32 / 150
hospital differs from previously published distributions from other
countries.
ID: 4793
Antimicrobial susceptibility pattern of
Staphylococcus aureus
isolated from clinical specimens to conventional and newer
antimicrobials in Eastern India
Srujana Mohanty
1
, Bijayini Behera
2
, Subhrajyoti Sahu
2
,
Ashok K. Praharaj
2
.
1
All India Institute of Medical Sciences (AIIMS)
Bhubaneswar Odisha, India,
2
All India Institute of Medical Sciences
(AIIMS) Bhubaneswar Odisha, India
Background:
Global spread of methicillin resistant
Staphylococcus
aureus
(MRSA) constitutes one of the most serious contemporary
challenges to the treatment of hospital-acquired infections.
Aim(s)/Objective(s):
We aimed to assess the antibiotic susceptibility
pattern of
S. aureus
from clinical specimens in a tertiary care hospital in
Eastern India.
Method(s):
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.
Results:
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-
sensitive
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
periodically.
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
Background:
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
sepsis
Taku Sugai
1
, Katharine Lazarus
1
, Yee Man Tracey Hui
2
,
Prasanna Kumari
1
.
1
The Hillingdon Hospitals NHS Foundation Trust,
2
Ealing Hospital, North West London NHS Trust
Background:
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.
Aim(s)/Objective(s):
To review antibiotic usage, microbial identifica-
tions and antimicrobial sensitivities amongst adults with neutropenic
sepsis.
Method(s):
Data was collected as part of a retrospective audit of
neutropenic sepsis at Hillingdon Hospital between 1/4/15 and 31/5/16.
Results:
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
mechanism.
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
1
, Matthew Malone
2
, Honghua Hu
3
, Iain Gosbell
4
,
Slade Jensen
5
, Karen Vickery
3
.
1
Macquarie University,
2
High Risk Foot
Service, Liverpool Hospital, South Western Sydney LHD,
3
Surgical
Infection Research Group, Faculty of Medicine & Health Sciences,
Macquarie University,
4
Antimicrobial Resistance and Mobile Elements
Group, Ingham Institute of Applied Medical Research, Sydney,
5
Molecular
Medicine Research Group, Microbiology & Infectious Diseases, School of
Medicine, Western Sydney University, Australia
Background:
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
–
S134
S27