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Tigecycline usage in osteomielitis caused by multidrug-resistent acinetobacter: A report of 10 cases from a single institution

Tigecycline usage in osteomielitis caused by multidrug-resistent acinetobacter: A report of 10 cases from a single institution

e200 14th International Congress on Infectious Diseases (ICID) Abstracts of infections. The widespread use of quinolones for this and other reasons ...

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14th International Congress on Infectious Diseases (ICID) Abstracts

of infections. The widespread use of quinolones for this and other reasons has led to an increase in resistant bacteria. Aims of this study: to evaluate the efficacy of single-dose gentamicin in comparison with single dose of ofloxacin in patients underwent transrectal ultrasound guided biopsy of prostate. Methods: 109 patients undergoing a prostate biopsy were randomly assigned to two groups: the first group was treated with a single dose of ofloxacin (400 mg) prior to the biopsy and the second with a single dose of gentamicin (3 mg/kg). Clinical signs and symptoms, and urine tests and cultures were followed 2 and 7 days after procedure. Results: 57 patients received Ofloxacin and 52 Gentamicin. 3 patients in the Ofloxacin group (5.2%) and 4 in the gentamicin group (7.6%) developed urinary tract infections (N.S). No diferences were seen in the clinical outcome between the groups. Conclusion: The development of quinolone resistant bacteria has led us to examine alternative options for prophylactic treatment before prostate biopsies. Gentamicin, was as efficient as quinolones in the prevention of urinary tract infections. A single dose prior to the procedure is sufficient and longer treatment duration is unnecessary. doi:10.1016/j.ijid.2010.02.1930 50.005 Reducing inappropriate antibiotic usage and costs in an academic Hematology-Oncology unit via antimicrobial stewardship C.L. Yeo ∗ , T.S. Wu, R. Lim, P.A. Tambyah, L.Y. Hsu National University Health System, Singapore, Singapore Background: Rising consumption of broad spectrum antimicrobials and increasing prevalence of resistant pathogens have raised concerns about antimicrobial use in recent years. Antimicrobial stewardship programs have been reported to improve patient and institutional outcomes while potentially reducing cost and resistance rates. In the light of these findings, an antimicrobial stewardship program (ASP) was initiated in a tertiary care hospital in Singapore. Methods: The program was initiated in July 2009 and piloted in the haematology-oncology department. A prospective audit and feedback mechanism was employed for review of patients on selected broad spectrum antimicrobials. Appropriateness for use was assessed based on indication of therapy, dose of antimicrobials used, and duration of therapy. Recommendations were made by infectious disease physicians to the primary team in writing. Appropriateness of use, recommendations made, patient savings and clinical outcomes were analyzed for a period of four months after initiation of the program. Results: A total of 462 cases were reviewed of which 64% of them were appropriate. The most commonly prescribed antimicrobials were piperacillin/tazobactam, ceftazidime and imipenem, making up 19%, 16% and 15% of the cases audited respectively. Among the recommendations made, de-escalation and discontinuation of antimicrobials were the most common, each making up 27% of the recommendations. This was followed by recommendations for IV-to-PO switch and advice on treatment duration, which made up 11% of

the recommendations each. The overall acceptance rate of the recommendations was 89%. An estimate of the potential patient savings due to the accepted recommendations came up to $24, 590 over the four months period. There was no significant negative impact on clinical outcomes following the recommendations. Conclusion: ASP has demonstrated its impact in reducing unnecessary use of broad spectrum antimicrobials and cost to patients. Extension of the program is likely to reduce selection pressure for drug-resistant pathogens in the institution and decrease antimicrobial expenditure. doi:10.1016/j.ijid.2010.02.1931 50.006 Tigecycline usage in osteomielitis caused by multidrugresistent acinetobacter: A report of 10 cases from a single institution N.M. Ruiz 1 , E. Gayoso 2,∗ , Y. Vasquez 3 1

Hospital militar, Caracas, DC, Venezuela Hospital Millitar, caracas, DC, Venezuela 3 Hospital Militar Dr. carlos Arvelo, Caracas, DC, Venezuela 2

Background: Acinetobacter infectious has been identified in soldiers who participated in wars as Korean, Vietnam and Middle Orient, by now the therapeutics options are limited for this type of multidrug resistant microorganism, we know that the use is not approved for de treatment a bone infectious, so we found necessary to evaluate the efficacy of tigecycline in the treatment of this entity. Methods: We identified 10 patients with chronic osteomielitis during 2007-2008, this study of cases is prospective, descriptive analytical, we use the microbiological method of Kirby-Bauer and the criteria of inclusion were patients with clinical diagnosis, microbiology isolation, imaging and bone biopsy. Exclusion criteria: inmunocompromised and pregnant woman. Results: 10 patients completed the study; the 88% were males, age 19 to 72 years, mean 39 years. The more common location were: hip, femur, tibia, sacrum and calcaneus. The risk factors identificated were: open fracture, vascular compromise, prolong use of antibiotic, long stay and reinterventions. Positive cultures for A. baumannii 100%. They received different regimens of antibiotics without success, at this time we began with tigecycline IV 100 mg the first day and then 50 mg IV q 12hs for 6-7 weeks, all the patients included a combined surgical and medical management. Conclusion: 90% showed clinical improvement, and the importance of this study is that tigecycline may be a therapeutic option for chronic osteomyelitis resistant Acinetobacter sp, under which treatment options are very limited. doi:10.1016/j.ijid.2010.02.1932