Results: RepigelTMtreatment showed no recovery of P. aeruginosa biofilm material (>5 Log reduction vs. untreated controls) at both the commercial concentration and 1:10 dilution at both time-points. Topical preparations containing mupirocin 2% and fusidic acid 2% showed no difference vs. con-trols at 1:10 dilution. Four hours of treatment did not significantly reduce the biofilm load, but a>1 Log reduction in P. aeruginosa biofilm material was demonstrated after 24 hours. Treatment of mixed C. albicans/MRSA bio-films with RepigelTMresulted in a 5 Log reduction in biofilm material at both time-points. The 1:10 dilution of RepigelTMproduced a>1 Log reduction in mixed biofilm material at both time-points, similar to findings with the other topical preparations.
Conclusions: RepigelTMat commercial concentration and 1:10 dilution pre-vented the recovery of viable P. aeruginosa biofilm material and reduced the recovery of viable organisms from multispecies biofilms of C. albicans and MRSA. The efficacy of RepigelTMin this in vitro model supports its potential antiseptic effectiveness against multiple bacterial strains in exuding chronic wounds.
Funded: Mundipharma PS 1-068
THE FIRST ISOLATE OF KLEBSIELLA PNEUMONIAE CARBAPENEMASE (KPC)ePRODUCING KLEBSIELLA PNEUMONIAE AT A REGIONAL HOSPITAL Chao-Tai Leea, Hung-Ming Chua, Chin-Lu Changb.aDepartment of Clinical Laboratory, Taiwan;bCommittee of Infection Control, Tainan Municipal Hospital, Tainan, Taiwan
Purpose: To report an isolate of Klebsiella pneumoniae with Klebsiella pneumoniae carbapenemase (KPC), which is the first isolate of KPC-produc-ing strain at a regional hospital.
Methods: The K. pneumoniae was isolated from sputum specimen in a pa-tient who came from nursing home. The antimicrobial susceptibility testing was performed by disk diffusion test and the Phoenix NMIC/ID-32 identification system (Becton Dickinson Diagnostic Systems, Sparks, MD). The results were interpreted according to the criteria recommended by the Clinical Laboratory Standards Institute 2014. The modified Hodge test (MHT) was performed for the presence of carbapenemase. The carba-penemase genes were confirmed at the Centers for Disease Control (CDC), Taiwan.
Results: The K. pneumoniae was susceptible to gentamicin, amikacin, and-trimethoprim-sulfamethoxazole, but resistant to piperacillin-tazobactam, levofloxacin, cefuroxime, ceftriaxone, ceftazidime, imipenem, and merope-nem. The MHT revealed the presence of a carbapenemase, and then the CDC confirmed that the carbapenemase was KPC.
Conclusions: This was the first isolate of KPC-producing strain in this hospi-tal. Especially, the strain was not a hospital-acquired strain, but a nursing home-acquired strain. Infection control measures are recognized the impor-tant measure to prevent the spread of multidrug-resisimpor-tant (MDR) strains. In order to reduce the incidence of MDR strains, herein, we suggest that both monitoring MDR strains and infection control measures should be performed not only in hospitals but also in long-term care facilities.
PS 1-069
EFFECT OF POSITIVE-NEGATIVE SYMPTOMS OF PATIENTS WITH SCHIZOPHRENIA AFTER SURGERY COMORBIDITY PHYSICAL: EVISERASI BULBI THAT INSTALLED IN PREVENTION EVENT URINARY CATHETER URINARY TRACT INFECTIONS
Sri Redjeki Julianingsih.SKep.Ns. Mental Head Room with Physical Comorbidity, Infection Control Nurse in Psychiatric Hospital Marzoeki Mahdi Bogor, Indonesia
Purpose: To provide an overview of the effects are positive symptoms of schizophrenia with negative post-surgical physical comorbidity eviserasi bulbi were catheterized urine in preventing urinary tract infections. Methods: The observations were made during 30 days on 7 September 2014 through October 6, 2014, to study the development of up and down his negative positive symptoms of schizophrenia patients every day. Measurement of symp-toms using the PANSS instrument Indonesian version by Salan, et al (1994).
Results: Measurement of preoperative obtained a Score PANSS Positive Scale 13, a Score Scale negative 47, a Score General Pathology 73. Patients were given oral psychiatric therapy Risperidone 1x1 mg and Trihexyphenidyl 2x2mg. Mea-surements obtained a Score after surgery PANSS Positive Scale 17, a Score Scale negative 47, a Score General Pathology 73 Risperidone administration increased to 2x2mg and Trihexyphenidyl 2x2 mg. After this dose increase the patient be-comes calm and cooperative. In preventing urinary tract infections for 19 days, patients were given life skills training, namely: how to care for themselves, maintaining the integrity of the catheter position and report to the nurse if there are any changes or problems related to the urinary catheter and hand hy-giene compliance through procedures for officers. Results of laboratory tests of blood and urine analysis dated 6 October 2014 declared the results within normal limits and no signs of infection.
