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Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: On January 12, 2010, an earthquake of magnitude 7.0 Mw struck southern Haiti. Within 24 hours after the earthquake, patients were transferred to south Florida hospitals, including Jackson Healthcare System.
Objective: To determine the degree of rectal colonization of patients with resistant Gram-negative organisms, and especially to evaluate the occurrence of extended-spectrum ß-lactamase (ESBL) producers.
Methods: Consecutive patients transferred from Haiti to Jackson Memorial Hospital (a 1,500 bed teaching hospital) underwent rectal swab cultures within 72 hours of admission. Swabs (BBL culture swabs-Becton Dickinson) were platted in 3 different media: MacConkey, Chrom ID ESBL (Biomerieux, France), and MacConkey with ceftazidime 4 ug/ml. Antibiograms were subsequently performed on solid agar plates by selecting different colonies according to their colour and morphology. Production of an ESBL was confirmed by a double disk synergy test using ceftazidime or cefotaxime and a clavulanic acid-containing disk.
Results: From January 12th until February 8th 2010, a total of 56 patients were admitted for over 24 hours to Jackson Memorial Hospital. Forty six patients have been screened, from which 19 (41%) were positive for ESBL producing Gram-negatives. The percentage of colonization among patients admitted increased during the weeks after the earthquake. Most of the ESBL-producing isolates were E. coli, but some K. pneumoniae and E. cloacae isolates were also identified. Interestingly, we identified some ESBL-positive A. baumannii isolates, although production of ESBLs in that species has been rarely documented in that species. Noteworthy, all the ESBL-producing Enterobacteriaceae remained susceptible to carbapenems. Almost all ESBLs identified were CTX-M-15. Four patients had more than one (2-5 strains) ESBL-producer strain isolated in their stool.
Conclusions: A high rate of colonization with ESBL-producing isolates was detected among Haitian transfers to a Miami hospital after the January 12th earthquake
Objective: To determine the degree of rectal colonization of patients with resistant Gram-negative organisms, and especially to evaluate the occurrence of extended-spectrum ß-lactamase (ESBL) producers.
Methods: Consecutive patients transferred from Haiti to Jackson Memorial Hospital (a 1,500 bed teaching hospital) underwent rectal swab cultures within 72 hours of admission. Swabs (BBL culture swabs-Becton Dickinson) were platted in 3 different media: MacConkey, Chrom ID ESBL (Biomerieux, France), and MacConkey with ceftazidime 4 ug/ml. Antibiograms were subsequently performed on solid agar plates by selecting different colonies according to their colour and morphology. Production of an ESBL was confirmed by a double disk synergy test using ceftazidime or cefotaxime and a clavulanic acid-containing disk.
Results: From January 12th until February 8th 2010, a total of 56 patients were admitted for over 24 hours to Jackson Memorial Hospital. Forty six patients have been screened, from which 19 (41%) were positive for ESBL producing Gram-negatives. The percentage of colonization among patients admitted increased during the weeks after the earthquake. Most of the ESBL-producing isolates were E. coli, but some K. pneumoniae and E. cloacae isolates were also identified. Interestingly, we identified some ESBL-positive A. baumannii isolates, although production of ESBLs in that species has been rarely documented in that species. Noteworthy, all the ESBL-producing Enterobacteriaceae remained susceptible to carbapenems. Almost all ESBLs identified were CTX-M-15. Four patients had more than one (2-5 strains) ESBL-producer strain isolated in their stool.
Conclusions: A high rate of colonization with ESBL-producing isolates was detected among Haitian transfers to a Miami hospital after the January 12th earthquake
| Number of week post-earthquake | Dates | Number of patients admitted | Number of Haitian patients (%) | Number of American citizens | Other nationalities | Number of patients tested | Number of Patients positive for ESBL (%) |
| 1 | 1/12/10- 1/17/10 | 24 | 7 (29) | 16 | 1 | 22 | 3 (14) |
| 2 | 1/18/10- 1/24/10 | 19 | 15 (79) | 2 | 2 | 14 | 7 (50) |
| 3 | 1/25/10- 1/31/10 | 6 | 5 (83) | 1 | 0 | 5 | 4 (80) |
| 4 | 2/1/10- 2/8/10 | 7 | 7 (100) | 0 | 0 | 5 | 5 (100) |
| Total | 1/12/10- 2/8/10 | 56 | 34 (61) | 19 | 3 | 46 | 19 (41) |