Extended-spectrum Beta-lactamase Enterobacteriaceae Research Articles

Impact of Discontinuing Contact Precautions for Multidrug-resistant Gram-negative Enterobacteriaceae in a Large Health System

Background: Contact precautions (CP) to prevent transmission of multidrug-resistant gram-negative (MDRGN) Enterobacteriaceae are recommended, although studies of discontinuation of CP (DcCP) have found no change in healthcare associated infections (HAI) due to extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae. Limited data exists on DcCP for MDRGN in a large health system. Methods: We performed a retrospective observational study analyzing the relationship between use of CP and HAI due to two definitions of MDRGN Enterobacteriaceae: ESBL, and non-susceptibility to ≥3 drug classes (3DC-GNR), with carbapenem resistant Enterobacteriaceae (CRE) serving as control. The study included all inpatient admissions from 2/2017 through 9/2022 at 21 acute care hospitals. Hospitals had latitude to determine CP practices based on local risk assessment, but in 2/2018, system-wide transmission-based precautions guidance was updated to recommend DcCP for MDRGN Enterobacteriaceae and in 12/2019 was updated to clarify DcCP specifically for ESBL and 3DC-GNR while continuing CP for carbapenem-resistant organism carriage. We interviewed infection preventionists to define when CP were used for CRE, ESBL, and 3DC-GNR Enterobacteriaceae. HAI were defined using National Healthcare Safety Network criteria including all HAI categories. We compared the incidence rate of HAI attributable to the two MDRGN types in hospital months with and without use of CP, with HAI due to CRE as a comparison group since all hospitals used CP for CRE throughout the study period. Results: The periods of CP use, by hospital, are shown in Figure 1. Throughout the study period, there were 987 HAI attributed to ESBL Enterobacteriaceae, 579 due to 3DC-GNR Enterobacteriaceae, and 329 due to CRE. Figure 2 shows the unadjusted aggregate rate of HAI for each of the three MRGN types, including among hospitals with and without CP in each month, for ESBL and 3DC-GNR. In months with and without CP, the rate of HAI was 1.482/10,000 and 1.093/10,000 patient days (incidence rate ratio [IRR], 1.356 [95% confidence interval, 1.195-1.540]) for ESBL Enterobacteriaceae. In months with and without CP, the rate of HAI was 1.071/10,000 and 0.493/10,000 patient days (IRR,2.173[95% confidence interval, 1.838-2.569]) for 3DC-GNR Enterobacteriaceae. Conclusion: DcCP was not associated with an increase in HAI due to ESBL and 3DC-GNR Enterobacteriaceae in aggregated facilities that self-selected for DcCP. Facilities that used CP were associated with significantly higher rates of ESBL and 3DC-GNR Enterobacteriaceae, a relationship that did not change as hospitals DcCP for these MDRGN. Further analyses are necessary to assess for a causal relationship.

Prevalence of Multidrug-Resistant and ESBL-Producing Bacterial Pathogens in Patients with Chronic Wound Infections and Spinal Cord Injury Admitted to a Tertiary Care Rehabilitation Hospital.

A pressure ulcer is defined as a skin lesion of ischemic origin, a condition that contributes to morbidity and mortality in patients with spinal cord injuries. The most common complication of ulcers is a bacterial infection. Antimicrobial therapy should be selected with caution for spinal cord injury patients since they have a high risk of developing multidrug-resistant (MDR) infections. The aim of this study was to determine the prevalence of different bacterial pathogens in patients with pressure ulcers admitted with spinal cord injuries. This was a retrospective single-center study that included adult patients aged 18 years and above, admitted with chronic pressure wounds after a spinal cord injury requiring hospitalization between 2015 and 2021. A total of 203 spinal cord injury patients with pressure ulcers were included in the study. Ulcers were commonly infected by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, and they were mostly located in the sacral and gluteal areas. More than half of the bacteria isolated from patients were sensitive to commonly tested antibiotics, while 10% were either MDR- or pan-drug-resistant organisms. Of the MDR bacterial isolates, 25.61% were methicillin-resistant S. aureus, and 17.73% were extended-spectrum beta-lactamase Enterobacteriaceae. The most prevalent bacteria in pressure ulcers of spinal cord injury patients were S. aureus. Other antibiotic-resistant organisms were also isolated from the wounds.