Conclusion: The success of the process of post-surgical treatment of pa-tients with schizophrenia: Eviserasi Bulbi that gets action urinary catheter for 19 days with uncomplicated urinary tract infections declared successful. The success is supported by adequate medical management and life skills training provision by Tim Nursing optimum
Keyword: Schizophrenia, Preventing urinary tract infections, Catheterized urine.
PS 1-070
THE PROJECT TO IMPROVE T.B. CASES TO RETURN TO CLINIC FOR TREATMENT
Ya-Jhen Ji , Tsui-Fen Chang. Yunlin Christian Hospital, Taiwan
Purpose: The rates of TB cases returned clinics are 78% in 2011 and 79% in 2012. The pretest was 65.2% health care workers for tuberculosis. The knowledge deficits in Tuberculosis (T.B.) and side effects of medications .We strengthened in cases education, family members and health workers about the knowledge of T.B. We provide transport for T.B. patient, improve process and public health cooperation, increase patient medication compli-ance.Return to clinic rate for treatment reach to 100%.
Methods: To elevate return rate, methods are following. (1) patient and fam-ily: the Tuberculosis case manager changed the way of health education by using language that patients understand. (2) We strengthen staff to guide educational resources related to internet search, to sharing case. Cognitive test score was improved to 95.4%. (3) Modify health education leaflets. Pro-vides bus schedules to increase willingness to back to hospital. (4) the T.B. case manager calls case back for treatment and provides public nurse contact. Results: In 2013 year , return to clinic rate for treatment( after hospital discharge diagnosis ) can reach 100%, no loss of any patients; another found by telephone to ask drug side effects more frequently than 2012 year 20%, medication compliance of patients are 100%. Last year, We lost 15 cases ,the treatment course of 9 months estimated annual loss of health insurance of approximately 321060NT＄.
Conclusions: Enhance cognitive education, hospitals and public cooperation in the management of T.B. Patients improve medication compliance with complete and effective course of treatment. Thereby reducing community cluster infections with multiple drug-resistant T.B. .Reducing government cost and improving the quality of patient care.
We lost 5 cases, but we do cooperate with public nurse to lead cases to follow-up . We suggest that hospital can afford a private education room to patient to have consult in the future.
PS 1-071
USE ENVIRONMENTAL CLEAN PROJECT TO IMPROVE HEALTHCARE-ASSOCIATED INFECTION IN THE HOSPITAL
Chiu-Chi Tsaia, Chiung-Yi Huanga, Kuei-Chu Lia, Chen-Chen Huanga,
Li-Ling Chuanga, Ching-Ying Chianga, Tsen-Lu Choa, Yi-Jung Liua,
Kao-Pin Hwanga,b.aCommittee of Infection Control, Taiwan;bDivision of Pediatric Infectious Disease, Department of Pediatrics, China Medical University Hospital, China Medical University School Medicine, Taichung, Taiwan
Purpose: The sanitary of hospital environment is the most important factor to provide the clean healthcare. It’s also related to health care associated
infection. We use environmental clean project to improve healthcare-asso-ciated infection in the hospital.
Methods: The infection rate of critical patients is relatively higher because of their poor immunity and invasive procedures of treatment. In 2012, 2 of top 5ward with high resistant area are MICU and RICU. Therefore, we choose these two units to join this project–“Introduction of disposable cleaning wipers”. We collected the sample at the time of before introduction and af-ter introduction of disposable cleaning wipers; comparing ATP and Bacaf-terial culture (Qualitative) results.
Results: The ideal rate of ATP pretest is increasing from 27.5% to 39.5%, the result shows the environment cleanness level improved even before wiping; Re-education to housekeeping staff and introducing disposable cleaning wipers, 8 weeks later, ATP ideal rate improved from 55% to 65.8%. Conclusions: It showed the cleaning wipers work is effectively in decreasing strains colonization and causing infection.
PS 1-072
DELAYED VERSUS IMMEDIATE INOCULATION OF SPUTUM MEDIA FOR DIAGNOSIS OF PNEUMONIA
Fu-Chieh Changa, Ying-shih Sub.aMackay Memorial Hospital, Infection Control Center, Taiwan;bCenters for Disease Control, Ministry of Health and Welfare, Taiwan, ROC
Purpose: Proper collection of specimens is important to maximize the outcome of laboratory test for the diagnosis of infectious disease. For urinal-ysis and culture and sensitivity testing, CLSI guideline recommends testing within two hours of collection. In this study, we will discuss the impact of the delayed inoculation.
Methods: A total of 40 consecutively collected midstream and/or catheter-catch urine samples from patients were cultured in medium. The samples were inoculated immediately, one hour, two hours and 4 hours separately. Results: The culture result yields that the difference between the immediate cultures and delayed inoculations were influenced by the period of delaying. Conclusion: Direct sample inoculation into selective growth medium may improve the likelihood of detecting real pathogen.
