This site is part of the Global Exhibitions Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 3099067.

Informa

APSIC Abstracts on Antimicrobial Resistance

The following abstracts on the topic of antimicrobial resistance are from the meeting of the eighth International Congress of the Asia Pacific Society of Infection Control (APSIC), held in Bangkok, Thailand, Feb. 12-15, 2017.

Reference: Antimicrobial Resistance & Infection Control. Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC) Volume 6, Supplement 2. February 2017.

AR1: Key stakeholders’ perspectives on the underlying causes of antimicrobial resistance in Thailand

Nantanit Sutthiruk, Mari Botti, Julie Considine, Andrea Driscoll, Ana Hutchinson, Kumthorn Malathum

Background
Antimicrobial resistance (AMR) is a major problem worldwide. Antimicrobial stewardship (AMS) has the vital aim of ensuring optimal use of antimicrobial medicines to minimize AMR. New strategies are needed to reduce AMR. It is vital to ensure that key stakeholders are involved in the development of these strategies. This study aimed to examine key stakeholders’ perspectives on the underlying causes of AMR in Thailand.

Materials and methods
Semi-structured interviews were conducted with 15 key multidisciplinary clinicians, heads of department and healthcare administrators who were involved in AMS programs in a 1,000-bed university hospital in Bangkok Thailand. Qualitative content analysis was used to analyze the interview data.

Results
One of the key themes that emerged was lack of regulatory control resulting in widespread antibiotic availability and use both in health and agriculture in Thailand, including over-the-counter availability of antibiotics. This ease of accessibility combined with poor consumer knowledge was considered one of the most important contributors to the increasing prevalence of AMR. The development and implementation of more effective infection prevention and control strategies was identified as a priority, particularly in healthcare. Three major concerns related to the perception that many patients admitted to hospital already have AMR infections, that staff prescribing behaviors are not ideal, and that the lack of resources to develop and implement AMS programs is an important barrier to decreasing the overuse of antibiotics.

Conclusions
Participants recognized that AMR is a major problem in Thailand and in healthcare. There was agreement that what is required is better regulatory control of antibiotics and medical engagement in AMS.

AR2: Bacteriological profile of neurosurgical infections in a secondary care centre, Tangerang, Indonesia: implication for empirical antibiotic treatment

Cucunawangsih Cucunawangsih, Veronica Wiwing, Vivien Puspitasari

Background
Antimicrobial resistance is a major problem of post-operative neurosurgical infection over the recent years. This study aimed to evaluate an increasing trend of infection in neurosurgical patients and susceptibility pattern of the causative pathogen.

Material and methods
Over a period of five years (June 2010 to June 2015), 216 cerebrospinal fluid and pus samples derived from clinically suspected cases of post-operative neurosurgical infection were processed using the standard procedures for culture and antibiotic susceptibility testing.

Results
Of these 216 patients, causative pathogens were identified in 55 patients (25.5%). Majority of infections were caused by multidrug- resistant gram-negative bacilli (MDRGNB) including Pseudomonas aeruginosa (n = 7, 12.7%), Acinetobacter baumannii (n = 6, 10.9%), Sphingomonas paucimobilis (n = 5, 9.0%), Escherichia coli(n = 4, 7.3%), Aeromonas salmonocida (n = 3, 5.4%), and Klebsiella pneumoniae (n = 3, 5.4%). The common isolates showed a high susceptibility to tigecycline (86.7%) and amikacin (90%), ceftriaxone (76.9%) and ceftazidime (70%). All Gram-positive bacteria isolates were susceptible to tigecycline and vancomycin.

Conclusions
Based on our result of susceptibility pattern, a combination of tigecycline and amikacin should be considered for empirical therapy to treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to work out the issue of emerging MDR-GNB infections.


AR3: A newly developed single-strand tag hybridization – printed array strip technique for identification of carbapenemase-producing Enterobacteriaceae

Rathina Kumar Shanmugakani, Yukihiro Akeda, Takuya Kodera, PitakSantanirand5, Kazunori Tomono

Background
Carbapenem resistant organisms are known to risk the life of both immunocompromised and immunocompetent patients due to their resistance towards the drug of the last resort. In carbapenemase-producing Enterobacteriaceae (CPE), carbapenemase genes serve as the main reservoir of carbapenem resistance due to their plasmid-mediated transferability to naïve Enterobacteriaceae. In this regard, CPE infections are a global health issue due to their hasty dissemination throughout the world. The detection of CPE at the earliest is crucial to control its transmission. Several detection systems are being developed and modified for CPE detection but have various constraints in different criteria.

Materials and methods
We attempted to develop single-strand tag hybridization –printed array strip (STH-PAS), a new genotypic multiplex detection system to detect CPE directly in clinical samples. STH-PAS is a PCR-based technique that targets the four major carbapenemase genes - bla NDM, bla KPC, bla IMP, and bla OXA-48 for CPE detection. The sensitivity and specificity of STH-PAS in detecting the CPE were determined for the clinical isolates and direct clinical specimens.

Results

STH-PAS showed 100% sensitivity and specificity in detecting the CPE clinical isolates in comparison with the culture methods and PCR. For detection of CPE directly in stool specimens, STH-PAS showed a sensitivity and specificity of 92% and 99.4%, respectively.

Conclusions
The results of the current study depict that STH-PAS possesses several advantages as a good detection system for CPE. The simplicity and rapidity of STH-PAS show that it could serve as an effective tool for surveillance and infection control purposes


AR4: Invasive infections due to multidrug-resistant gram-negative bacilli among Japanese children

Takayuki Yamanaki, Hiroyuki Moriuchi, Hiroyuki Kitajima, Yuho Horikoshi

Background
Although multidrug-resistant (MDR) gram-negative bacilli (GNB) become a global concern, the disease burden of MDR GNB in children has not been reported yet in Japan. We elucidate the impact of invasive MDR GNB infections among Japanese children in the hospital setting.

