S16 Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90

and lymphocytes and on Gram stain Gram negative rods were

seen. Fluid was inoculated on Blood and MacConkey agar and

incubated at 37°C aerobically. Culture yielded the growth of non

lactose fermenting colonies on MacConkey agar. The organism was

identified as Salmonella enteritidis and was confirmed by type

specific antisera. The isolate was found sensitive to piperacillin-

tazobactam, ciprofloxacin, ampicillin, cotrimoxazole, amoxicillin-

clavulanate amoxicillin and ceftriaxone but resistant to nalidixic

acid. The patient was already receiving Syp. Metronidazole, Inj.

meropenem but was not responding, however she started to

improve by Inj. ceftriaxone and was discharged on maintenance

treatment.

Conclusion: Physicians should be alert to the possibility of non

typhoidal Salmonella infection in patients with SBP and normal

protein levels in ascitic fluid.

Poster Session 5 – Community Healthcare Infections

P05.01

Prevalence study of infections in a Mental Health Trust

J. Hughes, L. Rosbottom, L. Jennings. 5 Boroughs Partnership NHS

Foundation Trust, United Kingdom

Background and Aims: Patients in mental health care facilities are

at lesser risk of health care associated infections (HCAI) than those

in acute care settings. However, they can have predisposing risk

factors as they often have more underlying physical health problems

than the general population due to lifestyle and medication. In

addition there is little information re infection rates in these areas.

Aims/Objectives: To establish the prevalence of healthcare

associated infections in a mental health setting.

Methods: Monthly prevalence studies were undertaken at a 360

bedded inpatient Mental Health facility. This study covers a twelve

month period. Wards were visited monthly by the Infection Control

Nurse Specialist and 3575 prescription sheets surveyed.

Results: Of 153 infections identified 98 (64%) were classed as

acquired >48 hours post admission with 55 (36%) <48 hours.

The main >48 hours infections were urinary tract (29%) and

chest infections (21%). Urinary tract infections accounted for 21%

of the <48 hour infections with 21% related to foot/leg ulcers.

When specimens were obtained main organisms identified for UTI

included Eschericia coli with MRSA in foot ulcers.

Conclusion and Recommendations: It is difficult to distinguish

between infections acquired within the trust or in the community.

As screening for MRSA only started within the trust last year the

prevalence study will be continued to help gain more insight into

HCAI in this setting.

Discussion: Patients in MH facilities often have more underlying

physical health problems than the general population sometimes

due to lifestyle practices which predisposes them to related

illnesses. They are often ‘revolving door’ patients for acute

healthcare facilities and therefore it is essential to gain more insight

into HCAI in this area.

P05.02

Evaluation of Oxoid Contrast™ MRSA broth for the detection

of MRSA

D. Crabtree. Thermo Fisher Scientific: Oxoid, United Kingdom

Background: The frequency of meticillin-resistant Staphylococcus

aureus (MRSA) infections remains high in the community and

healthcare environments. Oxoid Contrast™ MRSA Broth is designed

for the rapid and reliable screening of clinical samples for MRSA.

Objectives: This study aimed to compare the performance of Oxoid

Contrast MRSA Broth with MAST REDIPREP™ MRSA Broth, using

a range of pure isolates. The performance of Contrast MRSA Broth

was also evaluated, using a range of clinical screening swabs.

Methods: Overnight cultures of 196 organisms were used to prepare

0.5 McFarland standard turbidity suspensions. Both Contrast MRSA

Broth and REDIPREP MRSA Broth were inoculated with 50ml neatsuspension. This was repeated with 50ml of a 10−4 dilution of

each MRSA pure isolate. Clinical swabs (119 including throat,

nose, wound, axillae and groin swabs) sourced from UK hospitals

were emulsified in 1ml saline. A 250ml sample of the resulting

suspension was used to inoculate Contrast MRSA Broth. Broths

were incubated at 37°C and read at 18h and 24h. In both broths, a

colour change from red to orange/yellow indicated MRSA presence.

Positive results were confirmed using Oxoid products: Brilliance™

MRSA Agar, Staphaurex Plus™, Penicilin Binding Protein (PBP2′)Latex Agglutination Test and Oxacillin M.I.C.Evaluator™ Strip.

Results: For neat suspension (106–107 CFU/ml) and dilute

suspension (102–103 CFU/ml) results, see Table 1. When testing

clinical samples, Contrast MRSA Broth, showed a sensitivity of 100%

at both 18h and 24h and a specificity of 95% at both 18h and 24h.

