14th ICID - Poster Abstracts - International Society for Infectious ...

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When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 76.026 Session: Emerging Infectious Diseases Date: Friday, March 12, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation The emergence of Clostridium difficile NAP1 hypervirulent strain in Latin America C. Quesada-Gómez 1 , T. Du 2 , M. D. M. Gamboa-Coronado 1 , C. Rodríguez 1 , M. R. Mulvey 2 , E. Rodríguez-Cavallini 1 1 University of Costa Rica, San José, Costa Rica, 2 National Microbiology Laboratory, Winnipeg, MB, Canada Background: The NAP1 strain of Clostridium difficile have been linked to nosocomial outbreaks of antibiotic-associated diarrhea (AAD) in North American and European countries. We found these strains, together with seven additional PFGE patterns, among 37 isolates recently recovered from patients with AAD in a Costa Rican hospital Methods: The isolates were recovered by inoculating a loopful of diarrheic stool samples onto CCFA agar plates (Oxoid®). They were identified with the rapid ID32A (bioMerièux®) and a PCR reaction targeting the tpi. We typed the isolates using pulsed-field gel electrophoresis (PFGE) with SmaI and amplified fragments of the tcdA, tcdB, tcdC, and cdtB genes using PCR. Minimal inhibitory concentrations (MICs) of clindamycin, metronidazole, vancomycin, moxifloxacin, ciprofloxacin, and amoxicillin-clavulanate were determined using E-test strips. Results: Nine different PFGE types were identified. All isolates were positive for tcdA and tcdB and susceptible to vancomycin and metronidazole, which are the first antibiotics to be prescribed for this type of infections. They were also susceptible to amoxicillin/clavulanate. More than half the isolates exhibited the macro-restriction pattern of the NAP1 strain (54%). Ten NAP1 were intermediate (50%) and another nine resistant to clindamycin (45%). One clindamycin-resistant NAP1 strain had a MIC of >256 μg-ml-1. All NAP1 isolates were highly resistant to the two fluoroquinolones (>32 μg-ml-1). The 13 isolates with novel PFGE patterns 447, 448, 449, and 452 clustered together. These isolates lacked the binary toxin but had a deletion in tcdC. They were without exception categorized as highly resistant to clindamycin, moxifloxacin and ciprofloxacin. All the NAP1 isolates had the ctdB and a deletion in tcdC. One isolate with the pattern 447, and the isolates with the patterns 449 and 452 exhibited the highest MICs to vancomycin (2-4 μg-ml-1). The isolates with the PFGE patterns 100, 450, 451 (NAP2) and 247 (NAP9) were negative for ctdB and did not have deletions in tcdC. The strains with the patterns 100, 450, and 247 (NAP9) were resistant to clindamycin, moxifloxacin and ciprofloxacin. Conclusion: The finding of the NAP1 strain in Latin American countries is novel and deserves attention from infectious disease specialists and epidemiologists to prevent its dissemination.
When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 76.027 Session: Emerging Infectious Diseases Date: Friday, March 12, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Differential patterns of tuberculosis disease between immigrant and native Spanish patients P. Merino, A. Vanegas, R. Cias, I. Gestoso, J. Picazo Hospital Clinico San Carlos, Madrid, Spain Background: The increase of the tuberculosis (TB) cases in Spain has been observed in the last years respect to the European Union. This fact correlates with the high immigrants waves coming from countries with high-incidence of the disease. The knowledge of the possible differential characteristics of the disease depending on its origin could be useful for the correct diagnosis and treatment. Methods: Patients newly identified with M.tuberculosis culture positive in January 2004 to July 2009 were included. Drug susceptibility testing was performed on at least one isolate per patient by using a radiometric BACTEC 460 system (Becton Dickinson Diagnostic Systems). Results: 193 (57,1%) out of 338 patients with positive culture were from Spain and the remaining 145 (42,9%) were immigrants. Taking into account the whole group, the resistance to isoniazid, and rifampicin was 4,9% and 1,9%, respectively and the multirresistance (isoniazid and rifampicin) was 1,9%. These percentages totally correlate with the immigrant group. Pulmonar TB was the most frequent form of the disease (80%) independently of the patient origin. Miliar TB was more frequent in Spanish patients (statistically non significant). Renal failure and haematology diseases are the differential risk factors in developing TB in Spaniards respect to the immigrant group. Conclusion: This study demonstrates that the immigrants presented more resistance than the Spanish group and they had less risk factors to develop TB. Therefore, the origin of the patients is important in the diagnosis and treatment of the disease.
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