132 / 150
ID: 5013
Urinary catheter and CAUTI prevalence in hospitalized patients in a
large tertiary-care Italian hospital: results from a repeated data
point prevalence survey
Elisabetta Mantengoli
1
, Christopher Petrilli
2
, Lea Magistri
3
,
Maria Beatrice Pulci
3
, Alessandro Bartoloni
1
, Fabrizio Niccolini
3
,
Professional Unit
“
Healthcare Infection Prevention
”
3
.
1
Department of
Experimental and Clinical Medicine, University of Florence, Florence,
Italy;
2
Department of Medicine, Division of General Internal Medicine,
University of Michigan, Ann Arbor, MI, USA;
3
Medical Direction, Careggi
University Hospital, Florence, Italy
Background:
Indwelling urinary catheters are often placed in the
hospital setting without an appropriate indication. Inappropriate use
of catheters may lead to complications including catheter-associated
urinary tract infection (CAUTI) and other non-infectious consequences
of urinary catheters.
Aim(s)/Objective(s):
In this study, we examined the appropriateness
of indwelling urinary catheters and the association with CAUTI among
hospitalized patients.
Method(s):
Six point prevalence surveys were conducted from a
random sampling of 1297 beds unit, semi-annually, beginning May
2012. Data on urinary catheter utilization and CAUTI were collected
from participating units. Since November 2014, we captured urinary
catheter appropriateness as defined by the international HICPAC
Guidelines 2014.
Results:
A mean of 599 patients (range 518
–
637) were analyzed
in each chart review. Overall catheter utilization was 38.3% (range
34.0
–
42.9%). Urinary catheters placed without an appropriate indica-
tion represented 19.7
–
21.5% of all catheters inserted. The CAUTI rate
since 2012, ranged from 1.1% to 5.4% with a higher CAUTI rate found in
patients with an inappropriate indication for a urinary catheter
compared with those with an appropriate indication (8.0% versus
4.2%). Microorganisms most commonly isolated were Gram negative
bacteria, such as
Escherichia coli
and
Klebsiella pneumoniae
.
Discussion and/or Conclusion(s):
The prevalence of CAUTI was lower
than that reported in literature. However, given the significantly
higher CAUTI rate seen in patients with an inappropriate indication,
further research to reduce the inappropriate use of urinary catheters
appears necessary.
ID: 5015
Epidemiology of carbapenemase-producing Enterobacteriaceae
from screening samples
Rob Shorten
1
, Philip Ascroft
2
, Andy Dodgson
3
.
1
Public Health England,
2
Central Manchester NHS Foundation Trust,
3
Public Health Laboratory
Manchester, Manchester Royal Infirmary
Background:
Carbapenemase-producing Enterobacteriaceae (CPE)
are a significant healthcare threat. Infections caused by them are
more problematic to manage due to reduced antimicrobial choice
and are associated with poorer outcomes. As they as transmissible
between individuals, their rapid detection in colonised patients is vital
in containing their spread and starting appropriate empirical
antimicrobials when required. Based on national guidelines and
local risk assessment, patients at Central Manchester Foundation
Trust are screened for colonisation with CPE using one of two
molecular methods; CARBA-R (Cepheid, Sunnydale, California) or an
in-house nucleic acid amplification test (NAAT). Samples with a
positive NAAT are subsequently cultured to attempt to isolate the CPE.
Aim(s)/Objective(s):
To establish the epidemiology of CPE in screening
samples in this high incidence setting.
Method(s):
We retrospectively analysed the results of more than
68,000 rectal swabs submitted to the laboratory for the purpose of
screening for the carriage of CPE.
Results:
We present the epidemiology of KPC, OXA-48 and NDM,
including organism identification and susceptibility data in this large
cohort of patients.
ID: 5020
A comparison of the 2014
–
15 and 2015
–
16 Influenza seasons at
Royal Free London NHS Foundation Trust
Jennifer Hart
1
, Tehmina Bharucha
2
, Ons El Hayet Ben Ismail
2
,
Beatrice Cockbain
2
, Joanna Ellis
3
, Angie Lackenby
3
, Dianne Irish
2
,
Tabitha Mahungu
2
, Tanzina Haque
2
, Paul Griffiths
2
.