Contrast MRSA Broth REDIPREP MRSA Broth

18h 24h 18h 24h

Inclusivity % (neat) 99.0 99.0 97.0 98.0

Exclusivity % (neat) 85.6 78.4 87.6 84.5

Inclusivity % (dilute) 91.9 95.0 46.5 62.6

Discussion: Oxoid Contrast MRSA Broth was shown to have superior

inclusivity to MAST REDIPREP MRSA Broth at both 18h and 24h

with both neat and dilute cultures with clearer readability. A greater

number of positive results was identified correctly within 18h using

Contrast MRSA Broth. Oxoid Contrast MRSA Broth is recommended

as a reliable selective medium for the rapid and effective detection

of MRSA.

P05.03

High frequency of resistance to fluoroquinolones &

cephalosporins in Gram negative bacteria in healthy neonates

from community

Charu1, R. Gaind1, L.C. Singh2, A. Sinha2, M. Deb1, S. Saxena2.1VMMC and Safdurjung Hospital, India; 2Indian Council of Medical

Research, India

Introduction: Gastrointestinal tract is inhabited by more than

400 pathogenic bacteria. E. coli is predominant species, frequently

associated with bacterial sepsis, meningitis, UTI & gastrointeritis.

Antimicrobial resistance is an emerging threat. Quinolones and

3rd generation cephalosporins (3GC) are defined as critically

important antibiotic for human by WHO. There is scarcity of

information regarding resistance to these agents in community.

Resistance to these antibiotics is mediated by plasmid and can

be disseminated in human gut. Neonates without exposure to

antibiotic form an important group to study the prevalence of

resistance in community. In the present study, frequency of

transferrable resistance in neonatal gut flora was investigated.

Material & Methods: 50 healthy newborns delivered by normal

vaginal delivery were enrolled to study efficacy of probiotics. The

Gram negative gut flora was studied on day 0, 21 and 60. Presence of

Extended spectrum b-lactamase (ESBL) was detected by combined

double disc diffusion method. Resistance to fluoroquinolones

was screened by 1 g ciprofloxacin disc. Resistance, intermediate

susceptibility and sensitivity were defined by zone diameter (mm)

of 6, 17–23 and >23 respectively. PCR was performed to look for

plasmid mediated quinolone resistance (PMQR) i.e. qnr (A, S, B),

aac-6-Ib and qepA in randomly selected 25 babies.

Results: 185 Gram negative bacteria were isolated from 50 babies

(from all the three stool samples) and E. coli was predominant flora.

The incidence of ESBL on day 0, 21 and 60 was 15%, 39% and 49%

respectively. Resistance to ciprofloxacin on day 0, 21 and 60 were

Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S17

6, 9.8 and 14.7 percent respectively. 41 (58.6%) isolates had PMQR

gene and 19 (27%) had more than one resistance mechanism.

Conclusion: Healthy neonates carry resistance to antibiotics to

which they are not exposed. This unrecognized reservoir of

floroquinolone and 3GC resistant potential pathogens poses public

health challenges.

P05.04

Cluster of two patients with community-acquired MRSA

arthritis in the eastern part of the Netherlands traced to a

general practitioner

E. Mascini1, M. Schouten2, P. Cornelissen3, T. Waegemaekers4.1Alysis Zorggroep, Netherlands; 2Hospital Gelderse Vallei, Netherlands;3Municipal Health Service Rivierenland, Netherlands; 4Municipal

Health Service Gelderland Midden, Netherlands

Background: In the Netherlands, the prevalence of methicillin-

resistant Staphylococcus aureus (MRSA) is low. All MRSA isolates are

spa-typed at the national reference center. Since December 2008

it is made obligatory that clusters of community-acquired MRSA

(CA-MRSA) infections are reported to the municipal health service.

Within two weeks, two patients with CA MRSA t032 arthritis of the

shoulder were admitted to a hospital in the eastern region of the

Netherlands. The two patients shared no common elements, except

their family doctor. In both patients, the family doctor had injected

lidocaine in the bursa subacromialis.

Aim: To detect possible gaps in infection control in the doctor’s

practice and to elucidate a common source of MRSA; to evaluate

clusters of CA-MRSA infection in the eastern part of The

Netherlands.

Patients and Methods: All staff members of the family doctor’s

practice were screened for MRSA-carriage. An infection control

audit of the practice was performed, including an interview with

the physicians. We described clusters of CA-MRSA reported to the

municipal health services in the eastern part of the Netherlands

during 2009.

Results: Cultures from the general practitioner’s staff yielded no

MRSA. Generally, the staff worked according to the infection control

guidelines. However, bottles of lidocaine were handled improperly.