388. Epidemiologic and Microbiologic Characteristics of Hospital-acquired Infections in Patients with COVID-19 at Intensive Care Unit, Mexico City

BackgroundPatients with severe SARS-CoV-2 infection are at high risk of complications due to the intensive care unit stay. Hospital-acquired infections (HAI) are one of the most common complication and cause of death in this group of patients, it is important to know the epidemiology and microbiology of this hospital-acquired infections in order to begin to the patients a proper empirical treatment. We describe the epidemiologic and microbiologic characteristics of HAI in patients with COVID-19 hospitalized at intensive care unit (ICU) in a tertiary level private hospital in Mexico City.MethodsFrom April to December 2020, data from all HAIs in patients with severe pneumonia due to SARS-CoV-2 infection with mechanical ventilation at ICU were obtained. The type of infection, microorganisms and antimicrobial susceptibility patterns were determined.ResultsA total of 61 episodes of HAIs were obtained, the most common was ventilator associated pneumonia (VAP) in 52.4% (n=32) followed by urinary tract infection (UTI) 34.4%(n=21) and bloodstream infection (BSI) 9.84% (n=6). Only two episodes corresponded to C. difficile associated diarrhea. We identified 82 different microorganisms, the most frequent cause of VAP was P. aeruginosa 22% (10/45) followed by K. pneumoniae 20% (9/45); for UTI, E. coli 28.5% (6/21), and S. marcescens 19% (4/21); for BSI the most frequent microorganism was S. aureus 28.5 (2/7). Regarding the antimicrobial susceptibility patters the most common were Extended Spectrum Beta-Lactamase (ESBL) Gram-negative rods followed by Methicillin-resistant Staphylococcus aureus.ConclusionIn patients with severe COVID-19 hospitalized in the ICU the most frequent HAIs were VAP and UTI caused by P. aeruginosa and E. coli respectively. ESBL enterobacteriaceae was the most common resistant pattern identifed in the bacterial isolations in our series.Disclosures All Authors: No reported disclosures

Retrospective assessment of antimicrobial stewardship initiative in outpatient use of ertapenem for uncomplicated extended spectrum beta lactamase Enterobacteriaceae urinary tract infections

BackgroundUrinary tract infections (UTI) are often over-diagnosed and over-treated, which can induce and select for resistant pathogens. After observing wide-spread outpatient use of ertapenem, a broad-spectrum antibiotic, a structured antimicrobial stewardship initiative (ASI) to improve appropriate antimicrobial prescribing was undertaken. ASI objectives were to achieve a goal of reducing ertapenem utilization for extended spectrum beta lactamase Enterobacteriaceae (ESBL-EB) UTI by 10% and evaluate the clinical outcomes associated with the ASI.MethodsA pre-to-post cohort study was conducted at a single-center integrated healthcare system between November 1, 2014 and February 26, 2017. An intensive, 90-day, pharmacist-driven, structured ASI was implemented between November 1, 2015 and January 29, 2016. Female patients aged ≥18 years who were treated for an uncomplicated, ESBL-EB urinary tract infection (UTI) were included. Primary outcome was clinical resolution defined as cure, persistence, relapse and recurrence. Secondary outcome measured was monthly ertapenem use expressed as number of days of therapy (DOT)/1000 adjusted patient days (APD). Segmented regression analysis for interrupted time series was performed to estimate ASI intervention effect.ResultsA total of 184 patients were included in the study. Ertapenem utilization decreased from 0.0145 DOT/1000 APD in Nov. 2014 to 0.0078 DOT/1000 APD Feb. 2017(p < 0.01). The mean ertapenem DOT declined 19% overall from the pre vs. post intervention periods (32 vs 26, p < 0.01). Frequency of recurrent UTIs between treatments did not significantly differ and no adverse effects were reported in patients treated with aminoglycosides.ConclusionsA structured ASI for uncomplicated ESBL-EB UTI was associated with a clinically meaningful decrease in ertapenem utilization and once-daily, 5-day aminoglycoside treatment was well-tolerated.

