Abstracts e39

In agreement with these studies, these two clones werealso responsible for majority of infection in the ICU wardsof the Aberdeen Royal Infirmary. We also report theprevalence of a third clone, CC45 which has not yet beenreported in healthcare settings in Scotland. We alsoobserved an association between CCs and antimicrobialsusceptibility profiles.

PFGE and spa-typing provided higher strain discrimina-tion than MLST. However, PFGE profiles were closelyrelated within a CC and most isolates belonged to a singleCC-specific spa-type.

Conclusions

These results suggest persistence of three major MRSAclones within the ICU of Aberdeen Royal Infirmary. This isthe first study characterizing MRSA in a Scottish ICU and willfacilitate future MRSA surveillance and epidemiologicalinvestigations in healthcare settings in Scotland.

EVALUATION OF THE PREVALENCE ANDANTIBIOTIC SUSCEPTIBILITIES OF ESBL, AMPCAND INDUCIBLE AMPC’S AMONG URINARYISOLATESCATEGORY: SCIENTIFIC FREE PAPER

Rebecca Turner, Deborah GnanarajahRoyal Derby Hospitals, Derby, United Kingdom

Introduction

Extended Spectrum Beta-Lactamases (ESBL) and AmpCBeta-Lactamase (AmpC) producing coliforms are increasingin number, especially among the urine isolates, reducingthe possible oral options available for treatment. Currentlyall new isolates have a full Vitek2� identification andsensitivity to ascertain their resistance pattern and alsoa 5 disc diffusion method for identification of their re-sistance mechanism.

Objectives: To calculate the prevalence of ESBL, AmpCandinducible AmpC producing organisms over a 3 month period.

To analysis the sensitivity rates of trimethoprim, nitro-furatoin, gentamicin and ciprofloxacin among urine isolatesover a 3 month period.

Method: A retrospective analysis of all urine isolates wascarried out at the Microbiology Department, Royal DerbyHospital from Dec 2009 - Feb 2010. ESBL, AmpC andInducible AmpC’s were identified using the 5 disc diffusionmethod of cefpodoxime +/- clavulanic acid, and cefepime+/- clavulanic acid for ESBL and AmpC detection andcefoxitin for inducible AmpC detection. Samples from thesame patient within this period were considered to beduplicates and excluded.

Scientific findings

� Total number of urines received was 29,780, ofwhich 6074werepositive&of those 217were foundto isolate an ESBL, AmpC or Inducible AmpC.

� Of those 45% were ESBL’s, 51% AmpC’s, 2% ESBL’sand AmpC’s and 2% inducible AmpC’s.

� The age range was from 3 months - 100 years.� 77% of the isolates were community versus 23%from in-patients.

� Four antibiotic susceptibilities were analysed forresistant patterns. The study found trimethoprimto have the highest resistance of 53% and genta-micin the lowest at 32%, with nitrofurantoin andciprofloxacin 43% and 40% respectively.

� 9% were resistant to all four antibiotics.

Discussion

The prevalence of ESBL and AmpC producing organisms islikely to increase with the majority of isolates coming fromcommunity patients. The possible oral antibiotic choices totreat ESBLs and AmpC’s are fast running out with theresistance to nitrofurantoin and trimethoprim at a highrate. Symptomatic urosepsis infections are admitted for I.VMeropenem and more worryingly 9% of the isolates testedalso required treatment with Meropenem. The increase inthe gentamicin resistance is disturbing as it is the empiricchoice to cover resistant Gram negatives in patients with noprevious ESBL or AmpC isolates.

Conclusions

Increased age, catheters and previous isolation of a multi-resistant organism are clinical risk factors for acquiringurinary infections, which is supported by the average age ofthe study and 9% having a previous isolate. Treatmentoptions are becoming limited as the organisms becomemore resistant to antibiotics.

IS FRAX� A VALID SCREENING TOOL FORFRAGILITY FRACTURE RISK ASSESSMENT IN HIV-POSITIVE INDIVIDUALS?CATEGORY: SCIENTIFICFREE PAPER

Ben Stone 1, Eugene McCloskey 2,Christine Bowman 3, David Dockrell 4

1Department of Infection and Tropical Medicine, SheffieldTeaching Hospitals, Sheffield, United Kingdom2Academic Unit of Bone Metabolism, The University ofSheffield, Sheffield, United Kingdom3Department of Genitourinary Medicine, SheffieldTeaching Hospitals, Sheffield, United Kingdom4Department of Infection and Immunity, The University ofSheffield, United Kingdom

Introduction

The prevalence of reduced bone mineral density (BMD) andprobably also fracture incidence are increased in HIV-positive individuals compared to HIV-negative controls.There are many potential explanations for this - an