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Rapid Screening for carbapenem resistant organisms: Current results and future approaches
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journal of patient safety & infection control 3 ( 2 0 1 5 ) 50–69
specimen. Culture was done in BHI broth, Blood Agar and MacConkey agar. Identification of isolates and sensitivity testing was performed as per standard guidelines. Results: Total of 464 patients were admitted to the ICU during the study period. Of these 354 required mechanical ventilation. Of these 154 (43.5%) developed nosocomial pneumonia while 141 were culture positive. Patients were mechanically ventilated through endotracheal or tracheostomy tubes connected to constant volume ventilators. Thirty five cultures were positive in 2011, 48 positive in 2012, 57 were positive in 2013. Of these 14 (40.0%), 21 (43.7%) and 26 (45.6%) isolates were identified as Citrobacter species while 9 (25.7%), 8 (16.6%), 6 (10.5%) were Klebsiella in 2011, 2012 and 2013 respectively. Other isolates over three years were 15 (10.6%) Pseudomonas, 13 (9.2%) E.coli, 3 (2.1%) Proteus species, 5 (3.5%) S. aureus, 5 (3.5%) Acinetobacter 6 (4.2%) Candida species while one isolate was Enterococcus faecalis. Citrobacter species were the most resistant, of these 46 (75.4%) were Amp C producers while 21 (34.4%) were ESBL producers, only 4 (6.5%) were sensitive strains. Imipenem, polymyxin B, amikacin and colistin showed good results. Conclusions: Endotracheal aspirate culture is non-invasive technique to look for nosocomial pathogens. Citrobacter species is evolving as an important clinical entity in nosocomial pneumonia replacing Klebsiella.
(n = 32) and K. pneumoniae (n = 88). Conventional PCR identifies 40% (n = 48) of NDM, followed by 39.2% (n = 47) of OXA-48 like and 15 (12.5%) of carbapenem resistant isolates were found to be co-producers of OXA-48 and NDM. Ten isolates were found to be negative for all tested targets. In Xpert® Carba-R, interestingly only NDM was identified in 55% (n = 66) of isolates. Surprisingly 3 NDM genes were additionally identified in Xpert® Carba-R test. However Xpert® Carba-R test fails to pick up OXA-48 like. The identified OXA-48 like variant was found to be OXA-181 by sequencing. Conclusion: Xpert® Carba-R missed to identify OXA-48 like variant. Among the 10 known variants manufacturers acknowledge only four variant were designed to identify, this does not include OXA-181. Currently, OXA-181 is the predominant enzyme variant seen across India. Incorporating, OXA-181 into Xpert® Carba-R may improve sensitivity. It is simple to perform and would be useful for the prompt detection and isolation of patients infected or colonized with strains that may harbor carbapenemase genes. http://dx.doi.org/10.1016/j.jpsic.2015.10.053
C048 A cross-sectional study of risk factors of fungal sepsis in paediatric patients at a tertiary care centre in India
http://dx.doi.org/10.1016/j.jpsic.2015.10.052 D. Ponraj 1,∗ , R. Kaur 1 , A. Kumar 2 , U. Jhamb 2 , C. Baveja 1
C047 Rapid Screening for carbapenem resistant organisms: Current results and future approaches Shalini Anandan ∗ , Sukanya Radha, Yamuna Devi, Balaji Veeraraghavan Christian Medical College, Vellore, India Introduction: The spread of carbapenem-resistant Enterobacteriaceae (CRE) is a relevant clinical issue as carbapenemase confer resistance to most of the beta-lactam antibiotics. Accurate detection of infected patients or carriers is needed to prevent outbreak of carbapenemase producing organisms. Rapid identification of CRE with short turnaround time helps in patient management. Objectives: To evaluate the performance of Xpert Carba R. Method: Twenty six faeces samples were screened for the presence of carbapenem resistant Enterobacteriaceae (CRE). In addition, Enterobacteriaceae