Epidemiology, risk factors and outcomes of multidrug-resistant bacteria colonization in a Moroccan medical intensive care unit

INTRODUCTION: Multidrug-resistant bacteria (MDRB) infection is a major health problem, particularly in low- and middle-income countries. Since colonization is the first step of infection, we aimed to evaluate the epidemiology and risk factors of colonization by multidrug-resistant bacteria, as well as outcomes in patients hospitalized in the medical intensive care unit. METHODS: this was a cohort study that was conducted over 12 months, including all patients hospitalized in the medical intensive care unit (ICU) of Mohammed VIth University Hospital of Marrakech. All patients had nasal and rectal swabs collected at admission and repeated weekly until discharge or death. Also, we collected data including age, gender, medical history, cause of admission, Acute physiology and chronic health disease classification system II, invasive procedures, results of culture swabs, colonization pressure, treatments, and outcomes. These data were collected from hospital files. Generated data were analyzed using SPSS 10 for Windows. RESULTS: the prevalence of MDRB colonization, at ICU-admission, was 25.3%. The incidence of colonization was 21.7%. The most frequently isolated organisms were extended-spectrum beta-lactamase Enterobacteriaceae (45%), multidrug-resistant Acinetobacter baumannii (28%), and carbapenemase-producing Enterobacteriaceae (12%). The most significant independent risk factors for MDRB colonization were the transfer from another ICU (OR 9.8, 95% CI 1.8-54.5, p=0.009) or a private structure (OR 36, 95% CI 5-262, p=0.001), prior antibiotics before ICU admission (OR 5.2, 95% CI 1.92-13.96, p=0.001), central venous catheter use (OR 4.6, 95% CI 1.06-20, p=0.04), and colonization pressure (OR 1.3, 95% CI 1.16-1.45, p=0.001). The mortality, mechanical ventilation, and nosocomial infection rates were higher in colonized than non-colonized patients. CONCLUSION: admission prevalence and incidence of MDRB carriage were high compared to developed countries. Therefore, the hospital needs to reinforce precautions to minimize cross-transmission and infections in critically ill patients, such as compliance with hand hygiene and control cleaning, as well as implementing antibiotic stewardship programs.

Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae and Associated Factors Among Hospitalized Patients in Arba Minch General Hospital, Arba Minch, Ethiopia.

BackgroundThe incidence of hospital-acquired enterobacteria that produce extended-spectrum beta-lactamases (ESBLs) is on the rise worldwide. Colonization of gastrointestinal tract by extended-spectrum beta-lactamase Enterobacteriaceae, a prominent causative agent, results in life-threatening infections.ObjectiveTo determine the rate of gastrointestinal colonization by extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae and also to elucidate the antibiotic susceptibility profile and associated risk factors among hospitalized patients in Arba Minch General Hospital, Ethiopia.MethodologyA facility-based cross-sectional study was conducted in Arba Minch General Hospital from May 2018 to July 2019. Sociodemographic data and associated factors were collected using a pre-tested-structured questionnaire. Stool specimens were collected using sterile stool cups. Each sample was then inoculated onto MacConkey agar. Bacterial isolates were identified using various biochemical tests. Screening and confirmatory tests for extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae were performed using the modified Kirby–Bauer disc diffusion technique. Statistical package for Social Science was used to analyze the data. The P-value ≤0.05 was considered as statistically significant.ResultsA total of 421 hospitalized patients were enrolled in this study of which there were 240 (57%) females. The mean age of the study participants was 28.8 with SD of 15.7. Majority of participants were in the age range of 25–40 years 179 (42.5%). About 146 (34.7%) participants were found to be colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae. The predominant ESBL-producing isolates were Escherichia coli 62 (42.46%) followed by Klebsiella pneumoniae 60 (41.09%). Six (1.43%) carbapenemase-producing K. pneumoniae were isolated. ESBL-producing Enterobacteriaceae showed higher resistance against tetracycline (91.1%) and cotrimoxazole (93.84%). Colonization of the gastrointestinal tract by ESBL showed statistically significant association with regard to chronic diseases (p<0.001) and the administration of oral antibiotics after admission (p=0.020).ConclusionThe overall colonization rate of the gastrointestinal tract by extended-spectrum beta-lactamase-producing Enterobacteriaceae was prominent. The extended-spectrum beta-lactamase-producing isolates exhibited a higher level of resistance against the commonly used antibiotics which further needs greater attention.

Trends in resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States: 2013\u20132017