1
Royal Free Hospital
London NHS Foundation Trust,
2
Royal Free London NHS Foundation Trust,
3
Public Health England, Colindale
Background:
Influenza is a significant cause of morbidity and
mortality, with an estimated cost to the NHS of £286 million per
year. Viral and host factors are both known to influence patient
outcome.
Aim(s)/Objective(s):
To compare the 2014
–
15 and 2015
–
16 Influenza
seasons.
Method(s):
Information was obtained from patient records, internal
and referral laboratory reports.
Results:
During the 2014
–
15 Influenza season there were 247 cases
in total, with 177 (71.7%) Influenza A and 70 (28.3%) Influenza B. In
2015
–
16 there were 208 cases with 160 Influenza A (76.9%) and 48
Influenza B (23.1%). Of the Influenza A cases in 2014
–
15, 5 (2.0%) were
H1, 152 (61.5%) H3 and 20 (8.1%) untypeable. In 2015
–
16, 117 (56.3%)
were H1, 23 (11.1%) H3 and 20 (9.6%) untypeable.
In 2014
–
15, 203 (82.2%) patients received treatment for Influenza,
with 190 (76.9%) receiving Oseltamivir and 13 (5.3%) Zanamivir. In
2015
–
16, 122 (58.7%) patients received Oseltamivir and 2 (1.0%)
Zanamivir. Antiviral resistance to Oseltamivir affected 3 patients in
2014
–
15 with one of these isolates also low level resistant to
Zanamivir. No resistance was observed in 2015
–
16.
82 patients (33.2%) who contracted Influenza in 2014
–
15 were
immunosuppressed/pregnant, compared to 53 (25.5%) in 2015
–
16.
Mortality rate was 1.2% in 2014
–
15 and 1.0% in 2015
–
16.
Discussion and/or Conclusion(s):
There was a higher total number of
cases in 2014
–
15, with Influenza A H3 predominating, compared to
Influenza A H1 in 2015
–
16.
Vaccine mismatch may explain higher treatment rates in 2014
–
15 as
well as higher infection rates amongst immunosuppressed/pregnant
patients. Higher antiviral resistance rates in 2014
–
15 may also
reflect this.
ID: 5025
Evaluation of in-house prepared selective media for screening gut
colonization with carbapenemase producing enterobacteriaceae
(CPE)
Rajni Gaind
1
, Gajanand Mittal
1
, Monorama Deb
2
, P.k Verma
3
.
1
VMMC
and Safdarjung Hospital,
2
VMMC and Sfadrjung Hospital,
3
VMMC and
Safdarrjung Hospital
Background:
Most commercial media have been used to study coloni-
zation with KPC Enterobacteriaceae. Detection of Enterobacteriaceae
with NDM and OXA genes and with susceptibility to carbapenems is a
challenge
Aim(s)/Objective(s):
Performance of selective media for detection gut
colonization with CPE.
Method(s):
A total of 322 fecal samples were screened for CPE
using four in house prepared selective media: (i) overnight selective
enrichment in tryptic soy broth with a 10μg ertapenem disk. (CDC
protocol) (ii) MacConkey agar supplemented with imipenem at 1mg/L
(MacI), (iii) MacConkey agar supplemented with cefotaxime at 1mg/L
(MacC ESBL), (iv) MacConkey agar with standard Imipenem, Merope-
nem and Ertapenem Disk (10
μ
g Disk), (MacD). Isolates were screened
for KPC1 and 2, NDM-1, IMP, VIM, OXA- 48 and OXA-181.
Results:
A total of 444 morphologically distinct
Enterobacteriaceae
were isolated. 91 (20.5%)
Enterobacteriaceae
were CRE (ErtapenemMIC
>0.5 mg/L). Carbapenemase genes were detected in 50/91 CRE and
defined as CPE, 41/91 isolates were non CPE.
Among CPE, 38/50 were resistant to both imipenem and merope-
nem and 12 showed varied susceptibility. 38 CPE (76%) were
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S127