Recent Antibiotic Use Research Articles

Surgical Site Infections in Elderly Fragility Hip Fractures Patients Undergoing Warfarin Treatment.

Surgical site infection (SSI) is a devastating complication of proximal femoral fracture surgery, related with an increased morbidity and mortality. As warfarin treatment has been described as a risk factor for SSI, we aimed to compare patient and SSI characteristics in warfarin and nonanticoagulated patients. Retrospective cohort study. Level-1 trauma center. Individuals 65 years of age and older with fragility hip fractures. Patients were divided into 2 cohorts: warfarin treated (n = 85) or nonanticoagulated (n = 771). Demographics, in-hospital characteristics, laboratory data, prior hospitalizations, recent antibiotic use, and 1-year incidence of SSIs and their characteristics were gathered. Postoperative SSIs. Twelve patients (14.1%) from the warfarin group and 21 patients (2.7%) from the noncoagulated group had SSI (P < 0.001). Both groups were comparable in terms of demographics and Charlson comorbidity score. Warfarin-treated patients had reduced white blood and neutrophils counts (10.1 ± 3.2 vs. 11.6 ± 4.0 cells/mm and 8.1 ± 3.2 vs. 9.6 ± 3.9 cells/mm for both comparisons respectively; P < 0.001 for both). They were more likely to be admitted to a geriatric ward than to orthopedics ward and were delayed to theater (58.5 ± 44.5 vs. 30.6 ± 27.4 hours; P < 0.001). Following surgery, there was no difference in blood transfusions required, in-hospital complications, or time to infection. Rates of prior hospitalizations, antibiotic use, or type of bacteria did not differ. Warfarin treatment in fragility hip fracture surgery is correlated with an increased risk for SSI, regardless of in-hospital complications, and hospitalizations before surgery or to the infection itself. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1647 To Flex or Not to Flex? A Case of Immune Checkpoint Inhibitor-Induced Colitis

INTRODUCTION: Diarrhea is a frequent and well-recognized adverse effect of checkpoint inhibitor therapy, occurring in up to 30% of patients. Management depends on the severity of the symptoms and endoscopic investigation should not delay treatment. We report a case of a patient with metastatic melanoma who developed severe checkpoint inhibitor-induced colitis responsive to one dose of infliximab, and did not require flexible sigmoidoscopy. CASE DESCRIPTION/METHODS: A 46-year-old male with metastatic melanoma on Ipilumumab and Pembrolizumab developed diarrhea after his third infusion. He presented to the emergency room with two weeks of 6-7 watery bowel movements daily, nocturnal stools, cramping abdominal pain and nausea. He denied melena, hematochezia or tenesmus. He denied other medical conditions, recent travel, frequent NSAID or recent antibiotic use. His vital signs were normal; physical exam was notable for generalized abdominal tenderness without peritoneal signs. Labs were notable for WBC 9.4 × 109/L, hemoglobin 13.8 g/dL, CRP 1.39 mg/L, and negative HIV-1/2 Ag/Ab screen, C. difficile PCR, stool culture, ova and parasites, Entamoeba histolytica Ag, CMV IgM, and Quantiferon Gold. CT of the abdomen and pelvis with IV contrast showed increased attenuation of the colonic mucosa from the transverse colon to the rectum, compatible with colitis. He received IV methylprednisolone and maximum dose loperamide with no improvement after 3 days. He was diagnosed with presumed checkpoint inhibitor-induced grade 3 toxicity colitis for which he received one dose of infliximab IV 5mg/kg. His symptoms rapidly improved within 24 hours and he was discharged on a steroid taper. Due to his rapid improvement, a previously planned flexible sigmoidoscopy was not performed. DISCUSSION: Gastroenterologists are becoming increasingly familiar with colitis as an adverse effect of checkpoint inhibitors. About 1% of patients with severe disease require treatment with immunosuppressive medications such as infliximab. Endoscopic evaluation is recommended for severe or persistent disease to confirm the diagnosis. Our patient suffered from severe colitis which resolved with one dose of infliximab and steroid taper. We propose that when clinical presentation is consistent with severe checkpoint inhibitor-induced colitis and thorough infectious work up is negative, flexible sigmoidoscopy should not delay treatment and may not be necessary prior to treatment with infliximab.

