P24.18 Risk factors associated with resistance to 3rd gen cephalosporins in Enterobacteriaceae isolates from intensive care unit patients in Saudi Arabia

s, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S73 analysis for ER-Kp carriage underlined the importance of carbapenems (OR 12.9; 95%CI 3.09–53.7; p< 0.01), 2nd generation cephalosporins (OR 11.8; 95%CI 1.86–74.4; p < 0.01), endoscopy (OR 5.59; 95%CI 1.32–23.6; p < 0.02), acute renal failure (OR 5.32; 95%CI 1.13–25.1; p < 0.04) and 3rd generation cephalosporins (OR 4.15; 95%CI 1.09–15.8; p < 0.04). Overall 30 patients out of 100 died and among the infected, although not significant, mortality was higher in ER-Kp (39.3%) than ES-Kp (27.9%). Conclusion: As ER-Kp is an emerging clinical threat, spread control is crucial. Our findings confirm that prior use of certain antimicrobials, specifically carbapenems and cephalosporins are primary independent risk factors for the development of ER. P24.18 Risk factors associated with resistance to 3rd gen cephalosporins in Enterobacteriaceae isolates from intensive care unit patients in Saudi Arabia D. Baxter, N. Al-Abdullah. King Abdulaziz University Hospital, Saudi Arabia Intensive care units (ICUs) are high-risk areas for the acquisition of HAIs by Gram-negative bacteria, especially Enterobacteriaceae. This study set out to identify the risk factors associated with Enterobacteriaceae HAIs. It was conducted prospectively in four ICUs in tertiary care hospitals in Saudi Arabia from September 2006 to April 2007. ICU-acquired Enterobacteriaceae infections were found in 149 patients, of whom 76 were resistant to third generation cephalosporins (3GCs). Fiftey six had E. coli, 58 had K. pneumoniae and 35 had Enterobacter spp. Previous hospitalisation, impaired immunity, length of ICU stay, exposure to invasive lines and duration of catheterisation were significant risk factors for Enterobacteriaceae HAIs. In multivariate analysis, CVCs and NGTs were independently associated with Enterobacteriaceae infections. Poster Session 25 – Resistant Gram Positive Bacterial Infection P25.01 Methicillin-resistant Staphilococcus Aureus infections in a service of vascular surgery: evaluation of a prevention strategy V. Garcia-Roman, J. Sanchez-Paya, R. Camargo-Angeles, C. Villanueva-Ruiz, C. Garcia-Gonzalez, M. Fuster-Perez, C. EscrivaPons, J. Barrenengoa-Sanudo. Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Spain Background: One of the measures to prevent nosocomial MRSA infections, is the check of the situation of carrier condition in patients at the admission moment in a medical center. Objective: Evaluate the effectiveness of initiating this measure in a Service of Vascular Surgery after an increase of the incidence of this kind of infections during the 1 semester of 2009. Methods: Intervention: the current recommendations of extended contact precautions when a case of MRSA is detected, are complemented by the checking of MRSA nasal carrier condition, at the patient’s admission moment, from May, 2009. All the hospitalized patients in the Service of Vascular Surgery were included in the Cohort study, from July, 2008 to April, 2009. The patients have been grouped in four periods: 2 semester of 2008, 1 semester of 2009, 2 semester of 2009 and the period from January to April at this year 2010. The definition criteria of infection case are from the CDC. The Incidence Rate has been calculated for every 10,000 days of hospital stay for each period of time, and the Relative Risk (RR) has been calculated with its 95% confidence intervals (95% CI) using as reference category the 1 semester of 2009. Results: The incidence of infection cases during the second semester of 2008 was 7 cases per 10,000 days of hospital stay, RR: 0.62 (0.10–2.71); during the first semester of 2009, 12 cases per 10,000 days of hospital stay; during the second semester of 2009, 4 cases per 10,000 days of hospital stay, RR: 0.39 (0.04– 2.04); and from January to April 2010, there have been 3 cases per 10,000 days of hospital stay, RR: 0.24 (0.01–1.85). Conclusions: The carrying out of the checking of MRSA’s carrier condition at the patient’s admission moment, as a complementary measure to the habitual prevention and control infection measures of this unit, is demonstrating its effectiveness, although the decrease achieved in infections incidence is not statistically significant. P25.02 Are there regional differences in the burden of MRSA, VRE and ESBL in 219 German intensive care units, 2008–2009? F. Schwab, E. Meyer, C. Geffers, P. Gastmeier. Charite University Medicine, Germany Objectives: To determine the burden of multidrug resistant organisms (MDRO) in the years 2009 and 2009 and to analyse the regional distribution in 219 German intensive care units participating in the German Nosocomial Infection Surveillance System (ICU-KISS). Methods: The ICUs reported data on MRSA, VRE and ESBLproducing E. coli (EC) and K. pneumoniae (KP)-cases and presence of these MDRO both on admission (defined as known carriage or detection within 48 hours of admission) and on acquisition during the ICU-stay (defined as detection ≥ 48 hours after admission). For the regional analysis the 16 German Federal States were grouped into 5 geographic regions (east, south east, south west, north and west). Incidence densities (ID) of MDR-bacteria per 1000 patient days (pd). Results: 219 ICUs with 378,500 patients and 1,390,268 pd provided data. There were significant differences in IDs of MRSA, VRE, ESBLEC and ESBL-KP between the 5 regions. The ID of MRSA ranged between 2.4 in north and 5.3 in east Germany. ESBL-EC was also highest in east Germany and only 0.6 in the north as it was VRE (0.9 in the east and 0.1 in the north). ESBL-KP ranged from 0.2 in the south-west to o.7 in the east. The regions also differed in the proportion of ICUs per region that had encountered at least one case of MDR-bacteria. These differences ranged from 30% to 70% for VRE, from 65% to 88% for ESBL-EC and from 42% to 69% for ESBL-KP but only 93–98% for MRSA. Conclusion: MRSA shows the highest incidence density of the analysed bacteria and is endemic in all German regions. The burden of ESBL-ECO/KLE and VRE is still lower, however, there are larger regional differences indicating ongoing regional spread. The strong regional variation of the incidence of MRSA, VRE and ESBL-ECO/KLE in Germany indicates that high incidences of these bacteria are not only due to problems with infection control in individual ICUs and that a nationwide strategy for the reduction of antimicrobial resistance is needed. P25.03 Bed occupancy and methicillin-resistant Staphylococcus aureus infection rate in intensive care units: 2003–2008 M.J. Hernandez-Navarrete, D. Bordonaba-Bosque, C. Lapresta-Moros, G. Santana-Lopez, S. Belkebir, S. PastorEixarch. Miguel Servet Teaching Hospital, Spain; The Health Science Aragones Institute, Spain; Teaching Unit of Preventive Medicine and Public Health, Spain Background: There is an increasing concern about the levels of bed occupancy and its effect on the rate of healthcare-associated infections (HAIs). Objective: To detect the impact of workload in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods: Routine active surveillance data collected from four adults ICUs from 2003 to 2008. The MRSA surveillance was passive