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Infections caused by carbapenem resistant



(CRE) are increasing.


To study the epidemiology and outcomes of CRE

infections in our center.


Retrospective review of CRE isolated in a single, 1,000

beded tertiary care center in Saudi Arabia, during the years 2012 to



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



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


Non-intrinsic colistin resistance in Gram-negative bacilli

(CRGNB) has been associated with poor clinical outcomes


Describe microbiological and clinical outcomes

of patiens colonised or infected with CRGNB


Retrospective search of Microbiology database for CRGNB

isolated between 2010 and 2015.


10 CRGNB isolates were identified (

K. pneumoniae


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



(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


32). Clinical and microbiological response was achieved in all but 1


Five patients were colonised with CRGNB (

K. pneumoniae




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


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


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.


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.


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


, Luke SP Moore


, Mark Gilchrist


, James Hatcher




Imperial College Healthcare NHS trust,


Imperial College London (UK)

Imperial College Healthcare NHS TrustNIHR Health Protection Research

Unit in Healthcare Associated Infections and Antimicrobial Resistance,


Imperial College London (UK) Imperial College Healthcare NHS Trust,


Infectious Diseases/Microbiology, Imperial College London (UK) Imperial

College Healthcare NHS Trust, London, UK


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.


The primary aim was to analyse mecillinam

susceptibility to community-acquired

E. coli



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.


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.


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



spp., and

P. mirabilis.

Sensitivity rates to nitrofurantoin, co-amoxiclav,

Abstracts of FIS/HIS 2016

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