BackgroundTrends in antimicrobial resistance help inform infection control efforts. We examined trends in resistance for Enterobacteriaceae and Acinetobacter spp. from 2013 to 2017 in hospitalized US patients.MethodsWe analyzed antimicrobial susceptibility of non-duplicate isolates in hospitalized patients (not limited to hospital-acquired infections) in the US BD Insights Research Database. Resistance profiles of interest were extended-spectrum beta-lactamase (ESBL)-producing, multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes of Enterobacteriaceae, and MDR and Carb-NS Acinetobacter spp. Time series models were used to evaluate the patterns of resistance trends in rate per 100 hospital admissions and proportion per isolates tested.ResultsMore than 1 million Enterobacteriaceae isolates were obtained from 411 hospitals; 12.05% were ESBL, 1.21% Carb-NS, and 7.08% MDR. Urine was the most common source. For Acinetobacter spp. (n = 19,325), 37.48% were Carb-NS, 47.66% were MDR, and the most common source was skin/wound cultures. Trend analyses showed that the rates of ESBL and Carb-NS Enterobacteriaceae per 100 hospital admissions increased significantly between 2013 and 2017. Rates of MDR Enterobacteriaceae and Carb-NS and MDR Acinetobacter spp. decreased during this time period. Trends in proportions of resistant isolates generally mirrored trends in rates per 100 hospital admissions. MDR Enterobacteriaceae and Carb-NS and MDR Acinetobacter spp. were more common in winter than summer.ConclusionsIn this large-scale study of patients in US hospitals, rates of ESBL and Carb-NS Enterobacteriaceae per 100 hospital admissions increased between 2013 and 2017. MDR Enterobacteriaceae and MDR and Carb-NS Acinetobacter spp. isolates decreased over this period. These data support continuing infection control and stewardship efforts and the development of new therapeutic options.

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

ObjectivesTo determine antimicrobial nonsusceptibility rates for Enterobacteriaceae and Acinetobacter spp. in US hospitals. MethodsWe analyzed antimicrobial susceptibilities of non-duplicate Enterobacteriaceae and Acinetobacter spp. isolates reported in 2017 from 375 US hospitals in the BD Insights Research Database. Logistic and Poisson regression modeling methods were used to estimate proportions of resistant isolates and rates per 1000 hospital admissions. National projections were generated based on raking (weighting) methods. ResultsThe nationwide proportions of resistant isolates in inpatients were an estimated 12.6%, 6.6%, and 1.2% for Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL), multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes, respectively, and 42.4% and 34.5% for Acinetobacter spp. with MDR and Carb-NS phenotypes. Resistance varied by geographic region and hospital size/type. Estimated nationwide rates per 1000 hospital admissions ranged from a high of 7.1 for ESBL Enterobacteriaceae to a low of 0.3 for Carb-NS Acinetobacter spp. The estimated number of isolates occurring in US inpatients each year was 290,220 ESBL, 173,984 MDR, and 30,194 Carb-NS for Enterobacteriaceae and 12,274 MDR and 9,991 Carb-NS for Acinetobacter spp. ConclusionsNational prevalence estimates suggest high levels of antimicrobial resistance and a substantial number of patients with resistant Enterobacteriaceae and Acinetobacter spp. in US hospitals.

Analysis of antimicrobial resistance pattern in a secondary care hospital

Background: Antimicrobial resistance is a grave global public health concern and has escalated in recent past. Aims and Objectives: This study was conducted to analyze the antimicrobial resistance pattern of commonly isolated microorganisms in a secondary care hospital in Saudi Arabia. Materials and Methods: This cross-sectional observational study was conducted at King Khalid Hospital, Al Majmaah. Antimicrobial resistance pattern of commonly isolated Gram-negative and Gram-positive microorganisms was checked against routinely used antimicrobials. Results: The prevalence rate calculated for methicillin-resistant Staphylococcus aureus was 44.2%. Extended-spectrum beta-lactamase Enterobacteriaceae was 14.70% and vancomycin-resistant enterococci were 8%. Conclusion: There is an increase in proportion of isolates resistant to commonly prescribed antibiotics highlighting the importance of ongoing surveillance and antibiotic stewardship program.

Coordinated surveillance of the multi drug resistant organisms in a French University Hospital: Results since 2013

