Clinical Microbiology and Infection
Surgical site infection (SSI) is one of the most frequent nosocomial infections. Since 1999, a national coordination of regional networks has been implemented to gather SSI incidence data according to standardised method. The aim of the current study was to describe the largest database ever collected in France on SSI and to analyse a 6-year temporal trend. Methods: Surgery patients were enrolled by voluntary participating wards in a yearly 3-month incidence survey. In each ward, 200
... surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard CDC criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed. Results: During 6 years, the study included 620,176 operations (17,430,253 operated patient-days follow-up; median post-operative follow-up: 28 days). The overall SSI incidence rate was 1.68%. Organ space and deep incisional SSI accounted for 41.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.91% [0.88-0.94%] for NNIS-0 patients to 13.8% [12.5−15.2%] for NNIS-2, 3 patients. The SSI incidence varied from 1.15% for herniorraphy to 9.2% for colon surgery. In NNIS-0 patients, emergency surgery increased the SSI risk for C-section whereas videoscopy surgery was at lower risk for cholecystectomy. From 1999 to 2004, NNIS-0 SSI incidence decreased from 1.1 to 0.9 for 100 operated patients (relative difference: −18%). According to procedure, the trend remained significant only for herniorraphy. Conclusion: This database provided thorough standardised estimate of SSI incidence according to various surgery procedures. Impact of the national policy on SSI incidence remains to be further evaluated, although encouraging results were evidenced for specific surgery. Objectives: Healthcare associated infection (HAI) incidence rates after delivery range from 0.26% to 20.3% according to the mode of delivery, the maternity activity, women risk factors. Data on HAI surveillance in maternity units are lacking. The Mater Sud-Est Study Group is a HAI continuous surveillance network on maternity units located in south eastern France. We report changes in risk-adjusted HAI rates over a 6-year long surveillance period in this maternity units network. Methods: 161,077 vaginal deliveries and 37,074 cesarean deliveries were included in the surveillance between January 1st 1997 and December 31st 2003. We studied the changes in four HAI: endometritis and Urinary tract infection (UTI) after vaginal deliveries, surgical site infection (SSI) and UTI after cesarean deliveries. We used a logistic regression modeling to estimate risk-adjusted HAI rates. The year of delivery was considered as a risk factor. The trend of risk-adjusted HAI rates over the study period was studied by a linear regression of the year-of-delivery odds ratios for each targeted HAI. Results: The rate of endometritis and UTI after vaginal deliveries was 0.3% (534/161,077) and 0.5% (728/161,077) respectively. Over the study period the decrease in endometritis odd ratios was statistically significant. We found no statistically significant trend in vaginal delivery's UTI. The rate of SSI and UTI after cesarean deliveries was 1.5% (571/37,074) and 1.8% (685/37,074) respectively. Over the study period the decrease in SSI and UTI odd ratios was statistically significant. Conclusion: These findings highlight the positive effect of participating in a surveillance network for infection control and for improvement of care. Infection Alert, Investigation & Surveillance Network (RAISIN) Bordeux, FR Background: National surveillance of occupational blood and body fluids exposures (BBFE) in France is conducted since 2002 through the Nosocomial Infection Early Warning, Investigation and Surveillance Network (Raisin) in collaboration with Geres (Groupe d'Etude sur le Risque d'Exposition des Soignants aux Agents Infectieux). Methods: Participation of healthcare facilities (HCF) is voluntary and anonymous. BBFE occurring from 01/01/04 to 31/12/04 were documented using a standardised questionnaire documenting the nature, circumstances (mechanism, type of device, infectious status of the source) and follow-up of each BBFE. Incidence of BBFE is reported per 100 hospitalisation beds, by type of personnel per 100 full time equivalents (FTE), or by type of material per 100,000 devices. S4 17th ECCMID / 25th ICC, Oral presentations Results: In 2004, 13,041 BBFE were documented in 371 participating HCF, which accounted for 15% of HCF and 29% of hospitalisation beds in France. BBFE overall incidence was 8.9 per 100 beds. Considering that all French hospitals account for 465,494 beds, 41,276 [95% CI: 40,896-41,656] BBFE could have occurred in France in 2004. HCV or HIV status of the source was not known for more than 20% of documented BBFE. Post-exposure prophylaxis (PEP) was prescribed to 4.5% of exposed personnel (vs. 5.8% in 2003 and 6.3% in 2002); this decrease may reflect the impact of April 2003 French recommendations, which reduced PEP indications. For the first time in 2004, sutures were the most frequent cause of BBFE associated with needles (more than subcutaneous injections) and accounted for 1,103 (11%) of all BBFE; one third occurred among residents, and 20% in ICU or emergency rooms (beyond surgery or obstetrics). Prevention through education and use of safety devices (such as blunt suture needles) may thus be a priority. Data from a cohort of 173 HCF which participated in 2003 and 2004 also were compared and demonstrate significant progresses. Compliance to glove use increased from 58.6% in 2003 to 62.3% in 2004, and BBFE incidence among nurse assistants fell from 2.3 in 2003 to 2.1 per 100 FTE in 2004. Last, BBFE incidence fell from 17.2 to 13.7 per 100,000 catheters, and from 71.6 to 43.2 per 100,000 implantable venous access systems. Conclusion: AES-Raisin is one of the biggest BBFE surveillance network and results demonstrate an increase in observance to standard precautions and a significant decrease in the incidence of some types of BBFE. They also point out future priorities for improvement. O18 A randomised trial of 2% chlorhexidine in 70% alcohol compared with 10% povidone-iodine for venipuncture site disinfection: effects on blood culture contamination rates G. Suwanpimolkul, M. Pongkumpai, W. Kulwichit, C. Suankratay (Bangkok, TH) Background: Contaminated blood cultures have been recognized as a bothersome issue for decades, and continue to cause a frustration for clinicians. The contamination rates vary widely between institutions from less than 1% to over 6%. Skin antiseptics can prevent the contamination of blood cultures. To our knowledge, no randomised trial of 2% chlorhexidine in 70% alcohol for venipuncture site disinfection has been conducted. Objective: Our study was aimed to evaluate the efficacy of venipuncture site disinfection with 2% chlorhexidine in 70% alcohol compared with 10% povidone-iodine in preventing blood culture contamination. Patients and Methods: A prospectively randomised investigator-blinded trial was conducted in all patients hospitalised in Internal Medicine wards and attended at emergency department at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from August 15 to October 31, 2006. Antecubital venipuncture sites were randomly disinfected with either 2% chlorhexidine in 70% alcohol or 10% povidone-iodine, and blood cultures were drawn by medical students or residents. The blood culture contamination rate associated with each antiseptic was then determined. Results: Of 2,146 blood culture collected during the study, 108 (5.03%) were contaminated with skin flora. The contamination rate for blood cultures after 2% chlorhexidine in 70% alcohol was 3.2% (34 of 1,068), compared with a rate of 6.9% (74 of 1,078) (P < 0.001) after 10% povidone-iodine. Of the inpatient wards, the contamination rate was 2.6% (18 of 695) and 3.9% (28 of 709) after 2% chlorhexidine in 70% alcohol and 10% povidone-iodine, respectively (P = 0.013). Of emergency department, the contamination rate was 4.3% (16 of 373) and 12.5% (46 of 369) after 2% chlorhexidine in 70% alcohol and 10% povidone-iodine, respectively (P < 0.001). The most common contaminant organism was coagulase-negative staphylococci (81%). Conclusion: 2% chlorhexidine in 70% alcohol is superior to 10% povidone-iodine for venipuncture site disinfection before blood culture sampling. O19 Assessing the biological efficacy and rate of recontamination following hydrogen peroxide vapour decontamination Objectives: The inanimate hospital environment can become contaminated with nosocomial pathogens. Hydrogen peroxide vapour (HPV) decontamination has proven effective for