isolates were collected from blood stream infections and screened for susceptibility to meropenem and imipenem by the disc diffusion method. For all the faeces specimens and blood stream isolates, presence of carbapenemase genes was detected using Xpert Carba R test. This assay detects proprietary sequences for the blaIMP, blaVIM, blaNDM, blaKPC, and blaOXA-48. All the clinical isolates used in this study have been previously characterized for carbapenemase genes by PCR and sequencing. Result: Totally 15 faeces samples were positive by Xpert® Carba-R. This includes 100% (n = 12), 8.3% (n = 1), 16.7% (n = 2) were identified as NDM, KPC and VIM respectively. Of the 120 tested Enterobacteriaceae, isolates were identified as E. coli
1
Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, India 2 Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, India Introduction: Fungal sepsis is one of the major causes of morbidity and mortality in long term hospitalized patients. This cross-sectional study was conducted to evaluate the occurrence and risk factors of fungal sepsis in neonates and children. Method: 85 consecutive children admitted in the Paediatric and Neonatal ICUs and wards with signs and symptoms of sepsis that persisted despite appropriate antibacterial therapy for ≥5 days were included in the study and were evaluated for the presence of predetermined risk factors. Diagnosis of fungal sepsis was based on the isolation of fungus from blood. Candida colonization index (CI) was calculated from surveillance samples including urine, skin, oral and rectal swabs. CI ≥0.5 was considered significant. Statistical analysis was performed using SPSS 15.0 software and p value <0.05 was considered significant. Result: Out of the 85 patients, 8 (9.41%) had fungal sepsis with Candida species isolated from blood in all 8 patients, 5 (62.5%) of whom expired. On comparing them with blood culture negative patients, hyperalimentation (p = 0.006; OR: 5.882, 95% CI: 1.45, 23.80) and presence of urinary catheter (p = 0.017; OR: 7.538, 95% CI: 1.17, 48.93) were found to be significant risk factors while history of recent surgery, prematurity, presence of endotracheal tube, intravascular access device, malignancy, treatment with immunosuppressive drugs, neutropenia and CI ≥0.5 were not statistically significant. Out of the 5 who
journal of patient safety & infection control 3 ( 2 0 1 5 ) 50–69
specimen. Culture was done in BHI broth, Blood Agar and MacConkey agar. Identification of isolates and sensitivity testing was performed as per standard guidelines. Results: Total of 464 patients were admitted to the ICU during the study period. Of these 354 required mechanical ventilation. Of these 154 (43.5%) developed nosocomial pneumonia while 141 were culture positive. Patients were mechanically ventilated through endotracheal or tracheostomy tubes connected to constant volume ventilators. Thirty five cultures were positive in 2011, 48 positive in 2012, 57 were positive in 2013. Of these 14 (40.0%), 21 (43.7%) and 26 (45.6%) isolates were identified as Citrobacter species while 9 (25.7%), 8 (16.6%), 6 (10.5%) were Klebsiella in 2011, 2012 and 2013 respectively. Other isolates over three years were 15 (10.6%) Pseudomonas, 13 (9.2%) E.coli, 3 (2.1%) Proteus species, 5 (3.5%) S. aureus, 5 (3.5%) Acinetobacter 6 (4.2%) Candida species while one isolate was Enterococcus faecalis. Citrobacter species were the most resistant, of these 46 (75.4%) were Amp C producers while 21 (34.4%) were ESBL producers, only 4 (6.5%) were sensitive strains. Imipenem, polymyxin B, amikacin and colistin showed good results. Conclusions: Endotracheal aspirate culture is non-invasive technique to look for nosocomial pathogens. Citrobacter species is evolving as an important clinical entity in nosocomial pneumonia replacing Klebsiella.
