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hospital differs from previously published distributions from other


ID: 4793

Antimicrobial susceptibility pattern of

Staphylococcus aureus

isolated from clinical specimens to conventional and newer

antimicrobials in Eastern India

Srujana Mohanty


, Bijayini Behera


, Subhrajyoti Sahu



Ashok K. Praharaj




All India Institute of Medical Sciences (AIIMS)

Bhubaneswar Odisha, India,


All India Institute of Medical Sciences

(AIIMS) Bhubaneswar Odisha, India


Global spread of methicillin resistant



(MRSA) constitutes one of the most serious contemporary

challenges to the treatment of hospital-acquired infections.


We aimed to assess the antibiotic susceptibility

pattern of

S. aureus

from clinical specimens in a tertiary care hospital in

Eastern India.


S. aureus

was isolated and identified using standard

methods between July 2015 and April 2016. Antimicrobial suscep-

tibility testing was performed per CLSI 2015 using standard disc-

diffusion or Etest.


Total 284

S. aureus

were obtained from pus (61.6%), respi-

ratory tract (10.9%), urine (9.5%), blood (8.8%), body fluids (6.3%), and

catheter tips (2.8%). Overall,127 (44.7%) were MRSA, while 158 (55.6%)

were multidrug resistant. MRSA was highest in respiratory samples

(67.7%), followed by urine (59.2%) and blood (56.0%). High resistance

was to penicillin (81.7%), erythromycin (62.3%) and ciprofloxacin

(52.1%), while low-level resistance was to linezolid (0.7%), tigecycline

(2.1%), rifampicin (8.1%) and doxycycline (9.5%). All were susceptible to

teicoplanin. 166 (58.4%) isolates were susceptible to vancomcin (MIC

2 μg/mL), while 118 (41.5%) demonstrated reduced vancomycin

susceptibility (RVS) (MIC >2 μg/mL). The proportion of isolates with

RVS was similar in both MRSA (53/127, 41.7%) and methicillin-


S. aureus

(MSSA) (65/157, 41.4%).

Discussion and/or Conclusion(s):

High percentage of

S. aureus

demonstrated RVS, which may limit its usefulness in MRSA and be

associated with increased complications in MSSA infections. Linezolid,

tigecycline, rifampicin and doxycycline may be considered as alter-

natives. As the glycopeptide resistance is increasing globally com-

mensuratewith their increased use, the rates of vancomycin resistance

along with other antibiotics among

S. aureus

should be investigated


ID: 4798

Managing complicated urosepsis in patients with significant

comorbidities: balance between antimicrobial therapies and

surgical intervention

Keith Yuen, Melis Altunel, Adeel Anwar, Sulman Hasnie, Philip Stanley.

Bradford Royal Infirmary


A 56-year-old diabetic with urosepsis had imaging

confirming emphysematous pyelonephritis. Augmentin resistant

enterobacter was cultured in admission urine and blood. As clinical

condition deteriorated piperacillin/tazobactam was switched to

Meropenem empirically and repeat imaging confirmed renal

abscesses formation. Radiologically-guided drainage of pus yielded

enterobacter again and drain fluid grew VRE. The patient was

discharged after recovery was made with three weeks of ertapenem

and linezolid.

Readmission was required due to persisting urosepsis compounded

by multi-organ failure. Urine again cultured enterobacter which was

now AmpC positive but remained carbapenem sensitive. Imaging

(third series) showed renal abscess recurrence not amenable for

drainage. There was further clinical deterioration after initial recovery

with Meropenem and attempts of continuous treatment in the

community, from where urine cultured enterobacter resistant to

carbepenems secondary to AmpC activity and porin loss. Further

readmission culture yielded two different strains of

E. coli

, both were

ESBL producers with Ciprofloxacin and Carbapenem sensitive and

resistant strains. Imaging showed repeated recurrence of renal

abscesses, which were drained radiologically. Treatment with mer-

openem, linezolid, ciprofloxacin and caspofungin saw marked clinical

improvement, and repeat invasive cultures yielded no growth.

Discussion and/or Conclusion(s):

Source control is key in managing

urosepsis. Empirical escalation of antimicrobial treatment at times of

clinical deterioration without source control with abscess drainage

in this case led to prolonged carbapenems use and the inevitable

development of carbapenem resistance.

Nephrectomy was indicated here due to recurring sepsis. However,

one has to consider nephron preservation in patients with significant

cardiovascular comorbidities, and the high peri-operative morbidities/

mortalities associated with unstable patients.

ID: 4802

A retrospective reviewof antibiotic usage, microbial identifications

and antimicrobial sensitivities in adult patients with neutropenic


Taku Sugai


, Katharine Lazarus


, Yee Man Tracey Hui



Prasanna Kumari




The Hillingdon Hospitals NHS Foundation Trust,


Ealing Hospital, North West London NHS Trust


Neutropenic sepsis is a leading cause of morbidity and

mortality amongst cancer patients receiving treatment. The manage-

ment of which remains a challenge. NICE guidelines discourage

the routine empirical use of aminoglycosides with broad-spectrum

antibiotics because of toxicity concerns. However, with the emergence

of resistant strains of micro-organisms; clinicians must identify those

at risk and adjust antimicrobial agents based on a local antibiogram.


To review antibiotic usage, microbial identifica-

tions and antimicrobial sensitivities amongst adults with neutropenic



Data was collected as part of a retrospective audit of

neutropenic sepsis at Hillingdon Hospital between 1/4/15 and 31/5/16.


There were eighty-three cases of neutropenic sepsis in

sixty-three patients, forty-two of these were haemato-oncology

patients and twenty-one oncology. Twenty-seven of fifty-eight

positive culture results were gram-negative organisms. Eight isolates

were resistant strains including six cases of Enterobacteriaceae and

two cases of

Stenotrophomonas maltophilia

. Within the six resistant

strains of Enterobacteriaceae, three isolates were ESBL producing, two

were AmpC beta producing and one was Tazocin resistant by another


Five of six resistant Enterobacteriaceae strains were identified in

haemato-oncology patients. Four of these strains were resistant to

single agent Tazocin but sensitive to bothGentamicin andMeropenem.

Discussion and/or Conclusion(s):

Our small study supports the use of

Gentamicinwith Tazocin as first-line emperical anti-microbial therapy

in high-risk haemato-oncology patients. A close collaboration

between the microbiology and the frontline clinicians is essential in

providing optimum antimicrobial therapy for neutropenic sepsis.

ID: 4804

Profiling biofilm-associated diabetic foot infections according to

current medical management strategies

Khalid Johani


, Matthew Malone


, Honghua Hu


, Iain Gosbell



Slade Jensen


, Karen Vickery




Macquarie University,


High Risk Foot

Service, Liverpool Hospital, South Western Sydney LHD,



Infection Research Group, Faculty of Medicine & Health Sciences,

Macquarie University,


Antimicrobial Resistance and Mobile Elements

Group, Ingham Institute of Applied Medical Research, Sydney,



Medicine Research Group, Microbiology & Infectious Diseases, School of

Medicine, Western Sydney University, Australia


Cadexomer iodine (Iodosorb) is commonly used in the

management of chronic, non-healing wounds to reduce the micro-

bial load. Molecular analyses are much more informative than

standard culture techniques allowing researchers to develop a detailed

Abstracts of FIS/HIS 2016

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24