Transcript S. pneumoniae - Infectoforum

Prevalence of penicillin-sensitive
Staphylococcus aureus (PSSA) over time
Chabot M. ECCMID 2014 abs. P1478
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Single-centre, retrospective analysis (2003-2013; MedMined database;
USA tertiary care hospital servicing catchment area of ± 6.3 million people)
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Study population: median age: 60 yr; 60% ♂; 78% white race
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N=697 blood cultures positive for Staphylococcus aureus (SA)
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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%
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Stethoscope bacterial contamination and cleaning
practices among healthcare workers (HCW)
Virgincar N. ECCMID 2014 abs. eP272
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Study among 47 HCWs in 720-bedded hospital (UK)
Questionnaire about stethoscope cleaning:
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Method of stethoscope cleaning: Alcohol-based: 43% − Detergent-based:
38% − Alcohol- or detergent-based: 17% − None: 2%
Data from poster
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Stethoscope bacterial contamination and cleaning
practices among healthcare workers (HCW)
Virgincar N. ECCMID 2014 abs. eP272
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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
Data from poster
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4-antigen S. aureus vaccine (SA4Ag):
safety, tolerability and immunogenicity
Frenck R. ECCMID 2014 abs. eP134
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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
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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
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Generally well tolerated across all rP305A dose levels tested
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Local reactions: more often with SA4Ag than with placebo, but mostly mild
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Systemic events: comparable across SA4Ag and placebo groups
Data from poster
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4-antigen S. aureus vaccine (SA4Ag):
safety, tolerability and immunogenicity
Frenck R. ECCMID 2014 abs. eP134
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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
In healthy adults, SA4Ag vaccin seems to be well tolerated and induced
rapid and robust functional antibody responses maintained for 12 mo
Data from poster
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In vitro activity of cloxacillin against haemolytic
streptococci, pneumococci and Enterococcus faecalis
Ghathian K. ECCMID 2014 abs. eP195
In vitro study:
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Cloxacillin minimum inhibitory concentration (MIC) per species:
Cloxacillin MIC Test Strip (Liofilchen, Italy) on Mueller-Hinton agar with 5%
horse blood
P: percentile
Data from poster
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In vitro activity of cloxacillin against haemolytic
streptococci, pneumococci and Enterococcus faecalis
Ghathian K. ECCMID 2014 abs. eP195
• 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
Data from poster
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Prevalence and resistance of commensal
S. pneumoniae in 9 European countries
Yahiaoui RY. ECCMID 2014 abs. P1586
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Appropriateness of prescribing antibiotics in primary healthcare in Europe
with respect to antibiotic resistance (APRES) study (2010-2011; 9 European
countries)
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N=31,182 patients (≥4 yr) visiting their general practitioner (GP) for a noninfectious 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)
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Overall prevalence of S. pneumoniae nasal carriage in outpatients: 2.9%
Prev.: prevalence
Data from poster
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Prevalence and resistance of commensal
S. pneumoniae in 9 European countries
Yahiaoui RY. ECCMID 2014 abs. P1586
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Highest overall antibiotic resistance: cefaclor: 52.6%
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No resistance observed for moxifloxacin and ciprofloxacin
Nasal S. pneumoniae carriage among European GP patients is low.
Antibiotic resistance varies largely between European countries
Data from poster
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Synergistic activity of antibiotic combinations
against colistin-resistant KPC-Kp isolates
Tascini C et al. Antimicrob Agents Chemother 2013;57:3990-3
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In vitro study (checkerboard method): evaluate synergistic activity of 10
antibiotic combinations against 13 colistin-resistant Klebsiella pneumoniae
carbapenemase-producing K. pneumoniae (KPC-Kp)
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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)
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Carbapenem MICs: range 128-256 mg/ml
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Tigecycline resistance: 4/10 strains
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Gentamicin resistance: 1 strain
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Synergistic activity of antibiotic combinations
against colistin-resistant KPC-Kp isolates
Tascini C et al. Antimicrob Agents Chemother 2013;57:3990-3
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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