(n = 32) and K. pneumoniae (n = 88). Conventional PCR identifies 40% (n = 48) of NDM, followed by 39.2% (n = 47) of OXA-48 like and 15 (12.5%) of carbapenem resistant isolates were found to be co-producers of OXA-48 and NDM. Ten isolates were found to be negative for all tested targets. In Xpert® Carba-R, interestingly only NDM was identified in 55% (n = 66) of isolates. Surprisingly 3 NDM genes were additionally identified in Xpert® Carba-R test. However Xpert® Carba-R test fails to pick up OXA-48 like. The identified OXA-48 like variant was found to be OXA-181 by sequencing. Conclusion: Xpert® Carba-R missed to identify OXA-48 like variant. Among the 10 known variants manufacturers acknowledge only four variant were designed to identify, this does not include OXA-181. Currently, OXA-181 is the predominant enzyme variant seen across India. Incorporating, OXA-181 into Xpert® Carba-R may improve sensitivity. It is simple to perform and would be useful for the prompt detection and isolation of patients infected or colonized with strains that may harbor carbapenemase genes. http://dx.doi.org/10.1016/j.jpsic.2015.10.053
C048 A cross-sectional study of risk factors of fungal sepsis in paediatric patients at a tertiary care centre in India
http://dx.doi.org/10.1016/j.jpsic.2015.10.052 D. Ponraj 1,∗ , R. Kaur 1 , A. Kumar 2 , U. Jhamb 2 , C. Baveja 1
C047 Rapid Screening for carbapenem resistant organisms: Current results and future approaches Shalini Anandan ∗ , Sukanya Radha, Yamuna Devi, Balaji Veeraraghavan Christian Medical College, Vellore, India Introduction: The spread of carbapenem-resistant Enterobacteriaceae (CRE) is a relevant clinical issue as carbapenemase confer resistance to most of the beta-lactam antibiotics. Accurate detection of infected patients or carriers is needed to prevent outbreak of carbapenemase producing organisms. Rapid identification of CRE with short turnaround time helps in patient management. Objectives: To evaluate the performance of Xpert Carba R. Method: Twenty six faeces samples were screened for the presence of carbapenem resistant Enterobacteriaceae (CRE). In addition, Enterobacteriaceae isolates were collected from blood stream infections and screened for susceptibility to meropenem and imipenem by the disc diffusion method. For all the faeces specimens and blood stream isolates, presence of carbapenemase genes was detected using Xpert Carba R test. This assay detects proprietary sequences for the blaIMP, blaVIM, blaNDM, blaKPC, and blaOXA-48. All the clinical isolates used in this study have been previously characterized for carbapenemase genes by PCR and sequencing. Result: Totally 15 faeces samples were positive by Xpert® Carba-R. This includes 100% (n = 12), 8.3% (n = 1), 16.7% (n = 2) were identified as NDM, KPC and VIM respectively. Of the 120 tested Enterobacteriaceae, isolates were identified as E. coli
1
Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, India 2 Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, India Introduction: Fungal sepsis is one of the major causes of morbidity and mortality in long term hospitalized patients. This cross-sectional study was conducted to evaluate the occurrence and risk factors of fungal sepsis in neonates and children. Method: 85 consecutive children admitted in the Paediatric and Neonatal ICUs and wards with signs and symptoms of sepsis that persisted despite appropriate antibacterial therapy for ≥5 days were included in the study and were evaluated for the presence of predetermined risk factors. Diagnosis of fungal sepsis was based on the isolation of fungus from blood. Candida colonization index (CI) was calculated from surveillance samples including urine, skin, oral and rectal swabs. CI ≥0.5 was considered significant. Statistical analysis was performed using SPSS 15.0 software and p value <0.05 was considered significant. Result: Out of the 85 patients, 8 (9.41%) had fungal sepsis with Candida species isolated from blood in all 8 patients, 5 (62.5%) of whom expired. On comparing them with blood culture negative patients, hyperalimentation (p = 0.006; OR: 5.882, 95% CI: 1.45, 23.80) and presence of urinary catheter (p = 0.017; OR: 7.538, 95% CI: 1.17, 48.93) were found to be significant risk factors while history of recent surgery, prematurity, presence of endotracheal tube, intravascular access device, malignancy, treatment with immunosuppressive drugs, neutropenia and CI ≥0.5 were not statistically significant. Out of the 5 who