Background: Each year in the United States, at least 2 million people become infected with multidrug resistant organisms and at least 23,000 people die each year as a direct result of these infections. Rapid molecular testing for Multidrug Resistance Genes (MDRG) may have a significant impact on patient care.
Methods: Taqman assays for MDRG were printed onto OpenArray plates (ThermoFisher Scientific) and used to screen for 17MDRG that encode for resistances to four classes of antibiotics: β-lactams, fluoroquinolones, and macrolides. Vancomycin resistant genes vanA and vanB were tested by Target Enriched Multiplex PCR (TEM-PCR). Urine samples were obtained from 73 patients referred for possible UTI.
Results: Patient mean age was 64 years (range 24-94), 63% female, 88% white. Most common comorbidities include diabetes 30%, urinary catheter 26%, cancer 16%, immunosuppressants 11% and renal stone 5%. 33% were asymptomatic. Among 73 patients, the following resistance genes were detected: CTX-M miscellaneous group (3), CTX-M group 1 (1), CTX-M group 9 (1), OXA-1 (3), ermB (21) and vanA (4). Females had higher or similar rates of detection for all MDRG especially ermB and vanA. We found a higher detection of OXA-1(6.7%) in the > 70 age group while the <50 age group had increased detection of CTX-M miscellaneous group (12.5%), ermB (44%) and van A (12.5%). Patients without urinary catheter had higher detection of all MDRG while immunosuppressed patients had no detection of any MDRG. Patients with cancer ermB gene detected while those with kidney stone had CTX-M group detected only. Patient with diabetes detection was similar to non diabetic patients. In the asymptomatic group, there was less detection of MDRG except for ermB. Patients with urine analysis WBC > 50/HPF or hematuria or positive nitrite had higher detection of MDRG. Patients referred to ID specialist in the outpatient setting had higher detection of MDRG. Detection of ESBL and vancomycin resistance in urine susceptibility testing correlated with MDRG testing.
Conclusion: MDRG were detected in our patients with suspected UTI. Further studies are needed to assess the benefit of molecular testing of MDRG for screening and management of patients at high risk of MDROs infection.
D. Hockman, Diatherix: Employee , Salary
M. Huff, Diatherix: Employee , Salary
D. Stalons, Diatherix: Employee , Salary
E. Grigorenko, Diatherix: Employee , Salary
A. Hassoun, None
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