Prevalence of penicillin-sensitive Staphylococcus aureus (PSSA) over time

• Single-centre, retrospective analysis (2003-2013; MedMined database;USA tertiary care hospital servicing catchment area of ± 6.3 million people)

• Study population: median age: 60 yr; 60% ♂; 78% white race

• N=697 blood cultures positive for Staphylococcus aureus (SA)

• Gradual increase in % of PSSA over time:

In this USA tertiary referral centre, the % PSSA increased >3-fold over 10 yr from 7.9% to 27.1%

Chabot M. ECCMID 2014 abs. P1478

Stethoscope bacterial contamination and cleaning practices among healthcare workers (HCW)

• Study among 47 HCWs in 720-bedded hospital (UK)

Questionnaire about stethoscope cleaning:

• Method of stethoscope cleaning: Alcohol-based: 43% − Detergent-based: 38% − Alcohol- or detergent-based: 17% − None: 2%

Virgincar N. ECCMID 2014 abs. eP272

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Data from poster

Stethoscope bacterial contamination and cleaning practices among healthcare workers (HCW)

• Identification of microorganisms on stethoscope diaphragm:(swab diaphragm with sterile cotton bud, moisten with sterile saline and inoculate onto blood agar plate, incubation 37°C 24h)

– 77% (N=36) of stethoscope diaphragms colonised with bacteria

No methicillin-resistant Staphylococcus aureus isolated

– In 66% (N=31) of stethoscopes: CFU count 1-50 microorganisms

Due to a lack of regular cleaning, stethoscope bacterial contamination was common, potentially causing bacterial transmission between pts

Virgincar N. ECCMID 2014 abs. eP272

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Data from poster

4-antigen S. aureus vaccine (SA4Ag): safety, tolerability and immunogenicity

• SA4Ag vaccine contains:

– Capsular polysaccharide serotype 5 (CP5) conjugated to the non-toxic mutant form of diphteria toxin (CRM197): 30 µg

– Capsular polysaccharide serotype 8 (CP8) conjugated to the non-toxic mutant form of CRM197: 30 µg

– Recombinant surface protein clumping factor A (rmClfA): 60 µg

– Recombinant manganese transporter protein C (rP305A): Low dose: 30 µg − Mid dose: 60 µg − High dose: 200 µg

• Double-blind, parallel-group, first-in-human phase I/IIa RCT: N=456 healthy subjects (18-65 yr; mean: 45 yr), receiving single SA4Ag dose or placebo:Low dose: N=117 − Mid dose: N=114 − High dose: N=113 − Placebo: N=112

Safety/tolerability

• Generally well tolerated across all rP305A dose levels tested

• Local reactions: more often with SA4Ag than with placebo, but mostly mild

• Systemic events: comparable across SA4Ag and placebo groups

Frenck R. ECCMID 2014 abs. eP134

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Data from poster

• No vaccine-related SAEs or deaths

Immunogenicity

• Substantial increases in opsonophagocytic activity and fibrinogen binding inhibition vs baseline at days 15 and 29

• Rapid increase in competitive Luminex® immunoassays (cLIA) geometric mean titers (GMTs), sustained with gradual wane through mo 12

4-antigen S. aureus vaccine (SA4Ag): safety, tolerability and immunogenicity

In healthy adults, SA4Ag vaccin seems to be well tolerated and induced rapid and robust functional antibody responses maintained for 12

mo

Frenck R. ECCMID 2014 abs. eP134

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Data from poster

In vitro activity of cloxacillin against haemolytic streptococci, pneumococci and Enterococcus faecalis

In vitro study:

•Cloxacillin minimum inhibitory concentration (MIC) per species:

Cloxacillin MIC Test Strip (Liofilchen, Italy) on Mueller-Hinton agar with 5%

horse blood

Ghathian K. ECCMID 2014 abs. eP195

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Data from poster

P: percentile

In vitro activity of cloxacillin against haemolytic streptococci, pneumococci and Enterococcus faecalis

• Susceptibility against oxacillin for all strains combined:

Oxacillin disc, 1 mg (Oxoid):

High correlation between MICs and oxacillin zone

diameters:

MIC =7.58 - 0.47x oxacillin zone diameter; R=-0.88; P<0.01

→ Oxacillin disc can be used to test for susceptibility

towards cloxacillin

In vitro, cloxacillin showed high activity against all types of haemolytic streptococci

Ghathian K. ECCMID 2014 abs. eP195

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Data from poster

Prevalence and resistance of commensal S. pneumoniae in 9 European countries

• Appropriateness of prescribing antibiotics in primary healthcare in Europe with respect to antibiotic resistance (APRES) study (2010-2011; 9 European countries)

• N=31,182 patients (≥4 yr) visiting their general practitioner (GP) for a non-infectious condition, who had not used antibiotics or had not been hospitalised in the past 3 months (exclusion: immunocompromised pts, nursing home residents)→ nasal swabs collected by GP (20 GPs/country) → isolation and identification of S. pneumoniae (1 lab/country) + antibiotic susceptibility testing (1 central lab for all countries)

• Overall prevalence of S. pneumoniae nasal carriage in outpatients: 2.9%

Yahiaoui RY. ECCMID 2014 abs. P1586

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Data from posterPrev.: prevalence

Prevalence and resistance of commensal S. pneumoniae in 9 European countries

• Highest overall antibiotic resistance: cefaclor: 52.6%

• No resistance observed for moxifloxacin and ciprofloxacin

Nasal S. pneumoniae carriage among European GP patients is low. Antibiotic resistance varies largely between European countries

Yahiaoui RY. ECCMID 2014 abs. P1586

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Data from poster

Synergistic activity of antibiotic combinations against colistin-resistant KPC-Kp isolates

• In vitro study (checkerboard method): evaluate synergistic activity of 10 antibiotic combinations against 13 colistin-resistant Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp)

• Source of KPC-Kp isolates: blood (N=6), abdominal drainage (N=2), sputum (N=2), vascular prosthesis (N=1), urine (N=1), faeces (N=1)

• Carbapenem MICs: range 128-256 mg/ml

• Tigecycline resistance: 4/10 strains

• Gentamicin resistance: 1 strain

Tascini C et al. Antimicrob Agents Chemother 2013;57:3990-3

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Synergistic activity of antibiotic combinations against colistin-resistant KPC-Kp isolates

• Colistin + rifampicin: also bacteriostatic synergistic activity against:

– 4/4 colistin-susceptible KPC-Kp isolates: colistin MIC: 0.5-2 mg/l

– 4/4 ertapenem-resistant extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae isolates: ertapenem MIC: 16-32 mg/l

In vitro, CS+RIF was the most consistently active antimicrobial combination against KPC-Kp, especially for CS-resistant strains

Tascini C et al. Antimicrob Agents Chemother 2013;57:3990-3

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