PS 1-074
THE EVALUATION OF THE ANTIMICROBIAL SUSCEPTIBILITY OF THE CLINICAL ISOLATES WITH THE AUTOMATED SYSTEM
Fu-Chieh Changa, Ying-shih Sub.aMackay Memorial Hospital, Infection Control Center, Taiwan;bCenters for Disease Control, Ministry of Health and Welfare, Taiwan, ROC
Purpose: The VITEK 2 is a new version of the automated system for organism identification and susceptibility testing. It’s very powerful to
Methods: Case control study. Case: Vitek 2 automated machine. Control group: True MIC: Sigma standard powder for MIC test.
Results: The sensitivity rate of Proteus showed major difference in Imipe-nem result. False negative rate is about 20%.
Conclusion: Our data suggest that disk diffusion, especially with merope-nem disks, may be used to confirm a carbapemerope-nem nonsusceptible result in K. pneumoniae isolates, which would warrant further testing. If treatment failure with carbapenems is observed for isolates of K. pneumoniae that were previously reported as suscep- tible to carbapenems, repeat testing with a nonautomated method, such as disk diffusion, may be warranted.
PS 1-075
ANTIMICROBIAL SUSCEPTIBILITY AMONG HOME CARE CASES WHO WERE HOSPITALIZED DUE TO URINARY TRACT INFECTION AT A TERTIARY CARE HOSPITAL
Chi-Chang Huang, Deng-Chi Yang, Chia-Ming Chang. Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
Purpose: The surveillance of antimicrobial resistant pathogens among the home care group was rare discussed in past literature. This study was designed to evaluate antimicrobial resistant pathogens among home care cases who were hospitalized due to urinary tract infection at a tertiary care hospital.
Methods: We prospectively collected the bacterial isolates from home care cases who had been hospitalized due to UTI at a tertiary care hospital during 2013/1/1w 2014/9/30. Only first episode of UTI during study period would be enrolled. The distributions of bacterial isolates and their antimicrobial resistance were analyzed. Rates of susceptibility to imipenem, ceftriaxone, ceftazidime, levofloxacin, trimethoprim/sulfamethoxazole and amikacin were measured using 2014-CLSI breakpoints.
Results: Total 85 isolates were collected from 59 cases who had been hos-pitalized at least once due to UTI. Gram negative bacilli (75.3%) were dominant pathogens. The ranking top six of grain negative bacilli and their susceptibility data were listed in table1. As for gram positive bacteria, Enterococcus spp occupied 47.6% and one isolate was vancomycin-resistant enterococcus. Two isolates of oxacillin- resistant S. aureus were also noted.
Conclusion: The dominant pathogens of UTI in home-care cases were E. coli, P. aeruginosa, K. pneumonia and Enterococcus spp. High rations of MDR Enterobacteriaceae (53.8%) were noted in our study. Only imipenem and amikacin were active against> 90 % GNB isolates. Ratio of ampicillin resistant enterococcus (10%) was low, and only one VRE was noted. Thus, when facing UTI issue from home-care cases, it is important to early identify the isolates by gram stain in order to choose appropriate antimicrobial agents.
PS 1-076
CLINICAL AND MICROBIOLOGICAL ANALYSIS OF ACINETOBACTER BAUMANNII BACTEREMIA IN NEONATAL INTENSIVE CARE UNITS Chih-Kai Wanga, Zhi-Seng Leea, Jen-Fu Hsua,b, Cheng-Hsun Chiua,c.
aDepartment of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan;bDivision of Neonatology, Taiwan;cPediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Objective: Acinetobacter baumannii is one of the most common bacterial pathogens to cause nosocomial infections, pneumonia and bacteremia in particular, in patients admitted in intensive care units. There have been few studies on A. baumannii infection in neonates. The study aimed to char-acterize the clinical manifestations and outcomes of patients with A. bau-mannii bacteremia in the neonatal intensive care units (NICUs). Molecular epidemiological analysis on the A. baumannii isolates derived from the neonatal patients was also carried out.
Methods: All patients with A. baumannii bacteremia in NICUs of a medical cen-ter from 2004 to 2014 were reviewed. We analyzed the clinical manifestations, Table 1 (PS 1-075)
Pathogens Total Number (%) CRO CAZ LVX SXT AN IPM #MDR ratio
1 E. coli 18(28.1) 10(55.6%) X 6(33.3%) 8(44.4%) 18(100%) 18(100%) 61.1% 2. P. aeruginosa 11(17.2) X 10(90.9%) 8(72.7%) X 10(90.9%) 9(81.8%) 18.2% 3 K. pneumoniae 10(15.6) 4(40%) x 6(60%) 4(40%) 10(100%) 10(100%) 60.0% 4 C. koseri 6(9.4) 4(66.6%) X 3(50%) 4(66.6%) 4(66.6%) 6(100%) 50.0% 5 P. mirabilis 5(7.8) 4(80%) X 4(80%) 4(80%) 4(80%) 5(100%) 20.0% 6 A. baumannii 4(6.3) X 3(75%) 1(25%) 1(25%) 3(75%) 4(100%) 75.0%
# MDR: multidrug resistant; non-susceptible to 1 agents in 3 antimircobial categories
CRO: Ceftriaxone, CAZ: Ceftazidime; LVX: Levofloxacin, SXT: Trimethoprim/sulfamethoxazole, AN: Amikacin, IPM: Imipenem