Introduction The control of the cross-transmission of multi drug resistant organisms (MDRO) is a major concern in the healthcare centers. That is the purpose of one of the axes of the French national program of prevention of healthcare-associated infections (Propias). To adapt the recommendations, a French multicenter university hospital started a coordinated and standardized surveillance of MDRO since 2013. The objective of the study is to know the global incidence rate of MDROs and to follow this rate along time. Methods An active standardized surveillance of MDRO was carried out in a university hospital of about 6000 beds. The methodology was based on the French national MDRO's surveillance network (BMR-RAISIN). All methicillin resistant Staphylococcus aureus (MRSA), and extended spectrum beta-lactamase Enterobacteriaceae (ESBLE) detected in clinical specimen performed between April 1, and June 30, in 2013, 2015, and 2017, in the hospitalized patients (in conventional ward or week hospitalization) were included. Screening for colonization and environment samples were excluded. To describe the population with MDROs, we collected data on patient characteristics, specimen sample site, acquired or imported, infection or colonization, ESBLE species, resistance profile for certain antibiotics markers. To calculate the incidence rates, the number of hospitalization days was collected for each period of surveillance. Results For the 3 surveillance periods, a total of 1191 MDRO were included, distributed in 989 ESBLEs (93.04%) and 202 MRSAs (16.96%). The main ESBLE species were Escherichia coli (41.6%), Klebsiella pneumoniae (31.6%) and Enterobacter cloacae (11.4%). The proportion of E. coli decreased along time to the detriment of the other Enterobacteriaceae species, in particular for imported ESBLE (P = 0.0304), while the time evolution was not statistically significant for acquired ESBLEs (P = 0.0555). There were 506 acquired MDROs (42.5%) and 651 imported (54.7%). The most frequent sample types were urine samples (N = 608, 52.9%), respiratory specimens (N = 185, 16.1%) and bloodstream specimens (N = 123, 10.7%). MDROs were responsible of 786 infections among the 1108 for which the information was available (70.9%). Fifteen ESBLEs among 952 were imipenem-resistant (1.6%), and 54 among 868 were ertapenem-resistant (6.2%). The proportion of ertapenem resistant ESBLE was 2-fold increased between 2013 and 2017, from 4.3% to 8.4% (P = 0.06). A 20% > decreased of the incidence rate of MRSA was observed between 2013 and 2017: from 0.25/1000 hospitalization-days in 2013, to 0.17 in 2015, and 0.20 in 2017. This decrease was higher in imported MRSA group. A 62.7% > increased of the ESBLE incidence rate was observed, from 0.83/1000 hospitalization-days in 2013 and 2015 to 1.35 in 2017. This increase was observed both for the imported and acquired ESBLE but was higher for the imported ones. Conclusions The implementation of this surveillance allowed the University hospital to know its global incidence rate of MRSA and ESBLE, and to propose straightaway coordinated prevention measures. We observed over the 3 periods of surveillance a decrease in the MRSA incidence and an increase in the ESBLE incidence. These results are coherent with the national network data. We observed also an increase in the proportion of ertapenem-resistant ESBLE. These data should be construed in the light of the change of the national epidemiology of the antibiotic resistance in Enterobacteriaceae, and particularly the increasing number of episodes of carbapenem-producing Enterobacteriaceae which the university hospital have to manage. These data suggest that a strengthening of campaigns of preventing MDROs cross transmission. Appropriate antibiotic use might also help to limit de diffusion of MDRO in hospital and community.

The infection risk scan (IRIS): standardization and transparency in infection control and antimicrobial use

BackgroundInfection control needs user-friendly standardized instruments to measure the compliance to guidelines and to implement targeted improvement actions. This abstract describes a tool to measure the quality of infection control and antimicrobial use, the Infection Risk Scan (IRIS). It has been applied in a hospital, several nursing homes and a rehabilitation clinic in the Netherlands.MethodThe IRIS consists of a set of objective reproducible measurements, combining patient- and healthcare related variables, such as: hand hygiene compliance, environmental contamination using ATP measurements, prevalence of resistant microorganisms by active screening, availability of infection control preconditions, personal hygiene of healthcare workers, appropriate use of indwelling medical devices and appropriate use of antimicrobials. Results are visualized in a spider plot using traffic light colors to facilitate the interpretation.ResultsThe IRIS provided ward specific results within the hospital that were the basis for targeted improvement programs resulting in measurable improvements. Hand hygiene compliance increased from 43% to 66% (more than 1000 observations per IRIS, p < 0.000) and ATP levels were significantly reduced (p < 0.000). In the nursing homes, large differences were observed with environmental contamination as common denominator. Most remarkable were the difference in Extended Spectrum Beta-Lactamase Enterobacteriaceae (ESBL-E) prevalence (mean 11%, range 0–21%).ConclusionThe bundle approach and visualization of the IRIS makes it a useful infection prevention tool providing standardization and transparency. Targeted interventions can be started based on the results of the improvement plot and repeated IRIS can show the effect of interventions. In that way, a quality control cycle with continuous improvement can be achieved.

Efficacy and Cost Comparison of Ertapenem as Outpatient Parenteral Antimicrobial Therapy in Acute Pyelonephritis due to Extended-spectrum Beta-lactamase-producing Enterobacteriaceae.