1504 Case Report: A Rare Case of Community-Acquired Clostridium difficile Infection After Colonoscopy

INTRODUCTION: Clostridium difficile (C.diff) infection (CDI) is commonly related to recent antibiotic use, usually occurring in hospitals and other health care facilities where a significantly higher percentage of people carry the bacteria. Here we reported a rare case of community acquired C.diff 3 days after colonoscopy in a low risk patient without a history of antibiotic use or recent hospitalization. CASE DESCRIPTION/METHODS: A 50-year-old healthy female with no past medical history presented for screening colonoscopy. She tolerated the bowel preparation regimen with polyethylene glycol well. The colonoscopy was unremarkable with one small tubular adenoma removed by snare polypectomy. Patient tolerated the procedure well without any complications. She ate raw blueberry from the local supermarket one day after colonoscopy. Then she presented with watery diarrhea up to 10 times per day with nocturnal symptoms 3 days after colonoscopy. Stool studies were ordered. Diarrhea gradually resolved with hydration and clear liquid diet after 3 days without antibiotics treatment. Stool studies came back with positive C. diff toxins. Patient has no risk factors include recent hospitalization, antibiotic use. She took proton pump inhibitor intermittently a few months prior to colonoscopy. All the other patients had procedures done on the same day in the endoscopy suite had no complications. DISCUSSION: The risk factors of CDI include antibiotics use, advanced age (&gt;65), gastrointestinal surgery, IBD and immunosuppression, etc. The effect of anti-acid use remains unsure because the C. diff spores are acid resistant. Recent studies reported a 7-fold and 13-fold increase in C. diff infection rate after colonoscopy for patients with Crohn's disease and ulcerative colitis compared with non-IBD patients. Another study reported the preoperative use of mechanical bowel preparation was not associated with increased risk of C. diff infection after colectomy. Generally, mechanical bowel preparation and colonoscopy are not risk factors of CDI for a healthy population. This is a rare case with no traditional risk factors acquired CDI by eating raw blueberry 3 days after colonoscopy. Bowel preparation might be a risk factor to disturb the normal gut flora, which increases the risk of CDI. The use of probiotics afterward to prevent C. diff colonization could be a safe and easily adoptable control strategy, but the routine use for prevention or treatment of active infection is not recommended.

2565 Clostridioides difficile Enteritis Refractory to Multiple Fecal Microbiota Transplantions

INTRODUCTION: Clostridioides difficile (CDI) is a spore-forming, toxin-producing, gram positive bacteria that can colonize the colon when the normal flora is disrupted causing colitis. However, it can rarely colonize the small intestines causing enteritis, especially in patients with recent antibiotic use, on immunosuppression or have surgically altered intestinal anatomies. CASE DESCRIPTION/METHODS: A 77-year-old female with a history of fulminant CDI colitis requiring subtotal colectomy with end ileostomy presented with abdominal pain and increase in ileostomy output two months after surgery. Her ileostomy drainage tested positive for CDI by PCR and she was started on oral vancomycin for CDI enteritis with resolution of her symptoms. Over the next year, she had multiple recurrences of her CDI that failed vancomycin, fidaxomicin and IV immunoglobulin (IVIG). She eventually had fecal microbiota transplantation (FMT) with stool infused into the proximal jejunum. Her symptoms improved initially, however recurred and her ileostomy drainage tested positive for CDI again. She had a total of four FMT due to recurrence. After her fourth FMT, her symptoms recurred, however; she tested negative for CDI this time. Infectious diarrhea as well as celiac disease were negative and her symptoms did not improve with antidiarrheal agents. She developed significant anxiety and requested to be placed on vancomycin understanding the risks of long-term use of antibiotics. She was started on a prophylactic daily dose of oral vancomycin 125 mg which helped to improve her symptoms. DISCUSSION: CDI enteritis is rare; yet, its incidence is rising. Diagnosis is made both clinically and biochemically by testing for CDI toxin by PCR. In the literature, there are no prospective studies on the treatment of CDI enteritis except for a few case reports. Oral metronidazole has been used, with oral vancomycin used for refractory cases. In our case, the patient failed vancomycin, fidaxomicin, IVIG and three FMT with recurrence of the symptoms after the fourth one. Prophylactic oral vancomycin was started on the patient's request and she noticed improvement in her symptoms. Prophylactic vancomycin has been effective in preventing recurrence of CDI in patients with a history of CDI being treated with oral antibiotics. Our case is unusual given the ongoing symptoms in a PCR negative CDI state. Further research is needed in patients with refractory CDI enteritis with analysis of their bowel flora to better understand this disease and how to treat it

