18 / 150
Results:
To the abstract deadline date, 27 risk factors were identified
and described with routine data. The multivariate regression models
and the development of the score are under way. The results will be
presented at the conference.
ID: 4994
Emergence of colistin resistant
Klebsiella pneumoniae
in an
Oncology Center in Eastern India
Gaurav Goel
1
, Mammen Chandy
2
, Manas Kumar Roy
2
, Sujoy Gupta
2
,
Sudakshina Mullick
2
, Kasturi Sengupta
2
, Sanjay Bhattacharya
2
.
1
Tata
Medical Center, Kolkata, India;
2
Tata Medical Center Kolkata
Background:
Colistin is often the only available antibiotic for multi
—
drug resistant Gram negative bacilli (MDR-GNB) like carbapenem
resistant enterobacteriaceae (CRE). There are occasional reports of
colistin resistance
Klebsiella
.
Aim(s)/Objective(s):
Study of epidemiology about colistin resistance
Klebsiella
in oncology patients.
Method(s):
Retrospective analysis
–
February 2014 to September 2015.
Results:
A total of 12,957 cultures were studied, including 6290
blood cultures. Predominant MDR-GNB included
Escherichia coli
(482),
Klebsiella pneumoniae
(343),
Pseudomonas aeruginosa
(56).
ESBL and CRE were 479 and 396 respectively. Fifteen colistin resistant
Klebsiella
(CRK) were isolated; from blood (3), respiratory specimens
(4), urine (3), pus (2) and 1 each from bile, tissue and stool surveillance
cultures. These included 10 males and 5 females (age 12
–
80 years;
median 44). Underlying malignancies included hematological (9),
gastro-intestinal tract (3) and urinary bladder (3). Three patients
have had bone marrow trasplantation. Susceptibility pattern being
carbapenems (all resistant), fosfomycin (all sensitive), tigecycline (8
sensitive-S); doxycycline (1-S); amikacin (1-S); cotrimoxazole (3-S)
and chloramphenicol (3-S). Eleven patients had prior infections with
carbapenem resistant
Klebsiella
(73%), while 3 had it in stool
surveillance cultures. Previous use of colistin was noted in 53% (8
patients). All cause mortality was 47% (7).
Discussion and/or Conclusion(s):
This study highlights CRK is
associated with high mortality. Colistin resistance can arise
de novo
due to selection pressure or horizontal spread as a breach in infection
control practices. There is a need to optimize use of colistin including
dosage schedules and adjustments in deranged renal profile. Further
molecular research is needed to see the predilection of
Klebsiella
pneumoniae
for colistin resistance.
Topic: Antimicrobial stewardship
ID: 4479
Articulating citizen participation in national antimicrobial
resistance policies: how does the UK compare to other European
countries?
Enrique Castro-Sanchez
1
, Michiyo Iwami
2
, Raheelah Ahmad
2
,
Alison Holmes
2
.
1
National Centre for Infection Prevention and
Management, Imperial College London,
2
Imperial College London
Background:
National policies articulate the vision, objectives and
resources required to deal with antimicrobial resistance (AMR).
Participation of citizens in AMR activities is deemed essential, but
may reflect and be limited to the roles allocated to them by national
policies.
Aim(s)/Objective(s):
We investigated and compared the language
used and role given to citizens by different European AMR policies.
Method(s):
We downloaded national policies from the European
Centre for Disease Prevention and Control website (March 2016)
selected a sample of policies available in English from the UK, Spain,
Norway, Germany and the Netherlands.
We conducted a documentary analysis of policies to assess citizen
participation using well established frameworks by Charles & DeMaio
(1993) and Carman et al. (2013).
Results:
For language, across the five countries, policies refer to
‘
the public
’
or
‘
patients
’
but not
‘
citizens
’
. The Norwegian policy used
clear, commanding and committed language (
‘
must
’
,
‘
will
’
) intended
to facilitate citizen engagement in optimal antimicrobial activities
and behaviours The Spanish policy adopted a
‘
rational
’
and didactic
attitude towards antibiotic use by citizens, whilst Norway presented a
progressive approach,
‘
assuring
’
,
‘
encouraging
’
and
‘
supporting
’
citizen
participation.
For roles, The Netherlands and Spain emphasised
‘
awareness
’
, UK
centred on
‘
education
’
and Germany
‘
training
’
. UK was the only
country explicitly incorporating behavioural elements.
Discussion and/or Conclusion(s):
Better performing countries in
terms of antimicrobial usage offer broader and comprehensive
approaches towards the integration of citizens in AMR activities. A
‘
rights
’
perspective is missing from the area, and in general citizen
advocacy is yet to be developed in AMR policies.
ID: 4740
Do antimicrobial guardians require stewardship?
Wael Elamin
1
, Hala Kandil
2
, Tejal Vaghela
2
.
1
Mid Essex Hospital Services
NHS Trust,
2
West Hertfordshire Hospitals NHS Trust
Background:
The choice and duration of antimicrobials in ITU setting
is closely monitored by microbiologists through their daily ward
rounds and as such should be an area with good antimicrobial
stewardship.
Aim(s)/Objective(s):
We retrospectively examined the variation in the
microbiologist-guided antimicrobial prescribing practice over six
month periods covered by different microbiology consultants and
the effect of this variation on antimicrobial stewardship.
Method(s):
Pharmacy records for total antimicrobial usage (DDD) for
every prescribed antibiotic in ITU were obtained and reviewed. The
demographic details of ITU patients, clinical diagnosis, and mortality
rates were collected for each of the specified periods. In addition, the
microbiology results during the same period were retrieved from the
laboratory information management system to compare the incidence
of resistance during the periods examined. A cost analysis for the
periods specified was also performed.
Results:
Despite similar patients
’
numbers, demographic and local
epidemiology during the periods of comparison, a significant variation
in antimicrobial prescriptionwas noted. While the consumption of the
commonly prescribed broad spectrum antibiotics (tazocin, augmentin
and meropenem) was similar, restricted antibiotics consumption
(daptomycin, tigecycline, temocillin) and aminoglycosides was sig-
nificantly different between the two periods.
Discussion and/or Conclusion(s):
We note a variation in the micro-
biologist-guided antimicrobial prescribing practice between different
consultants in a controlled environment. The differences cannot be
attributed to pathogen resistance, or the patient
’
s demography within
the ITU. Further analysis is required to outline if these are behavioural
differences or are indeed justified on clinical grounds.
ID: 4779
Course length and risk of repeat antibiotic prescription in women
with community onset lower UTI
Sean MacBride-Stewart
1
, R. Andrew Seaton
2
, Anne Thomson
3
.
1
Pharmacy and Prescribing Support Unit NHS Greater Glasgow and Clyde,
2
Antimicrobial Management Team NHS Greater Glasgow and Clyde,
3
Glasgow City Health Social Care Partnership (North East)
Background:
A 2005 Cochrane review concluded that 3 days of anti-
biotic therapy was similar in effectiveness to 5
–
10 days for achieving
symptomatic cure in non-pregnant women with lower UTI whilst
longer treatment courses were more effective in achieving bacterio-
logical cure. Current NHS Greater Glasgow and Clyde (GGC) guidance
recommends a 3 day course of either nitrofurantoin or trimethoprim
for uncomplicated lower UTI in women.
Aim(s)/Objective(s):
To determine whether shorter course therapy in
UTI is associated with higher rates of repeat prescribing.
Abstracts of FIS/HIS 2016
–
Oral Presentations / Journal of Hospital Infection 94S1 (2016) S11
–
S21
S13