Outpatient parenteral antimicrobial therapy (OPAT) programs are becoming an increasingly popular trend in clinical practice as they offer several benefits to both patients and health-care setups. While OPAT is an established clinical practice in the Western world, the concept itself is alien to patients in India as they prefer the security of hospitals to receive antibiotics over OPAT. We evaluated the clinical response and cost comparison of ertapenem under OPAT versus inpatient settings in patients with extended-spectrum beta-lactamase (ESBL)-positive acute pyelonephritis (APN) given the increasing importance of optimizing both hospital beds and overall cost of patient care in India. APN was chosen as the indication to be studied as it is one of the common complicated urinary tract infections treated in our OPAT unit requiring 10–14 days of parenteral therapy with an agent active against various Gram-negative bacilli and multidrug-resistant organisms. One hundred patients were retrospectively studied based on whether antibiotics were administered during hospital stay alone (hospital only), during both hospital stay, and also as OPAT post discharge (hospital/OPAT) or as OPAT alone (OPAT only). Response to ertapenem and cost of treatment in inpatient versus OPAT settings were compared using Pearson's Chi-square or Fisher's exact test for categorical variables. ANOVA (or Kruskal–Wallis) was used for continuous variables. Baseline urine cultures were ESBL positive with 98% prevalence of Gram-negative bacilli (GNB). Colony counts were ≥100,000 in 74% patients. Only ertapenem, imipenem, and meropenem showed 100% sensitivity to ESBL-positive GNB in baseline urine culture and sensitivity reports. Ertapenem showed 100% sensitivity and complete clinical resolution for 96% patients with APN due to ESBL Enterobacteriaceae. It was administered as OPAT in 90% patients and significantly reduced overall treatment costs.

Enterobacteriaceae Isolated from the River Danube: Antibiotic Resistances, with a Focus on the Presence of ESBL and Carbapenemases.

In a clinical setting it seems to be normal these days that a relevant proportion or even the majority of different bacterial species has already one or more acquired antibiotic resistances. Unfortunately, the overuse of antibiotics for livestock breeding and medicine has also altered the wild-type resistance profiles of many bacterial species in different environmental settings. As a matter of fact, getting in contact with resistant bacteria is no longer restricted to hospitals. Beside food and food production, the aquatic environment might also play an important role as reservoir and carrier. The aim of this study was the assessment of the resistance patterns of Escherichia coli and Klebsiella spp. out of surface water without prior enrichment and under non-selective culture conditions (for antibiotic resistance). In addition, the presence of clinically important extended spectrum beta lactamase (ESBL) and carbapenmase harboring Enterobacteriaceae should be investigated. During Joint Danube Survey 3 (2013), water samples were taken over the total course of the River Danube. Resistance testing was performed for 21 different antibiotics. Samples were additionally screened for ESBL or carbapenmase harboring Enterobacteriaceae. 39% of all isolated Escherichia coli and 15% of all Klebsiella spp. from the river Danube had at least one acquired resistance. Resistance was found against all tested antibiotics except tigecycline. Taking a look on the whole stretch of the River Danube the proportion of multiresistances did not differ significantly. In total, 35 ESBL harboring Enterobacteriaceae, 17 Escherichia coli, 13 Klebsiella pneumoniae and five Enterobacter spp. were isolated. One Klebsiella pneumoniae harboring NMD-1 carbapenmases and two Enterobacteriaceae with KPC-2 could be identified. Human generated antibiotic resistance is very common in E. coli and Klebsiella spp. in the River Danube. Even isolates with resistance patterns normally associated with intensive care units are present.

A Study on Comparative In Vitro Activity of Carbapenem Sparers Against Extended-Spectrum Beta Lactamase–Producing Enterobacteriaceae