Assessment of the necessity of routine lumber puncture among children with fever and convulsions

The routine investigation of doing lumbar puncture in patient with febrile convulsion is increasing practiced in many hospital.&#x0D; Objectives: &#x0D; The aim of this study was to assess the necessity of routine lumbar puncture (LP) to diagnose meningitis in children who present with fever and convulsions.&#x0D; Methods:&#x0D; This is an observational, cross-sectional, hospital-based study, carried out in Mohammed AL-Amin Hamid pediatrics hospital-Omdurman Sudan, during the period from the first of January through 31 July 2018. It involved all (146) children aged 5 months to 6years , who presented with fever and convulsions, undergone lumbar puncture, and parents signed written informed consents. Children with known neurological diseases were excluded from this study. Data collected included, age, gender, convulsions type and duration, post-ictal state, routine vaccination status, general condition, recent antibiotics use, past history of fever and convulsions, temperature degree, signs of meningeal irritation, and conscious level. Data were analyzed by Statistical Package for Social Sciences (SPSS) version 23.&#x0D; Results:&#x0D; The result revealed that total number of 146 children, male were 62% (n=91), female were 38% (n=55). 5-11 months 35.6% (n=52) 1-3years 43.8% (n=64), and 4-6 years 20.6% (n=30). About 80% of the patients were younger than 4 years of age. Convulsion was generalized in 97.9%, lasted less than 15 minutes in 99.3%, spontaneously aborted in 94.5%, post-ictal state was brief in 88.4%, first attack in 98.6%, and there was no family history in 97.3%,p=0.000. There was no neck stiffness and photophobia in 92.5% and 98.6% respectively, p=0.000. Patients general condition were well in 76.7% and toxic in 23.3%. Cerebrospinal fluids (CSF) color was clear in 97% and turbid in 3% of patients. CSF white cells was less than 5 in 93.8%, and CSF sugar and protein were normal in 97.3% and 96.6 % respectively, p=0.000. CSF culture was negative for all patients, and almost all (97%, n=141) of the patients were diagnosed as febrile convulsions and sent home, compared to 3% (n=5) who were diagnosed clinically as meningitis.&#x0D; Conclusion:&#x0D; This study revealed that, CSF culture was negative for all patients, and almost all were diagnosed as febrile convulsions. However, 5 patients were diagnosed clinically as meningitis. Hence, this findings, challenge the routine lumbar puncture in children who present with fever and convulsion.

New Recommendations to Improve Management of Uncomplicated UTI

New Recommendations to Improve Management of Uncomplicated UTI

41-Year-Old Man With Fever and Bloody Diarrhea

41-Year-Old Man With Fever and Bloody Diarrhea

Prevalence and Predictors of Third-Generation Cephalosporin Resistance in the Empirical Treatment of Spontaneous Bacterial Peritonitis

ObjectiveTo better characterize the changing patterns of spontaneous bacterial peritonitis (SBP) in a tertiary academic center in the United States by identifying the prevalence of gram-positive organisms and cephalosporin resistance along with predictors of mortality and antibiotic drug resistance. Patients and MethodsWe reviewed 481 consecutive patients with SBP at Mayo Clinic in Rochester, Minnesota, from January 1, 2005, through December 31, 2016. Data on comorbid conditions, etiology of cirrhosis, factors predisposing to infection, and antimicrobial and antibiotic drug use were collected. ResultsWe identified 96 patients (20%) with culture-positive SBP requiring treatment (median age, 60 years; age range, 22-87 years; 44% men). Gram-positive organisms account for more than half of the cases. Overall resistance to third-generation cephalosporins was 10% (n=10). Risk factors for third-generation cephalosporin resistance include nosocomial acquisition, recent antibiotic drug use, and hepatocellular carcinoma. The negative predictive value for antibiotic drug resistance in the present model was 96% (70 of 73). Overall mortality at 30 and 90 days was 23% and 37%, respectively. ConclusionThese findings support the recent observation of a rising prevalence of gram-positive organisms in SBP. Despite the changing pattern, third-generation cephalosporins seem to provide adequate empirical treatment in patients with community-acquired and health care–associated SBP without hepatocellular carcinoma.

