241. Clinical and Molecular Profile, Risk Factors and Outcome of ?-Lactamase-Producing Enterobacteriaceae Infections in a Government University Hospital
Session: Poster Abstract Session: Diagnostic Microbiology; Antimicrobial Sensitivities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • ESBL poster.pdf (1.0 MB)
  • Background: To determine the clinical and molecular profile, risk factors, and outcome of β- lactamase producing Enterobacteriaceae infections.

    Methods: : We prospectively collected isolates and reviewed the clinical data of patients with Enterobacteriaceae infections at the Philippine General Hospital. ESBL screening was via double disk synergy test utilizing ceftazidime and clavulanic acid and confirmed using the criteria set by the CLSI. Phenotypic determination was done using VITEK 2 system. We verified ESBL type by PCR amplification and gene sequencing.

    Results: Of the 177 clinical isolates, 37% were positive for ESBL. Majority was from respiratory secretions (53%) and produced by Klebsiella pneumoniae (54.6%). Mean age was 49 years (SD 18.3, range 19-85), 75.7% were isolated from ward patients, and 53% were nosocomial infections. On multivariate analysis, presence of mechanical ventilator was the only risk factor associated with ESBL development (OR 2.48, 95% CI (1.21-5.13). Mean duration of hospitalization was 14 days (SD12.9). No significant difference in mortality rate was seen for ESBL and non-ESBL infection (12% vs 9% p=0.34). Phenotypes of 61 ESBL-producing isolates were the following: ESBL alone (74%), ESBL + impermeability-cephamycin (16%), ESBL + carbapenemase (3%), ESBL+high level cephalosporinase-AmpC (6%). Of the 35 clinical isolates tested, the prevalent genotype was the combination of CTX-M group 1 + OXA (40%). One isolate had ESBL genes CTX-M group 1, TEM, OXA, SHV and CTX-M group 9.

    Conclusion: Klebsiella pneumonia was the most common ESBL-producing organism at the Philippine General Hospital. ESBL infection was common among patients on mechanical ventilator. However such infection did not significantly affect mortality rate. Presence of more than one ESBL type in a single isolate was common in this study demonstrating continued spread of resistance traits.

    Karen Marie Gregorio, MD1, Rosally Zamora, MD1, Raul Destura, MD2,3 and Marissa Alejandria, MD4, (1)University of the Philippines-Philippine General Hospital, Manila, Philippines, (2)National Institutes of Health - University of the Philippines Manila, Manila, Philippines, (3)Medicine, UP - Philippine General Hospital, Manila, Philippines, (4)University of the Philippines - Philippine General Hospital, Manila, Philippines


    K. M. Gregorio, None

    R. Zamora, None

    R. Destura, None

    M. Alejandria, None

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