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: 23.020 Session: Antibiotic Resistance Gram-Negative Date: Wednesday, March 10, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Can we rely on automated VITEK2 system the detection of KPC and other class A carbapenemase producers enterobacteriaceae? F. Pasteran, C. lucero, R. soloaga, A. Corso Instituto Nacional de Enfermedades Infecciosas "Dr. C. Malbrán" , Buenos Aires, Argentina Background: Class A carbapenemases have become more prevalent within Enterobacteriaceae. Proficient methods are needed for their early detection in clinical microbiology laboratories in any attempt aimed for targeting optimal antimicrobial therapy and controlling their spread. Automated systems, as VITEK2, are increasingly used for routine susceptibility testing to decrease the inlaboratory turnaround time. However, the performance of VITEK2 for the whole class A carbapenemase family detection has never been assessed before. Objective: to determine the performance of VITEK2 for carbapenemase detection compared with both, CLSI agar dilution MIC and the genotype obtained by molecular methods. Methods: Methods: we designed a panel composed by diverse bacterial genera with distinct carbapenem susceptibility patterns composed by 37 carbapenemase producers and 34 nonproducers (n): KPCs (17) Sme (10), NMC-A/IMI (2), GES (4), VIM/IMP (4) and CTX-M (12), AmpCs (12), combined mechanisms and others (10), respectively. The resistance mechanisms of the strains were assessed by PCR/DNA sequencing. Each isolate was tested with the VITEK2 using the AST-N082 cards specifically designed for South American countries (which included only imipenem -IPM- and meropenem -MEM-), according to the manufacturer's instructions and by CLSI agar dilution MICs for both carbapenems. Discrepant results were resolved by retesting the isolates. Results: Overall categorical interpretations with VITEK2 showed a 72% and 79% of agreement with reference MICs for IPM and MEM, respectively. Very major (VM), major (MA) and minor (MI) errors were: IPM, VM 3%, MA 11% and MI 13%; MEM, VM 4%, MA 6% and MI 11%. Most of the errors (>80%) occurred among carbapenemase producers. The expert system showed sensitivity (SN) of 76% and specificity (SP) of 87% for carbapenemase detection, when confronted to the genotype, with the greatest SN for KPCs (82%) and the lower for MBLs (25%). The recognition of suspected carbapenemase producers could be increased with the combined used of IPM and MEM with modified cut-off points of >=2.0mg/L and >=1.0mg/L, respectively (SN 97%, SP 90%). Conclusion: VITEK2 may be suitable in clinical laboratories for Class A carbapenemase detection, but should be accompanied with modifications in the cut-off used for screening of suspected carbapenemase producers to ensure their proper detection.
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: 23.021 Session: Antibiotic Resistance Gram-Negative Date: Wednesday, March 10, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Emergence of multidrugresistant gram negative bacilli and enterococci from rectal swabs of newborn and their mothers from Central India S. Chitnis 1 , V. Chitnis 2 , D. Chitnis 1 1 Choithram Hospital and research center, Indore, India, 2 Medical University of Americas, St James Parish, Saint Kitts and Nevis Background: Newborn babies acquire gut flora mainly from mother and surrounding. We had observed in the faecal samples of newborns prevalence, colonization of multidrug resistant , ESBL pandrug resistant gram negative bacteria, vancomycin resistant enterococci as a new threat in the newborn admitted in hospital.The influx of these bacteria into hospitals has major implications for infection–control and empirical treatment strategies Methods: A total of 140 samples of faeces from neonates and mothers admitted in general maternity ward and ICU of two hospital in central India were examined within 24-48 hours for presence of ESBL, pandrug resistant gram negative bacilli, and vancomycin resistant enterococci. Antibiotic susceptibility test were performed using Kirby-Bauer disc diffusion method and results were interpreted according to CLSI. Van A and ESBL gene was confirmed using E test, PCR and RT PCR. Results: 1. A total of 48 E.coli, 49 Klebsiella, 21 Pseudomonas and 52 Entercocci isolates were obtained. The percentage of multidrug resistant E.coli, Klebsiella, Pseudomonas and enterococci was 78.79, 66.67, 58.8 and 91.18% respectively. For gram negative bacilli % resistance for chloramphenicol (47%) , cabapenem 58.9% and ampicillin (74.3%) aminoglycosides (70.9%), quinolones (65.8%) and cefoparazone+ sulbactum (58.1%). piperacillin+tazobactum (69.2%) cotrimoxazole (47%) cephalosporin (71.1%).The prevalence of ESBL gene (TEM and SHV) among E.coli and Klebsiella was 100% and 75% respectively. The pandrug resistant was 18.15% among E.coli and 20.4% among Klebsiella and 1.5% among Pseudomonas Of 52 enterococci, 47.06%. of them were vancomycin resistant strain and harboured van A gene. Enterococci were showing a high level resistance to aminoglycosides (82.35%), ampicillin (82.35%), chloramphenicol (38.24%), teicoplanin (44.12%) and linezolid (8.82%). Conclusion: We report high rates of colonization with ESBL and pandrug resistant gram negative organism and vancomycin resistant enterococci among faecal samples from newborn admitted in ICU, maternity ward with in 24-48 hours from two hospitals in central India. The colonization is mainly due to antibiotic usage by the mother as well as newborn in ICU. Antibiotics used were cefotaxime, gentamicin amikacin and ciprofloxacin. It poses a great threat to infection control measures and complicates the selection of empirical treatment.
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