Antifungal and Antibacterial Properties of Graphene-based Nanomaterials: A Mini-review

In recent years, the availability and use of various antibiotics and antimicrobial agents have resulted in increase of drug resistant pathogens. Therefore, scientist’s attention has been diverted to find a suitable replacement for antimicrobial treatment. Graphene (G), as a two-dimensional (2D) carbon-based nanomaterials (CBNs) has a unique physicochemical properties including thermal, optical and electrically conductive activities along with high surface-to-volume ratio and mechanical strength. Also, they have gained significant attention in biomedical application, such as regenerative medicine and drug delivery carriers. With the emergent of nanomaterials over the past decades, there has been a growing interest in using GBNs to develop new antifungal and antimicrobial nanomaterials due to their diverse antifungal and bactericidal mechanisms and relatively low cytotoxicity towards mammalian cells. Numerous reviews on GBNs are available with different perspective. In this review, we summarized the latest progresses towards an understanding of the antifungal and antibacterial properties of GBNs for developing a new antifungal and antibacterial materials.

Epidemiology and genetic screening of diarrheagenic Escherichia coli among symptomatic and asymptomatic children.

Enteropathogens are frequently associated with diarrheal disease. Knowledge of their etiology and epidemiology is essential for the prevention and control of the sickness. This study describes the microbiological and epidemiological features of diarrheal disease in 197 symptomatic and 223 asymptomatic under-five-year-old children from southeastern Brazil, between January 2015 and September 2016. Isolation of Escherichia coli, Salmonella, Shigella and Campylobacter was realized by culture. E. coli strains were screened by multiplex PCR, PFGE and O:H serotyping. Antimicrobial susceptibility testing was also performed. Most of the 127 enteropathogens isolated were diarrheagenic E. coli (96.1 %), with predominance of several serotypes of enteropathogenic E. coli (EPEC) and enteroaggregative E. coli (EAEC). Age, sex, rotavirus vaccination, recent use of antibiotics and previous contact with pets, were factors that revealed no significant effects on the probability of infection by the predominant pathogens. Even so, higher incomes could be related to a lesser chance of testing positive for EPEC. Evidence of possible EAEC clonal spread was detected, as well as genetic similarity among strains from both symptomatic and asymptomatic children. Resistance to antimicrobial agents was more pronounced among EAEC than EPEC. The occurrence of genetically similar diarrheagenic E. coli in both groups of children, likewise resistant to these agents, underscores the importance of establishing strategies for the prevention of outbreaks, especially among low-income households.

Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey.

ObjectivesThe aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.DesignMulticentre descriptive and analytic cross-sectional survey.SettingEight EDs and four clinical microbiology departments in Denmark.ParticipantsAdults visiting the ED.Main outcome measuresSwabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.ResultsWe included 5117 patients in the study. Median age was 68 years (54–77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.ConclusionEvery 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.Trial registration number NCT03352167;Post-results.

Prevalence and Risk Factors for Positive Nasal Methicillin-Resistant Staphylococcus aureus Carriage Among Orthopedic Patients in Korea.

Methicillin-resistant Staphylococcus aureus (MRSA) causes purulent skin and soft tissue infections as well as other life-threatening diseases. Recent guidelines recommend screening for MRSA at the time of admission. However, few studies have been conducted to determine the prevalence and risk factors for MRSA colonization. A prospective data collection and retrospective analysis was performed. MRSA screening tests were performed using nasal swabs in patients enrolled between January 2017 and July 2018. Demographic data, socio-economic data, medical comorbidities, and other risk factors for MRSA carriage were evaluated among 1577 patients enrolled in the study. The prevalence of MRSA nasal carriage was 7.2%. Univariate regression analysis showed that colonization with MRSA at the time of hospital admission was significantly related to patient age, body mass index, smoking, alcohol, trauma, recent antibiotic use, and route of hospital admission. Multiple logistic regression analysis for the risk factors for positive MRSA nasal carriage showed that being under- or overweight, trauma diagnosis, antibiotic use one month prior to admission, and admission through an emergency department were related to MRSA colonization. This study highlights the importance of a preoperative screening test for patients scheduled to undergo surgery involving implant insertion, particularly those at risk for MRSA.