Materials and methods
A primary questionnaire was sent to 520 pediatric training facilities. A secondary questionnaire was sent to determine whether any cases showed a positive blood or cerebral spinal fluid culture for Extended Spectrum Beta-lactamase (ESBL) producing GNB, AmpC β-lactamases producing GNB, or carbapenem-resistant enterobacteriacae (CRE) between April 2012 and March 2015.The following data were collected; demographic data pertaining to both the care facilities and patients, clinical diagnosis, and outcomes.

Results
The response rate for the primary questionnaire was 57%. Among facilities that responded, 66 facilities were eligible for the secondary questionnaire. The response rate for secondary questionnaire was 48%. A total of 92 pediatric patients had invasive MDR GNB infection. The median age was 2.5 years old (interquartile range 3 months–10 years old). The number of patients with bacteremia caused by ESBL GNB, AmpC GNB, and CRE were 66 (72%), 22 (24%), and 4 (4%), respectively. The clinical diagnosis of ESBL and AmpC GNB showed 53 cases of sepsis. The clinical diagnosis of CRE showed 2 cases of catheter related blood stream infection and 2 cases of sepsis. Mortality at 30 days for ESBL, AmpC and CRE bacteremia was 6%, 9% and 0%, respectively.

Conclusions
The most common MDR GNB bacteremia was ESBL GNB among children in this survey.


AR5: The role of non-specific microflora in patients with tuberculosis

Alyona Lavrinenko, Ilya Azizov, Nurlan Tabriz, Margulan Kozhamuratov, Yekatherine Serbo

Background
Tuberculosis is often complicated by the addition of non-specific inflammation, which changes not only the clinical manifestation of tuberculosis, but the course and outcome of disease. This study aimed to study the spectrum of non-specific microflora from patients with active tuberculosis and to evaluate its susceptibility to antimicrobial agents.

Materials and methods
The study was conducted in 2014-2015; 343 sputum samples were investigated. Identification of microorganisms was carried out by MALDI-TOF methods using mass-spectrometer Microflex (Bruker Daltonics, Germany). The sensitivity of microorganisms to antibiotics was determined by disk-diffusion methods (CLSI 2012). Statistical processing and data analysis was performed using WhoNet 6.3 program.

Results
The growth of non-specific microflora in patients with tuberculosis was obtained in 21% of cases. The predominant etiologic role in non-specific inflammation belonged to S. aureus (22%), K. pneumoniae were isolated in 12.5%, A. baumannii – in 11.1%. Remaining microorganisms were isolated in individual cases. 12.5% staphylococci were MRSA, to other anti-staphylococcal drugs S. aureus has kept a high sensitivity. Isolated K. pneumoniae strains were resistant to cephalosporins of the 3rd generation in 12.5%, the resistance to meropenem marked in 11.1%. A. baumannii was characterized by a high resistance to antibiotics – 85.7% ESBL-producing strains, 37.5% and 62.5% strains were resistant to imipenem and meropenem, 80% A. baumannii strains were resistant to fluoroquinolones.

Conclusions
According to antibioticogram data, the isolated microorganisms obtained from non-specific microflora of patients with tuberculosis, may adversely affect the course of the disease and impede the selection of antibacterial drugs and affect the outcome of the disease.


AR6: Antimicrobial susceptibility of clinical isolates of Enterococcus faecium and Enterococcus faecalis in Korea

Dahae Yang, Woonhyoung Lee, Il Kwon Bae, Jae Hyun Lee, Hyukmin Lee, Jung Ok Kim, Seok Hoon Jeong, Kyungwon Lee

Background
Enterococcus species become a leading problem of nosocomial infections with their multidrug resistance (MDR) potential. This study was performed to investigate antimicrobial susceptibility of E. faecium and E. faecalis clinical isolates in Korea.

Materials and methods
A total of 152 non-duplicated E. faecium and 112 E. faecalis isolates recovered from clinical blood specimen were collected from 19 hospitals at various regions in Korea during 2014. Species identification was performed using MALDI-TOF (Bruker) and 16S rRNA gene sequencing. Antimicrobial susceptibility was tested by CLSI disk diffusion methods. The presence of vanA and vanB genes was detected by PCR experiments.

Results
All E. faecalis isolates were susceptible to ampicillin, while only 11.8% (18/152) E. faecium isolates were susceptible. E. faecalis isolates (96.4%, 108/112) exhibited higher susceptibility rate to vancomycin than E. faecium isolates (66.4%, 101/152). None of E. faecalis and E. faecium isolates showed resistance to linezolid. Only 52.6% (80/152) of E. faecium isolates were susceptible to quinupristin-dalfopristin. E. faecalis and E. faecium isolates exhibited high-level resistance to gentamicin (50% and 57.9%, respectively). PCR experiments showed that all vancomycin-resistant E. faecium and E. faecalis isolates carried the vanA. Interestingly, two vancomycin-susceptible E. faecalis and three vancomycin-susceptible E. faecium isolates carried the vanA gene.

Conclusions
This study shows further dissemination of MDR enterococci in Korea. Antimicrobial susceptibility of quinupristin-dalfopristin and gentamicin for E. faecium has lowered to near 50%. Discrepancy between antimicrobial susceptibility tests and PCR for vanA gene might be due to loss of some elements consisting transposon Tn1546 carrying the vanA gene.

« Previous12Next »
comments powered by Disqus