They were stored at room temperature and reused for injection

for several patients during 2–3 weeks. The lidocaine bottle which

had been used for patients A and B was not available for culture

anymore. In 2009, 2 other clusters of MRSA infections were reported

in the eastern region of the Netherlands, concerning transmission

between inhabitants of long-term care facilities and clients of

home-care organizations.

Conclusion: Apparently, two patients had developed CA-MRSA

arthritis as a result of improper use of lidocaine. Incidentally,

clusters of CA-MRSA infection in the eastern region of the

Netherlands are reported.

Poster Session 6 – Costs of Healthcare Associated Infections

P06.01

Direct costs of antibiotic treatment of hospital acquired

infections in Polish hospitals

A. Rozanska, J. Wojkowska-Mach, M. Bulanda, P.B. Heczko.

Jagiellonian University Medical College, Poland

Background: Hospital acquired infections (HAIs) have not only

clinical but also important economical consequences. Because of

HAIs nature: variety of clinical forms, course of HAI, even hospital

type, assessing their total, direct and indirect, costs is a very difficult

task. Consequently, studies in this field focus on selected aspects of

this costs.

Aims: The aim of this work was to assess costs of antibiotic therapy

of HAIs in Polish hospitals.

Materials and Methods: HAIs cases were detected in three Polish

hospitals of different level of specialization (one specialist –

hospital A, one community – hospital B, and one hospital with both

type of wards – hospital C) during one calendar year. Cases of HAIs

were detected using CDC definitions by educated infection control

nurses. Detailed demographic and clinical, with special attention to

etiological factors and antibiotic treatment, data on each HAI case

were gathered following the same protocol. Costs of antibiotics

used in HAIs treatment were derived from hospitals’ pharmacies

records.

Results: Detailed costs of antibiotic treatment of HAIs in three

analyzed hospitals were calculated for 295 cases of HAIs. Totally

it was the sum of 171,239 PLN (about 43,000 euro). Average cost

of antibiotics used in treatment of one HAI in hospital A was 691

PLN (about 171 euro), in hospital B – 340 PLN (about 85 euro) and

in hospital C – 526 PLN (about 131 euro). In each hospital costs of

individual cases were extremely diversified, depending mainly on

clinical form of HAI and type of ward. The lowest detected cost was

2 PLN (surgical site infection), and the highest one reached sum

of 4484 PLN (hospital acquired pneumonia in one of the intensive

care unit).

Conclusions: Obtained results show that effects of the infection

team work may be used in the management area in hospitals and

should serve as one of indicators in quality benchmarking. It is

especially important when hospitals struggle with limited financial

resources.

P06.02

Impact of healthcare-associated infections and antimicrobial

use in intensive care

M.J. Nobre Oliveira. Hospital Prof Dr Fernando Fonseca, Portugal

Background: Healthcare-associated infections (HAIs), namely those

caused by drug-resistant pathogens, are a growing problem in

intensive care units (UCIs) all over the world. They are difficult

to treat, influence antimicrobial use and have huge impact in

morbidity and mortality rates, contributing for the increase of

health costs and social burden.

Objective(s): To characterize the impact of HAIs and antimicrobial

use.

Methods: A 6-month prospective observational non-randomized

study was conducted in two ICUs of a 800-bed hospital. HAI were

defined as a positive microbiological result collected 48 hours after

ICU admission. All data was collected in the hospital database and

statistical analysis was conducted using Statistical Package for Social

Science software.

Results: Of the 213 patients included, 43.7% (n =93) suffered,

at least, one HAI and 234 HAIs were detected. We detected

523 antimicrobial prescriptions and piperacillin/tazobactam,

meropenem and ceftriaxone were the first, second and fourth most

prescribed ones, due to the high number of Gram-negative HAIs

(38.5%). Vancomycin and fluconazole were, respectively, third and

fourth, probably due to the 28% of HAIs caused by methicillin-

resistant Staphylococcus spp. and also to the high prevalence

of Candida spp. (20.9%). We also observed a high number of

broad-spectrum antimicrobial prescriptions in patients without

HAIs, probably due to the prevention of infection and/or to non-

microbiological confirmed HAI. A strong statistically association

were observed between the occurrence of HAI and length of stay

and the number, duration and cost of antimicrobials per patient

(p < 0.001).

Conclusions: The pattern of antimicrobial use was influenced by

the pathogens causing HAIs. Also, a patient with HAI was treated for

a longer time, had two times more antimicrobials and antimicrobial

treatment cost four times more than in patients without HAI.

Nevertheless, patients without HAIs had also high HAIs prevention

costs.