PO 8609 PREVALENCE AND RISK FACTORS FOR GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY IN TWOP. VIVAXMALARIA-ENDEMIC AREAS IN SUDAN

BackgroundPlasmodium vivaxmalaria is a major health problem in Sudan and the parasite has become widely distributed in the recent years. The WHO recommends the use of primaquine as radical cure for liver dormant stage, the hypnozoite. However, prior its use, a test for Glucose-6-phosphate Dehydrogenase (G6PD) should be performed. The objective of the current study was to determine prevalence and risk factors for G6PD deficiency in twoP. vivaxmalaria-endemic areas in Sudan.MethodsA cross-sectional study recruiting 557 subjects from two malaria-endemic areas in Sudan was conducted. Demographic data and blood samples were collected. G6PD activity was measured by spectrometry using SPINREACT enzymatic-UV kit.ResultsThe measured G6PD activities for both sites ranged from 0.6 to 37.7 U/g Hb, with a median value of 12.8 U/g Hb. There was a significant difference in enzyme activity by study site (p&lt;0.001), but not by sex (p=0.91). Overall, across the two study sites, 22 (3.9%) is G6PDd (&lt;30%). Prevalence of G6PDd (&lt;30%) in Khartoum is 1.8% (4/230) compared to 4.8% (16/327) in New Hafla. In univariate analysis predictors of G6PDd were study site (odds ratio of G6PD activity &lt;3.8, Khartoum relative to New Halfa=0.22 (95% CI: 0.08 to 0.66), p=0.006), and recent antibiotic use (OR=2.45 (95% CI: 1.1 to 5.5), p=0.027). In multivariate analysis, the only factor that was significant was the individual’s weight in kilograms, with an OR of 0.97 (95% CI 0.95 to 0.99, p=0.014).ConclusionG6PD deficiency is less prevalent among Sudanese population and this indicates that the use of primaquine for radical cure ofP. vivaxmalaria is safe.

Risk factors for Staphylococcus aureus colonization in a presurgical orthopedic population

Preoperative colonization with Staphylococcus aureus (SA) increases risk of surgical site infection. Screening for SA followed by skin and nasal decolonization can help to reduce the risk of postoperative infections. Risk factors for colonization are, however, not completely understood. A case-control study using questionnaires and patient demographics specifically designed to observe SA colonization risk factors in a presurgical orthopedic population. A total of 115 subjects with a positive preoperative screen for SA nasal colonization prior to orthopedic surgery completed a questionnaire to assess for SA risk factors: these subjects served as our cases. An additional 476 controls completed similar questionnaires. Data collected included demographic, health, and lifestyle information. Multivariable logistic regression was used to generate odds ratios (OR) for risk of SA colonization. Several risk factors were identified. Male sex (OR 2.3; 95% confidence interval [CI], [1.4-3.8]) and diabetes (OR 3.8 [1.8-7.8]) significantly increased the risk of SA colonization. Older age, visiting public places (OR 0.2 [0.1-0.3]), recent antibiotic use (OR 0.2 [0.1-0.6]), and the presence of facial hair (OR 0.3 [0.1-0.6]) significantly lowered the risk of SA colonization. By identifying patients who may be at greater risk of SA colonization, we can better streamline our presurgical techniques to help reduce risk of surgical site infections and improve patient outcomes.

Risk factors for contagious gastroenteritis in adult patients with diarrhoea in the emergency department - a prospective observational multicentre study

BackgroundInfectious gastroenteritis is common in the emergency department (ED). Patients infected with either Norovirus or toxigenic Clostridium difficile require special isolation procedures. The aims were to describe the aetiology of infectious gastroenteritis in the ED, evaluate whether current isolation procedures, based on clinical judgement are sufficient, and to identify information that might be used to identify patients requiring isolation.MethodsProspective, observational, multicentre study. We collected information on symptoms, vital signs, travel history, the recent use of antibiotics, and infectious contacts and tested faecal samples for Norovirus, C. difficile, and enteropathogenic bacteria.ResultsThe study enrolled 227 patients, of whom 163 (71%) delivered a faecal sample for Norovirus analysis (13% positive), 171 (74%) for C. difficile (13% positive), and 173 (76%) for enteropathogenic bacteria (16% positive). In total 71% of the patients were isolated using strict precautions, 29% of the isolated patient and 14% of the patients who were not isolated had had a highly contagious GE. Risk factors for Norovirus included frequent vomiting (OR 5.5), recent admission of another patient with Norovirus (OR 2.6), and a short duration of diarrhoea. Risk factors for C. difficile infections included older age (OR 6.0), longer duration of diarrhoea (OR 5.2), mucus in stool (OR 3.5), and previous antibiotic use (OR 23.4).ConclusionHighly contagious GE occurs in ¼ of the GE patients in the EDs, isolation based on clinical judgement is not very efficient. Several risk factors can predict the presence of Norovirus or toxigenic Clostridium difficile. It is uncertain whether this knowledge can improve isolation practices in ED settings.Trial registrationThis study was retrospectively registered in the Clinical Trials Data Base (NCT02685527) and prospectively approved by the Regional Committees on Health Research Ethics for Southern Denmark (project ID S20140200) and Ethics Committee at the Medical Association of Schleswig-Holstein [“Ethikkommission bei der Ärztekammer Schleswig-Holstein”, project ID 120/15(I)] and registered with the Danish Data Protection Agency (project ID nr. 2008-58-0035/ 1608).