the eradication of persistent environmental contamination but the rate of recontamination following HPV decontamination is largely unknown. We investigated the extent of methicillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant enterococci (VRE) and gentamicin-resistant Gram-negative rod (GNR) contamination in a ward side-room occupied by a patient with a history of MRSA, VRE and GNR infection and colonisation. Methods: Fifteen standardised sites in the room were sampled using a selective broth enrichment protocol to culture for MRSA, VRE and GNR. Sampling was carried out before cleaning, after cleaning, after HPV decontamination and at intervals over the subsequent 19 days on two separate occasions. Results: Environmental contamination was identified before cleaning on 60%, 30% and 6.7% of sites for MRSA, GNR and VRE, respectively and 40%, 10% and 6.7% of sites after cleaning (figure). Only one site (3.3%) was contaminated with MRSA after HPV decontamination (figure). No recontamination with VRE was identified and no recontamination with MRSA and GNR was identified in the two days following HPV decontamination (figure). Substantial recontamination towards pre-cleaning levels was identified by day five and six after HPV decontamination for MRSA. Recontamination with GNR at approximately post-cleaning levels was noted on days 7, 8 and 19 ( Figure 1 ). Infection control S5 infection control measures. Detection of risk groups and infection sources and knowing the transmission ways of infections are important for the prevention from NI. In this study it was aimed to evaluate the knowledge level and behaviour models of hospital cleaning staff about NI in our setting which is a 1788 bedded tertiary care educational hospital. Methods: A questionnaire of with 21 questions was implemented to the hospital cleaning staff, who volunteered to enter the study. The questionnaire was composed of two parts: first part contained parameters for determination of sociodemographic properties and the second contained questions about evaluation of the knowledge about prevention from NI. Questions were prepared by using the references about the subject and by the help of the executives of the cleaning staff firm and statistics unit. Data were evaluated by SPSS 13.0 programme using Chi square and Student's t tests. The questionnaire was completed by one by one interview method. Results: A total of 240 of 290 (82.7% of total, 122 male, 118 female, aged 36.2±8.7) hospital cleaning staff volunteered to enter the study. When evaluated according to the educational status; 55.4% were graduated from primary school and only 54% had been working in the hospital more than three years. Mean knowledge level was 18.15±3.97 (maximum 24). Knowledge level was not associated with gender, educational status and duration of working as cleaning staff (p > 0.05) but mean knowledge level of the staff working in the clinics was found higher than staff working in administrative sections (p < 0.05). 71.3% had received a formal education about prevention from NI before starting working but their mean knowledge level was not different from the others (p = 0.294). Only 48% and 50% knew the true order (x,y), while cleaning the patient rooms. 58.8% thought that they could prevent themselves from NI by hand washing before and after cleaning process, 80.8% stated they obeyed handwashing rules and 90.4% stated that they used gloves. Only 48.3% stated that they dried their hands by paper towels. Conclusion: Measurement of the level of the knowledge of the hospital cleaning staff may be beneficial for determination of the existing problems. Periodical well-established educational programmes should be started to improve the current situation. Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) causes increasing healthcare problems worldwide. Rapid and sensitive screening methods for direct detection of MRSA are essential to limit further spread in the hospital. The purpose of this study was to evaluate the new molecular dipstick assay GenoQuick ® MRSA (Hain Lifescience, Nehren, Germany) for the direct and specific detection of MRSA in clinical specimens. Methods: The analytical specificity of the assay was evaluated by using a subset of 25 MRSA isolates (including SCCmec types I−V); 17 methicillin-susceptible S. aureus (MSSA) and 38 coagulase-negative staphylocococi (CoNS) of different culture collections. The lower detection limit of the assay was determined by serial dilutions of MRSA strains representing SCCmec types I to IV. The test was evaluated for direct detection of MRSA in clinical swab specimens. MRSA carriage was analysed by both the standard culture methods [Chromagar MRSA (Becton Dickinson, Heidelberg, Germany), Columbia blood agar, trypticase soy broth] and two PCR assays [GenoQuick MRSA and GenoType ® MRSA Direct (Hain Lifescience)]. Both PCR assays were performed directly from the swab and after overnight incubation in trypticase soy broth. MRSA isolates were confirmed using a mecA gene and S. aureus specific PCR. Susceptibility testing was performed with an automated system (VITEK 2, bioMérieux, Nürtingen, Germany). Results: The lower detection limit of 25 CFU was determined with serially diluted MRSA strains. For analytical specificity all MRSA strains representing SCCmec types I to V were tested positive by the assay. The MSSA and CoNS were tested negative, respectively. Of 187 patient specimens tested for clinical evaluation, 24 were identified MRSA-positive by culture and by both PCR assays. One specimen was positive only by PCR. Among the 163 culture-negative specimens, 162 were negative with both PCR assays. The GenoQuick assay showed a diagnostic sensitivity of 100%, and a diagnostic specificity of 99.4%, a positive predictive value of 96% and a negative predictive value of 100%. Time-to-result for the direct detection of MRSA from clinial specimens is reduced to 2h 20min with the molecular GenoQuick MRSA dipstick assay (2h 5min for amplification and 15 min for detection). Conclusions: The GenoQuick MRSA dip stick assay proved to be a rapid, sensitive and specific assay for direct detection of MRSA in clinical swab specimens in 2h 20min. O22 Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus Background: The anterior nares are considered to be the primary colonisation site of Staphylococcus aureus (S. aureus) and approximately 30% of healthy people carry the bacteria in their anterior nares. However, recent studies indicate that the throat may be an additional important site of colonisation (Nilsson P. J Clin Microbiol 2006). Most screening programmes for S. aureus including methicillin-resistant S. aureus (MRSA) require a swab from the nose only, and a swab of the throat is not considered as standard. Objectives: To determine the frequency of positive S. aureus cultures with positive samples from the throat and negative from the nares. Methods: Specimens were obtained with a sterile polyester fiber-tipped swab moistened with sterile saline from the anterior nares (5 rotations in each anterior nostril), the posterior wall of the pharynx, and the soft palate. Swabs were transported to the laboratory in a transport tube (M40 Transystem, Copan, Brescia, Italy) and put in selective enrichment broth (Chapman broth containing brain heart infusion broth with 6% NaCl, Biomedics, Madrid, Spain). Results: A total of 905 individuals were screened for S. aureus between 2000 and 2005. Complete data were unavailable from 54 individuals who were excluded. Overall, S. aureus was isolated in 386/851 (45.4%) individuals from any site. Screening results No. of % of overall Nares Throat individuals positive pos pos 196 50.8% pos neg 119 30.8% neg pos 71 18.4% 386 100% neg neg 465 Conclusion: Limiting S. aureus screening to the nares fails to identify 18.4% of carriers. Additional cost can be avoided by pooling the specimens while maintaining the higher sensitivity. Therefore, optimal screening for S. aureus should include swabs from both the nares and the throat. This may be even more important if screening is focused on MRSA carriage. Objectives: MRSA rates in a hospital in the North-East of Scotland were significantly declining due to a series of infection control interventions. S6 17th ECCMID / 25th ICC, Oral presentations These included terminal disinfection of the environment in isolation rooms and cohort areas by application of 1:1000 sodium hypochlorite in place of detergent (ECCMID '06, abstract P1333). We evaluated the effect of replacing sodium hypochlorite with a standard detergent. Methods: From January 1997 to May 2006, monthly percentage, nonduplicate