher than candidemia due to C.albicans. The highest degree of resistance was to 5-fluorocytosin. Early identification and antifungal susceptibility are important on Candida bloodstream infections. P8.05 Outbreak of Vancomycin Resistant Enterococci Among Immunocompromized Patients in a Region with a Very Low Endemic VRE-Rate in Recent Years K. Weist1 *, C. Brandt2 , D. Jonas3 , M. Schmidt-Hieber4 , H. R¨ uden1 , T. Eckmanns1 . 1 Institute of Hygiene and Environmental Medicine, Charit´ e – Universit¨ atsmedizin Berlin, Germany, 2 Institute of Medical Microbiology and Hygiene, Wolfgang Goethe University, Frankfurt, Germany, 3 Institute of Environmental Medicine and Hospital Hygiene, University Freiburg, Germany, 4 Medical Clinic III, Charite – Universit¨ atsmedizin Berlin, Germany Background: Vancomycin resistant enterococci (VRE) are increasingly reported in immunocompromized patients in recent years and associated with an increased mortality. Objective: To describe the outbreak and infection control measures to stop the outbreak. Methods: The outbreak occurred in 2005 in a hematology/ oncology clinic of a 1,100 beds university hospital while in 2003 to 2004 no clinical isolates of VRE had been detected. Following infection control measures were implemented to abandon the outbreak: VRE-screening at the patient’s admission followed by quarantine and segregation accordingly the VRE status; weekly surveillances cultures; environmental screening cultures; a separated VRE-ward, contact isolation and intensified staff training. All VRE isolates were genotyped by amplified fragment length polymorphism technique and multiple-locus variablenumber tandem repeat analysis (MLVA). Results: From August 2005 to April 2006, 47 patients with vanA gene positive E. faecium VRE were detected (3 nosocomial infections, 1 fatal septicemia). The outbreak strain (MLVA type 7) belonged to an endemic group of strains (MLST clonal complex CC17) which have been identified Europe wide in recent outbreaks. Intensified infection control measures including a quarantine and cohorting system of VRE positive patients resulted in a control of this outbreak within 2 months. However, subsequent withdrawal of these infection control measures resulted in reoccurrence of VRE spread. After reinforcing the compliance to those measures the outbreak stopped in April, 2005 without having been transmitted to other wards of the hospital. Conclusion: We conclude that VRE outbreaks may be timely manageable by intensive infection control strategies even concerning VRE strains with high epidemic potential on “high risk wards” (e.g. hematological/oncological units). Premature withdrawal of infection control measures may again result in uncontrolled VRE spread.
S45 P8.06 Infection Control of Tuberculosis in a Japanese Emergency Hospital Without a Ward for Tuberculosis Y. Shibuya *, T. Hatakeyama, A. Yamagata, K. Ekuni, S. Yamaki, R. Mogi, S. Koyama. Tokyo Metropolitan Horoo General Hospital, Japan Background and Aim: Tokyo Metropolitan Hiroo General Hospital (our hospital) is a 500-bed emergency hospital in the heart of the Tokyo metropolitan area, providing primary, secondary and tertiary emergency services 24 hours a day to patients with various nationalities and backgrounds. We report the status of infection control at our hospital. Methods: A total of 40 patients reported between 1999 and 2005 to the Infection Control Committee of our hospital as positive for Mycobacterium infection were evaluated retrospectively. Results: The number of acid-fast bacterium infectious disease cases was 3 in 1999, 5 in 2000, 2 in 2001, 5 in 2002, 8 in 2003, 12 in 2004, and 5 in 2005. Of the 40 cases, 33 were from wards and 7 from the outpatient clinic. The majority (27 patients) were patients of the respiratory medicine department and the rest were patients of many departments. Three out of 7 patients in the tertiary care division were smear positive, and two were transferred to another hospital with a ward for tuberculosis. Another patient was a foreign woman who came because of hemoptysis with cardiopulmonary arrest. Discussion and Conclusions: 1. The importance of infection control for tuberculosis has been accepted since 2003 and infection control for tuberculosis has been practiced throughout our hospital particularly in outpatient clinics and the emergency division. 2. Rapid detection with acid-fast staining was deemed quite useful for infection control for tuberculosis because it shortened the period between admission and isolation or transfer to high-level emergency areas of the hospital. 3. The triage of ambulant tuberculosis patients is indispensable in an emergency hospital that does not have a tuberculosis ward. As for emergency visits, safety measures such as the wearing of masks is especially necessary in primary care settings. 4. But patient transfer may be difficult. Thus, a regional network of emergency hospitals for patients with tuberculosis must be established. P8.07 Epidemiological Trends in Micobacterial Isolated in a Tertiary Care Hospital M.J. Unzaga1 *, I. Gerediaga1 , J.L. Barrios2 , C. Ezpeleta2 , J.A. Alava2 , R. Cisterna2 . 1 Hospital de Basurto, Spain, 2 Hospital Basurto, Spain Background: The incidence of tuberculosis (tbc) is changing, decreases and resurgences. Objectives: The purpose of this study was to describe epidemiological features of tbc cases identified in our 800-bed general teaching hospital, which provides care to the urban area of Bilbao. Material and Methods: We performed a retrospective evaluation of patients who had diagnosed of active tbc (microbiological results positive) during January 1994–December 2005. Results: Mycobacterias were isolated in 1174 patients with estimated incidence in health areas the past year of 15.8 cases per 100,000 habitants. The distribution of the isolates was as follow: 861 (73.3%) M tuberculosis (mytu), 229 (19.5%) M kansasii (myka), 75 (6.4%) M avium (myai), and 9 (0.8%) other non tuberculous mycobacteria. The trends in myai isolates were to decrease along the time. On the other hand myka isolates were increasing since 1994 (6.5%) to 1999 year (34.1%) and declined to 7.9% in 2005. While myka was increasing, the number of mytu isolates were decreasing (81% in 1994 to 63% in 2000) and we experienced a resurgence of mytu when myka declined although the overall number of mytu isolates nowadays