Third-generation cephalosporin-resistant urinary tract infections in children presenting to the paediatric emergency department.

The incidence of antibiotic-resistant urinary tract infections (UTIs) in children is increasing. The purpose of this study was to describe the incidence, clinical characteristics, and risk factors for third-generation cephalosporin-resistant UTIs presenting to the paediatric emergency department (ED). This was a retrospective cohort study conducted at British Columbia Children's Hospital. Children aged 0 to 18 years old presenting to the ED between July 1, 2013 and June 30, 2014 and were found to have UTI due to Enterobacteriaceae and Pseudomonas species were included. Patient demographics, clinical features, laboratory findings, and outcomes were compared using standard statistical analyses. Risk factors for resistant UTIs were analyzed using multiple logistic regression analysis. There were 294 eligible patients. The median age was 27.4 months. A third-generation cephalosporin-resistant organism was identified in 36 patients (12%). Patients with resistant UTI had lower rates of appropriate empiric antibiotic therapy (25% versus 95.3%, P<0.05), higher rates of hospitalization (38.9% versus 21.3%, P<0.05), higher rates of undergoing a voiding cystourethrogram (19.4% versus 5.0%, P<0.05), and higher rates of UTI recurrence within 30 days (13.9% versus 4.7%, P<0.05). In multivariate analysis, recent hospitalization (odds ratio [OR] 4.3, confidence interval [CI] 1.2 to 16) and antibiotic therapy (OR 3.5, CI 1.5 to 8.5) within the previous 30 days were risk factors for resistant UTI. Third-generation cephalosporin-resistant organisms account for a significant proportion of community-acquired paediatric UTIs. Recent hospitalization and antibiotic use are associated with increased risk of resistant UTI.

26 THE INTESTINAL MICROBIOME IN INFLAMMATORY BOWEL DISEASE ACROSS THE PEDIATRIC AGE RANGE

The influence of genomics, immune response, and environment on inflammatory bowel disease (IBD) varies among patients. We aimed to characterize the differences and determine age and disease effects on the gut microbiome across the pediatric age range, measured by the maturity of the microbiota. Eight week observational study of patients with very early onset IBD (VEO-IBD), diagnosed ≤6yo, pediatric IBD (>8yo) and healthy pediatric controls (HC) was performed at the Children’s Hospital of Philadelphia, including IBD patients on maintenance therapy. Antibiotic use was not an exclusion criteria. Subjects on/or recent antibiotic use were analyzed separately. Metadata including disease activity, therapies, and diet was collected. Total DNA from stool was sequenced using the Illumina HiSeq paired-end method. MetaPhlAn2 assessed taxonomic composition, identifying clade-specific marker genes from bacterial, fungal, archaeal and viral sources. A Microbiota Maturity Index (MMI) was generated from HC (Subramanian et al, Nature2014). We trained a random forest model to predict age based on 13 bacterial taxa that changed in abundance with age. Subsequently, we built a random forest model to apply to the IBD cohorts, determining age predicted by the taxa abundance. The predicted age is the MMI, which is plotted against the chronological age. 170 subjects were enrolled, 73 HC (4mo-17yo), 10 HC on antibiotics (16mo-6yo), 21 pediatric IBD, and 66 VEO-IBD. CD was diagnosed in 75% of all IBD subjects. Disease activity measured by fecal calprotectin was significantly higher in VEO-IBD than pediatric IBD. Current therapies included anti-TNF and vedolizumab in 28% of the VEO subjects and 90% of pediatric IBD subjects, and 23 VEO-IBD subjects were on antibiotics at baseline. The relative abundance of 6 species were significantly different between VEO-IBD and pediatric IBD, including increasedVeillonella dispar, Haemophilus parainfluenzae, Coprobacillus sp in VEO-IBD. The generated MMI was most influenced by the abundance of Firmicutes and Bacteroidetes. Several of the 13 taxa in the MMI significantly differed between younger and older HC, yet no difference was seen in the IBD cohorts. IBD cohorts were predicted to have a less mature microbiome than expected for their chronological age, however, the relative MMI index was significantly lower in pediatric IBD than VEO-IBD with/without antibiotic use. Both IBD cohorts demonstrated a lower microbiota maturity as compared to HC, indicative of disease effect on the microbial community. The MMI was lowest in pediatric IBD, suggesting that duration of disease may play a role in the maturity of the intestinal microbiome. Interestingly, there were several differences in the microbial community within IBD, suggesting an age effect and different environmental drivers in VEO-IBD and pediatric IBD.

