1623. Utility of surveillance cultures for carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and vancomycin-resistant enterococci in bone marrow transplantation unit
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Idweek_LisiaTomich.PNG (103.8 kB)
  • Background: Surveillance strategies to detect colonization have been considered important tools for preventing and controlling the spread of microorganisms in the hospital setting. The objective was to evaluate the use of routine surveillance culture to screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa) and vancomycin-resistant enterococci (VRE) in bone marrow transplantation (BMT) unit. 

    Methods: In January of 2012 surveillance cultures for CRE and CRPa with selective medium with carbapenem were implemented in BMT unit, but surveillance cultures of feces samples for VRE were already performed routinely. Swabs of patients were collected weekly until discharge or positive result. 

    Results: A total of 200 patients (age mean 45 years, 107 (53.5%) males) underwent surveillance, with 1323 samples collected. 554 (41.8%) surveillance cultures for CRPa, 413 (31.2%) for VRE and 356 (27%) for CRE. Of these, 179 surveillance culture were positive (13.5%), with greater positivity for oropharynx (6, 35.3%) and rectal (17, 20.7%), as shown in Table 1. Infection due to multidrug-resistant (MDR) pathogens occurred in 52 (21.5%) patients, among them 45 (86.5%) were bacteremia and 12 (23%) had positive surveillance culture before infection.  

    Table 1. Characterization of positive samples for surveillance cultures of patients in a BMT unit

    Positivity of surveillance cultures by site

    179 (13.5%)

    Axilla (n = 116)

    16 (13.8%)

    Feces (n = 1108)

    140 (12.6%)

    Oropharyx (n= 17)

    6 (35.3%)

    Rectum (n = 82)

    17 (20.7%)

    Mean length of stay until the first positive surveillance culture (days, range)

     

    CRE (n = 49)

    17.9 (1 - 55)

    CRPa (n = 31)

    20.1 (4 - 39)

    VRE (n = 46)

    10.5 (0 - 40)

    Mean number of surveillance cultures performed until the first positive (days, range)

     

    CRE

    2 (1 - 6)

    CRPa

    2.7 (1 - 8)

    VRE

    1.7 (1 - 6)

    Mean detection time to positivity surveillance cultures until infection due to MDR pathogens (days, range)

     

    CRE (n = 5)

    21.4 (1-34)

    CRPa (n = 7)

    14.1 (1 - 35)

    Conclusion: The most frequent MDR microorganism identified by surveillance culture was CRE. The body sites with highest positivity were oropharynx and rectum. The positive of surveillance culture was low before infection showing that its utility is questioned.

    Lísia G M M Tomich, MD1, Lauro Perdigão Neto1, Marjorie Vieira1, Jessica Ramos, MD1, Lucas Chaves, MD1, Thais Guimarães, MD, PhD2, Anna Sara Levin, MD, PhD3 and Silvia Costa, MD, PhD1, (1)Hospital Das Clínicas-FMUSP, São Paulo, Brazil, (2)Sccih, Instituto Central - Hospital Das Clínicas, São Paulo, Brazil, (3)University of São Paulo, São Paulo, Brazil

    Disclosures:

    L. G. M. M. Tomich, None

    L. Perdigão Neto, None

    M. Vieira, None

    J. Ramos, None

    L. Chaves, None

    T. Guimarães, None

    A. S. Levin, None

    S. Costa, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.