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Background:
Infections caused by carbapenem resistant
Enterobacter-
iaceae
(CRE) are increasing.
Aim(s)/Objective(s):
To study the epidemiology and outcomes of CRE
infections in our center.
Method(s):
Retrospective review of CRE isolated in a single, 1,000
beded tertiary care center in Saudi Arabia, during the years 2012 to
2015.
Results:
87 adult patients with CRE infections were identified. 39%
were males with median age of 59 years (IQR 29
–
70) and median
Charlson Co-morbidity index of 2 (IQR 1
–
5). Baseline co-morbidities
included diabetes mellitus (49%), malignancy (25%), organ transplant
(23%), chronic kidney disease (22%) and chronic liver disease (20%).
61% were in an intensive care unit at the time of CRE isolation. 37%
had received carbapenem therapy within the preceding 90 days.
Patients had been admitted a median of 2 (IQR 1
–
3) times within
the preceding year; with a median total length of stay of 18 days (IQR
2
–
30).
K. pneumoniae
(72%) and
E. coli
(13%) were the commonest CRE
species. Overall, 25% were susceptible to ciprofloxacin, 40% to
gentamicin and 77% to colistin. Respiratory tract (37%), skin (16%),
abdomen (15%) and urinary tract (12%) were the commonest sites of
infection. Median total duration of antimicrobial therapy was 27 days
(IQR 13
–
42). The majority (60%) of patients received combination
antimicrobial therapy. The most frequently used agents within those
combinations were carbapenems (49%), colistin (40%) and tigecycline
(24%). Clinical and microbiological responses were achieved in 51%
and 44% of patients, respectively. All-cause 30-day mortality was 29%.
Discussion and/or Conclusion(s):
Most patients with CRE infections
received combination antimicrobial therapy. Clinical outcomes
are poor.
ID: 4835
Colistin-resistant Gram-negative infections; case series from
Saudi Arabia
Reem Almaghrabi, Yamama Aljishi, Mohamed Alkathlan,
Layan Akkielah, Abdulrahman Alrajhi, Ali Omrani.
King Faisal Specialist
Hospital and Research Center
Background:
Non-intrinsic colistin resistance in Gram-negative bacilli
(CRGNB) has been associated with poor clinical outcomes
Aim(s)/Objective(s):
Describe microbiological and clinical outcomes
of patiens colonised or infected with CRGNB
Method(s):
Retrospective search of Microbiology database for CRGNB
isolated between 2010 and 2015.
Results:
10 CRGNB isolates were identified (
K. pneumoniae
7,
P. aeruginosa
2 and 1
A. baumannii
) from 9 individual patients.
Colistin MIC ranged from 8 to 256 mg/L. Median age was 53 years
(range 30
–
94), 5 males. Eight patients were admitted to the ICU. Two
patients had received kidney transplants abroad within the preceding
3 months. Six patients required mechanical ventilation during their
hospital stay; all patients had central venous access.
Only 4 patients had active CRGNB infection, all caused by
K.
pneumoniae
(bacteraemia 1, urinary tract infection with secondary
bacteraemia 1, hospital acquired pneumonia 1 and intra-abdominal
infection 1). Treatment regimens included tigecycline, meropenem,
co-trimoxazole and colistin for a median duration of 14 days (range
6
–
32). Clinical and microbiological response was achieved in all but 1
patient.
Five patients were colonised with CRGNB (
K. pneumoniae
3,
P.
aeruginosa
1 and A
. baumannii
1). Site of colonisation was the
respiratory tract in 3, wound in 2 and urinary tract in 1 patient.
Spontaneous microbiological clearance was demonstrated in 3 out of
5 patients within a median duration of 8 days.
Overall, the median hospital stay was 23 days and median ICU stay
was 10 days. All-cause 30-day mortality was 22.2% (2/9).
Discussion and/or Conclusion(s):
CRGNB infection are relatively
uncommon but are associated with considerable morbidity and
mortality.
ID: 4845
The management of MDR and XDR-TB: 5 year experience from a
tertiary referral centre
Naeem Desai, Farnaz Dave, Emma Mceldowney, Susan Humphreys,
Alec Bonington.
Pennine Acute Hospitals Trust
Background:
Multi-drug resistant tuberculosis (MDR-TB) is defined as
an infection with
Mycobacterium tuberculosis
strains resistant to at
least rifampicin and isoniazid, whereas extensively drug-resistant
tuberculosis (XDR-TB) has additional resistance to any fluoroquino-
lone and at least one injectable second line drug (amikacin, kanamycin
or capreomycin). In 2014, 502 cases of MDR-TB and two cases of XDR-
TB were reported in the UK. These patients require complex costly
antibiotic regimens with significant toxicities, and outcomes remain
poor. This highlights the need for more clinical experience with newer
agents such as bedaquiline.
Aim(s)/Objective(s):
Our aim is to present our experience of managing
MDR/XDR-TB, as well as to present our findings in three patients
managed using bedaquiline.
Results:
At our unit we have managed thirteen patients with MDR-TB
and one patient with XDR-TB between 2011 and 2015. We present
three of these patients who received six months of bedaquiline
through the compassionate use programme as part of their treatment
course. We explore the challenges in the two MDR-TB cases that led to
bedaquiline use in the second phase of both patient
’
s treatment,
and the sensitivities that led to use of bedaquiline from the outset in
our case of XDR-TB. Furthermore we discuss the significant risk
of toxicity with bedaquiline, including prolongation of the QTc
interval, and suggested monitoring schedules. All three patients
improved following treatment and have not required further TB
treatment to date.
Discussion and/or Conclusion(s):
This case series highlights the
complexities of managing resistant TB and adds to experiential
evidence of the use of bedaquiline.
ID: 4860
A prospective multicentre observational study of mecillinam
susceptibility to pathogenic urinary bacteria in a healthcare
network in the United Kingdom
Hassan Farah
1
, Luke SP Moore
2
, Mark Gilchrist
3
, James Hatcher
4
.
1
Imperial College Healthcare NHS trust,
2
Imperial College London (UK)
Imperial College Healthcare NHS TrustNIHR Health Protection Research
Unit in Healthcare Associated Infections and Antimicrobial Resistance,
3
Imperial College London (UK) Imperial College Healthcare NHS Trust,
4
Infectious Diseases/Microbiology, Imperial College London (UK) Imperial
College Healthcare NHS Trust, London, UK
Background:
Public Health England published guidelines in 2015
recommending the use of pivmecillinam as an empirical choice of
treatment for uncomplicated urinary tract infections. There is a
paucity of surveillance data on the susceptibility of uropathogens to
mecillinam. We conducted a prospective multicentre observational
study of mecillinam susceptibility.
Aim(s)/Objective(s):
The primary aim was to analyse mecillinam
susceptibility to community-acquired
E. coli
,
Klebsiella
spp., and
P. mirabilis
. Secondary aims were to compare susceptibilities of other
commonly prescribed antibiotics to mecillinam, and to collect
demographic data to assess differences in various population settings.
Method(s):
Urine culture and identification were performed using
standardised laboratory techniques. The corresponding sensitivities
were determined by disc diffusion method and in line with the
European Committee on Antimicrobial Susceptibility Testing
(EUCAST). Data on urine susceptibility was extracted from the
centralised laboratory information management system from
February to April 2016.
Results:
Significant growth occurred in 2701 out of 15464 urines
received from February to April 2016. Mecillinam showed a 97%
sensitivity rate from 2181 isolates of
E. coli
,
Klebsiella
spp., and
P. mirabilis.
Sensitivity rates to nitrofurantoin, co-amoxiclav,
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S29