Emergence and Spread of Extended Spectrum β-Lactamase Producing Enterobacteriaceae (ESBL-PE) in Pigs and Exposed Workers: A Multicentre Comparative Study between Cameroon and South Africa.

Extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) represent a significant public health concern globally and are recognized by the World Health Organization as pathogens of critical priority. However, the prevalence of ESBL-PE in food animals and humans across the farm-to-plate continuum is yet to be elucidated in Sub-Saharan countries including Cameroon and South Africa. This work sought to determine the risk factors, carriage, antimicrobial resistance profiles and genetic relatedness of extended spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) amid pigs and abattoir workers in Cameroon and South Africa. ESBL-PE from pooled samples of 432 pigs and nasal and hand swabs of 82 humans were confirmed with VITEK 2 system. Genomic fingerprinting was performed by ERIC-PCR. Logistic regression (univariate and multivariate) analyses were carried out to identify risk factors for human ESBL-PE carriage using a questionnaire survey amongst abattoir workers. ESBL-PE prevalence in animal samples from Cameroon were higher than for South Africa and ESBL-PE carriage was observed in Cameroonian workers only. Nasal ESBL-PE colonization was statistically significantly associated with hand ESBL-PE (21.95% vs. 91.67%; p = 0.000; OR = 39.11; 95% CI 2.02–755.72; p = 0.015). Low level of education, lesser monthly income, previous hospitalization, recent antibiotic use, inadequate handwashing, lack of training and contact with poultry were the risk factors identified. The study highlights the threat posed by ESBL-PE in the food chain and recommends the implementation of effective strategies for antibiotic resistance containment in both countries.

Risk factors for community-associated Clostridioides difficile infection in young children.

The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case-control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014-February 2016. Case-patients were defined as children aged 1-5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P &lt; 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18-17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.

511 Managing antibiotics use: case the Netherlands.

Antibiotics use in animals has become part of societal discussion. Initial national goal was to reduce use by 50% in 2013 compared to 2009. Herd health and treatment plans were introduced. From 2012 on, 3/4 generation drugs (3/4GE) are only allowed in exceptional cases. To gain insight, antibiotic use and herd/farmer factors were examined on 94 dairy farms during 2005–2012. Level of use (in no. of daily dosages-ADDD) was rising in period 2005–2007, followed by a period of growing societal interest in animal antibiotic use resulting in a reduction in use from 2010/11 on. On average, 68% was applied to the udder: mastitis 25% and dry-cow therapy 43%; other drugs tended to decrease the most, while farmers were reluctant to lower use of dry-cow therapy tubes. Use of 3/4GE minimized from 18% of ADDD in period 2005–2010 to 1% in 2012. The drop in use varied between 3 groups of farmers studied of which one was guided for some years. In recent years antibiotic use stabilised at a relatively low level. A logistic function fitted to the adaptation process. Especially use for dry cow therapy could be well explained by health status, cell count and calving interval. The “more successful” farmers seemed to use somewhat more antibiotics than the other colleagues, and were also able to adapt more easily to the new conditions. Since 2012, all farms are monitored by Veterinary Medicines Authority. Benchmark thresholds are used to assess whether a livestock farm falls within the target, signalling or action zone Nationally, a 64% reduction was achieved through 2016: highest use and reductions in broiler (72%) and pig sector (57%); high use and lowest reduction in veal sector (38%); 48% reduction in dairy sector. Insight in variation in application use by veterinarians will also be presented.