Background In the era of increasing carbapenem resistance, there is an urgent need to explore alternative options (carbapenem sparers) such as various betalactam/beta-lactamase (BL/BLI) agents, aminoglycosides, fosfomycin, and chloramphenicol to treat infections due to extended-spectrum beta lactamase (ESBL)-producing Enterobacteriaceae. We evaluated the in vitro activities of these agents in comparison to carbapenem against ESBL-producing Enterobacteriaceae blood culture isolates. Methods A retrospective analysis on the comparative susceptibility of ESBL-producing Escherichia coli and Klebsiella blood culture isolates against various antibiotics such as cefoperazone-sulbactam, piperacillin-tazobactam, cefepime-tazobactam (C/T), colistin, tigecyline, aminoglycosides, ciprofloxacin, and chloramphenicol was carried out in a tertiary care oncology setting over a span of 18 months (January 2013 to June 2014). Identification of the isolates and susceptibility testing were done using VITEK 2 compact autoanalyzer. Colistin sensitivity was done using Etest, as per Clinical and Laboratory Standards Institute (CLSI) 2013 guidelines. Results A total of 125 ESBL E coli and Klebsiella isolates were analyzed, (E coli, 67; Klebsiella, 58). Cefepime-tazobactam and carbapenem sensitivities were similar against E coli as well as Klebsiella isolates. E coli had good sensitivity to amikacin (70%) and chloramphenicol (88.5%). Among all BL/BLI agents, C/T had the highest sensitivity. Conclusions Betalactam/beta-lactamase agents and carbapenem had similar susceptibility against ESBL Enterobacteriaceae. Among the BL/BLI combinations, C/T had the highest susceptibility, followed by cefoperazone-sulbactam. Betalactam/beta-lactamase agents may have significant potential as carbapenem sparers.

Evolution of Extended Spectrum Beta-Lactamase enterobacteriaceae in the Hospital Cheikh Zaid from 2009 to 2011.

Evolution of Extended Spectrum Beta-Lactamase enterobacteriaceae in the Hospital Cheikh Zaid from 2009 to 2011.

The bacterial microflora of diabetic foot infection and factors determining its spectrum in Ouagadougou (Burkina Faso)

The aim of the study was to describe the bacterial microflora of diabetic foot infection and to identify the factors which determine the bacterial spectrum in order to increase empiric antibiotic prescription in Ouagadougou. The study was a cross-sectional one, carried from July 1st, 2011 to June 30, 2012 in the departments of internal medicine and general and digestive surgery in Yalgado Ouédraogo teaching hospital. Samples for bacteriological tests consisted of aspiration of pus through the healthy skin, curettage and swab of the base of the ulceration or tissue biopsy from foot lesions. The bacteria's sensitivity to antibiotics has been tested by the qualitative method (Kirby-Bauer). The frequency of diabetic foot infection was 14.45% and the monthly incidence 5.33. The mean age of patients was 56 years and the sex ratio 1.37. Foot ulcerations were chronic in 33 (51.56%), necrotic in 51 (79.69%) and associated with osteitis in 40 (62.5%) patients. Infection was grade 3 in 70.3% cases. Thirty-nine patients had received antibiotics before hospital admission. Among the 71 samples, 62 (87.32%) cultures were positive: 53 (85.48%) monomicrobial and 9 (14.52%) bimicrobial. Aerobic Gram-positive cocci (76%) were the most frequent from ulcerations: Staphylococcus aureus (32.39%), Streptococcus sp (18.30%). Negative coagulase staphylococci have been found in 23.94% cases. Aerobic gram-negative bacilli have been isolated from 24% ulcerations. No factor was associated with the type of bacteria. Gram-positive pathogen cocci showed a high sensitivity to amoxicillin-clavulanic acid and oxacillin. No methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum beta lactamase Enterobacteriaceae (ESBL) have been isolated. A better design is necessary to a clarification of bacterial flora in diabetic foot infections. Prevention of bacterial resistance is also needed.

Antibiotic susceptibility of bacteria isolated from diabetic foot infections and prospects for empiric antibiotic therapy in Ouagadougou (Burkina Faso)

The aim of this study was to study the antibiotic susceptibility of bacteria isolated from diabetic foot infections to help improve empiric antibiotic prescription in Ouagadougou, where bacteriological testing is rarely possible. This cross-sectional study took place from July 1, 2011, to June 30, 2012, in the departments of internal medicine and general and gastrointestinal surgery in the Yalgado Ouédraogo teaching hospital. Bacteria were isolated from diabetic foot infections and their antibiotic sensitivity was tested by the qualitative method (Kirby-Bauer). The study included 64 patients, with a median age of 57 years (interquartile range: 48-75) and a M/F sex ratio of 1.37. Among them, 39 had received antibiotics before hospitalization. Among the 71 samples, 62 cultures (87%) were positive: 53 for a single microbe (85%) and 9 for two microbes (15%). Microorganisms were mainly aerobic and anaerobic Gram-positive cocci (76%), including Staphylococcus aureus (SA) (33%) and Streptococcus spp (18%). These Gram-positive cocci were highly sensitive to amoxicillin-clavulanic acid and oxacillin. No methicillin-resistant SA (MRSA) were isolated. Enterobacteriaceae (24 %) were highly susceptible to imipenem and ticarcillin, but not to ceftriaxone or ciprofloxacin. No extended-spectrum beta-lactamase Enterobacteriaceae (ESBL) were isolated. Pseudomonas aeruginosa was highly susceptible to ciprofloxacin and imipenem. Despite our study's limitations, our findings show that most diabetic foot infections can be successfully treated with standard antibiotics.

