The Journal of Hospital Infection - Supplement 1

ID: 5135

Carbapenemase-producing organisms in NHS Lothian

−

rapid and

reliable detection and confirmation

Geoff Toner

, Kate Templeton

, Fiona Hamilton

, Clark Russell

NHS Lothian,

University of Edinburgh

Background:

Carbapenemase-producing Organisms pose an increas-

ing clinical threat globally. Increasing resistance to carbapenems

(often considered the last line in antibiotics in the treatment of

gram-negative infections) has led to the requirement for rapid and

robust methods for the analysis of carbapenemase activity in these

organisms.

Aim(s)/Objective(s):

From September 2014, NHS Lothian has been

performing in-house multiplex real-time PCR for OXA-48, VIM, NDM,

KPC and IMP carbapenemase-producing organisms alongside Rapidec

Carba NP testing and detection of growth on ChromID CARBA SMART

media. The sensitivity and specificity of these assays were assessed

over a 24 month period.

Method(s):

This review detailed the investigation of 81 isolates from

the period September 2014 to Aug 2016 including 38 carbapenamase-

positive isolates and 43 carbapenemase-negative isolates.

Results:

The sensitivity and specificity of the in-house PCR to detect

the OXA-48, VIM, NDM, KPC and IMP (

“

big 5

”

) targets was assessed to

be 100% and 100%. The chromogenic screening agar ChromID CARBA

SMART had a sensitivity of 97.3% and a specificity of 95.3% for detection

of carbapenemase-producing organisms. The Rapidec Carba NP had a

sensitivity of 97.3% and a specificity of 97.6%. Two OXA-23 producing

isolates and two IMI-producing isolates were all positive by Rapidec

Carba NP and characterised by ARMRL Colindale.

Discussion and/or Conclusion(s):

The overall compilation of

Carbapenemase-producing Organisms over the 24 month period in

NHS Lothianwas NDM (21%), OXA-48 (29%), VIM (24%), IMP (11%), KPC

(5%), OXA-23 (5%) AND IMI (5%). A robust, reliable and rapid workflow

for laboratory detection of Carbapenemase-producing organisms has

been validated for use in NHS Lothian.

ID: 5175

Surveillance of antifungal resistance patterns in oral

Candida

infection

Noha Seoudi, Wala Belhaj.

QMUL

Background:

Oral microbiology investigation forms an important

role in managing orofacial infections and patient care. Recently, the

Public Health England (PHE) updated their oral mucosal standards for

microbiology investigations (SMI).

Candida

infection is one of the most

frequent oral infections that require proper diagnosis, for optimum

management especially with the increased immunocompromised

population and the reported emergence of antifungal resistance.

Therefore, this study analysed the antifungal resistance in oral

Candida

infection.

Aim(s)/Objective(s):

To analyse the antifungal resistance pattern in

oral

Candida

infection reported by one of the oral microbiology

laboratory in a dental hospital in the UK.

Method(s):

Data from oral microbiology laboratory reports was

collected electronically retrospectively in a two-year period (2014

–

2015). Subsequently, Oral

Candida

reports were studied and the

sensitivity patterns were analysed.

Results:

In the period between the 1st of January 2014 to the 31st

of December 2015, a total of 2051 oral mucosal swabs received, only

29% (594/2051) of these swabs grew yeasts, 95.6%(568/594) of

the yeast isolates were identified to species level. Susceptibility

tests were performed for 9.5% (54/568) of the reported

Candida

was reported 100% sensitive to Ambizome, Itraconazole,

Nystatin, Caspofungin and voriconazole, and 95% to Fluconazole and

Echinocandin. Resistance was reported only in non-albicans

Candida

(

Candida glabrata, Candida krusei

and

Candida guilliermondii

Discussion and/or Conclusion(s):

This study highlights that

Candida

isolated from oral infection remains very sensitive to the commonly

used antifungal agents. However, sensitivity testing is still justified

in cases of failure of treatment, immunocompromised patients and

infection with non-albicans

Candida

ID: 5176

Investigating new cases of Enteroccoci conferring Optr-A mediated

linezolid resistance from Scotland

Joanna Walker

, Anne Marie Karcher

, Michael Lockhart

, Ben Parcell

NHS Grampian,

National Services Scotland

Background:

Presently less than one percent of Gram positive

organisms have Linezolid resistance. This resistance can result from

mutations in chromosomal genes. Since 2012 there has been a Scottish

national alert flagging newly identified plasmid mediated trans-

ferable mechanisms via the cfr gene and recently the Optr-A gene. The

Optr-A gene encodes an ABC transporter which confers resistance to

oxazolidinones and phenicols.

We have identified three separate Optr-A mediated Linezolid resistant

Enterococcus faecalis

isolates from urine samples in NHS Grampian

from 2014 to 2016. It is extremely rare to identify this resistance

mechanism.

Aim(s)/Objective(s):

To describe these three cases and investigate risk

factors for acquiring these infections and identify potential links

between patients

Method(s):

To review lab system records, and Vitek 2 sensitivities and

typing for comparison; to collate clinical information and establish

whether the patients were managed for acute episodes of urinary

infection; and to identify epidemiological risk factors for acquiring

these isolates including past medical histories, hospital admissions,

links to farming, and travel histories including to Ireland.

Results:

The results from the lab system search and the case histories

from GP interviews will be described.

Discussion and/or Conclusion(s):

Plasmid mediated mechanisms

are of considerable public health importance due their potential to

transfer and confer resistance to other strains and species.

Topic: Antimicrobial stewardship

ID: 4464

The role of point of care tests in antibiotic stewardship for

urinary tract infections in a resource limited setting on the

Thailand-Myanmar border

Lauren Chalmers, Rose McGready, François Nosten, Jessica Cross,

Cindy S. Chu, Aung Pyae Phyo, Margreet Trip, Clare Ling,

Verena Carrara, Wanitda Watthanaworawit, Lily Keereecharoen,

Borimas Hanboonkunupakarn.

Shoklo Malaria Research Unit (SMRU),

Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical

Medicine, Mahidol University, Thailand

Background:

Published literature from resource-limited settings is

infrequent, although urinary tract infections (UTI) are a common cause

of outpatient presentation and antibiotic use. Point-of-care test (POCT)

interpretation relates to antibiotic use and antibiotic resistance.

Aim(s)/Objective(s):

We aimed to assess the diagnostic accuracy of

POCT and their role in UTI antibiotic stewardship.

Method(s):

One-year retrospective analysis in three clinics on the

Thailand-Myanmar border of non-pregnant adults presenting with

urinary symptoms. POCT (urine dipstick and microscopy) were com-

pared to culture with significant growth classified as pure growth of a

single organism >10(5) CFU/mL.

Results:

In 247 patients, 82.6% female, the most common symptoms

were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency

(53.7%). After excluding contaminated samples, UTI was diagnosed

in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture,

and >80% of these were

Escherichia coli

(20.9% produced extended-

spectrum

-lactamase (ESBL)). Positive urine dipstick (leucocyte

esterase

≥

1 and/or nitrate positive) compared against positive micro-

scopy (white blood cell >10/HPF, bacteria

≥

1/HPF, epithelial cells

<5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity

Abstracts of FIS/HIS 2016

–

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

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S134

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