Multiresistant bacteria isolated from chicken meat in Austria.

Multidrug resistant bacteria (MDR bacteria), such as extended spectrum beta-lactamase (ESBL) Enterobacteriaceae, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE), pose a challenge to the human health care system. In recent years, these MDR bacteria have been detected increasingly outside the hospital environment. Also the contamination of food with MDR bacteria, particularly of meat and meat products, is a concern. The aim of the study was to evaluate the occurrence of MDR bacteria in chicken meat on the Austrian market. For this study, 50 chicken meat samples were analysed. All samples originated from chickens slaughtered in Austrian slaughterhouses and were marked as produced in Austria. Samples were analysed for the presence of ESBL Enterobacteriaceae, methicillin resistant Staphylococci and VRE. Resistance genes of the isolated bacteria were characterised by PCR and sequencing. In the present study 26 ESBL producing E. coli, five mecA gene harbouring Staphylococci (but no MRSA), and four VRE were detected in chicken meat samples of Austrian origin. In 24 (48%) of the samples no ESBL Enterobacteriaceae, MRSA, methicillin resistant coagulase negative Staphylococcus (MRCNS) or VRE could be detected. None of the samples contained all three types of investigated multiresistant bacteria. In concordance to previous studies, CTX-M-1 and SHV-12 were the dominant ESBL genes.

P021: Effect of urinary tract infections at multiresistant bacteria (MRB) in hospital of Dakar

Results During the study period, 123 patients were followed up and 79 urine samples were made corresponding to 56.4% of all diagnostic samples. The average age of patients was 55 ± 21.22 and sex ratio of 0.97. Thirty-nine percent of patients were admitted with a neurological disorder. These patients were referred by another health facility (56.3%) came from home (34.4%) or had undergone internal transfer (9.4%). The attack rate of urinary tract infections was 3.96. These urinary tract infections were of nosocomial acquisition in 56 cases (78.9%) with an average delay of 12.75 days. The bacteria isolated were Enterobacteriaceae 61 (77.2%), non-fermenting Gram-negative bacilli 14 (17.7%) and staphylococci 4 (5.1%). In order of frequency, these were Escherichia coli 25 (31.6%), Klebsiella pneumoniae 21 (26.6%), Pseudomonas 8 (10.2%) and Enterobacter 5 (6.3%). We found 32 strains (40.5%) producing extended-spectrum beta-lactamase (ESBL) and 2 strains (2.5%) of Staphylococcus aureus resistant to methicillin (MRSA). From urinary tract infections associated with ESBL Enterobacteriaceae urinary catheter was potentially the source of infection in 18 cases. BMR attack rate was 1.80 per 100 admissions and the incidence rate of 1.99 BMR for 1000 days patients. To wane, 18 patients or 30% died. Conclusion The decrease in the incidence of nosocomial urinary tract infections must be accompanied by antibiotic stewardship and a strict hygiene policy. Disclosure of interest None declared.

P020: Multiresistant bacteria in positive urocultures in a Dakar university hospital (Senegal)

Results Three hundred and nine multiresistant bacteria (309) among the 709 mutiresistant strains were isolated from urines (43,58 %). The mean age was 39,73 years [range=1 – 83] with a sex ratio of 0.88. Most of the patients were hospitalized (62,5 %). The infectious diseases clinic provided most of the multiresistant bacteria (41,1 %), followed by the neurology department (14,24 %) and paediatrics department (12,23 %). The majority of multiresistant bacteria were constituted by extended spectrum betalactamase enterobacteriaceae (86, 08 %) and Acinetobacter spp (5, 50 %). E. coli were the most frequent bacteria (35, 92 %) followed by Klebsiella pneumoniae (35, 60). Enterobacteriaceae were susceptible to imipenem, amikacin and colistin but were resistant to quinolones and other aminosides. Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus saprophyticus were susceptible to vancomycin. Strains of Acinetobacter were susceptible to imipemem and colistin. Conclusion Most of the multiresistant bacteria in the teaching hospital of Fann are isolated from urines. That’s why it is important to insist on prevention by respecting hygiene measures during invasive gestures like pose of urinary catheters.