S. aureus clinical cases caused by MRSA were collated. In February 2005 hypochlorite cleaning solution as replaced by a standard detergent. Other infection control measures remained unchanged. Dynamic regression analysis with linear transfer functions and interrupted time-series analyses were used to estimate the effect to the intervention. Results: Previously, MRSA rates wee successfully reduced due to environmental screening (p = 0.03), use of hypochlorite for environmental disinfection (p = 0.002), use of alcohol based hand disinfection (p = 0.03) and patient admission screening (p < 0.01). Stopping the hypochlorite disinfection was associated with a sudden increase in clinical cases of MRSA from 10 to 25% over a 6 month period (p = 0.03), with levels approaching those seen prior to the start of the infection control programme in 2001 (see figure). Conclusions: Stopping hypochlorite environmental disinfection was strongly associated with an increase in clinical MRSA cases. This work adds significantly to the meagre published evidence that environmental contamination is important in the spread of MRSA. Objectives: To determine antibiotic-resistant enterococci in Portuguese piggery samples and to analyse antibiotic resistance genes among these strains after European growth promoter ban. Methods: Samples from waste treatment and dry faeces from 2 pig farms in the South of Portugal were studied during 2006. Samples were plated onto selective Slanetz-Bartley agar with or without antibiotics. Bacterial identification was performed by both standard biochemical profiles and amplification of species specific genes. Antibiotic susceptibility (12 antibiotics) was determined by disk diffusion method (CLSI). Detection of genes coding for resistance [vanA, B, C1, C2, ermA, B, C, tetM, L, O, K, S, aac(6 )-Ie-aph(2 )-Ia, aph(2 )-Ib,Ic,Id, aph(3 )-IIIa, vat E] were searched by PCR. Results: We identified 84 enterococci (9 E. faecalis, 17 E. faecium, 1 E. gallinarum, 2 E. casseliflavus and 55 Enterococcus spp.) . Most isolates showed decreased susceptibility to tetracycline, minocycline, erythromycin, and quinupristin-dalfopristin (95%, 94%, 80%, 54%, respectively), and to a lesser extent to high-level of resistance (HLR) of streptomycin, nitrofurantoin, ciprofloxacin, HLR to gentamicin, chloramphenicol and ampicillin (52%, 33%, 32%, 21%, 11%, 10%). All were susceptible to glycopeptides. Non-susceptible isolates to tetracyclines, aminoglycosides and macrolides contained tetM (55%), tetL (54%), tetM+tetL (32%), tetS (5%), aac(6 )-Ie-aph(2 )-Ia (89%), aac(6 )-Ie-aph(2 )-Ia+aph(3 )-IIIa (47%), ermB (49%). vanC1 was linked to E. gallinarum, and vanC2 to E. casseliflavus as expected. Conclusions: Although all growth promoters were progressively removed from EU in the course of the last 10 years, antibiotic multiresistant enterococci were isolated in Portuguese piggeries. Whether persistence of these antibiotic resistant strains is due to selection by antibiotics or other agents deserves further studies. O25 Experiences and results from the surveillance programme of resistance in feed, food and animals in Norway (NORM-VET) 2000-2005 M. Norström, H. Tharaldsen, M. Sunde (Oslo, NO) Objectives: The monitoring programme for antimicrobial resistance in the veterinary and food production sectors (NORM-VET) was established in 2000. The goals of the programme are to monitor the antimicrobial resistance situation in feed, food and animals over time, in relation to the human situation and to the resistance situation in other countries. Data from NORM-VET could form a basis for risk assessments and be a tool for targeting interventions and further to evaluate the effectiveness of such interventions. This study was performed to summarise the experiences and results obtained during the first six years of the programme. Methods: The zoonotic agents Salmonella (from feed, animals and food) and Campylobacter jejuni (from broiler and broiler meat) were monitored annually. E. coli and Enterococcus spp. (indicator bacteria) were sampled from various animal species and meat products biannually. Specific clinical isolates from the routine diagnostic have been included biannually. The isolates have mainly been tested using a microdilution technique (VetMICTM). The minimum inhibitory concentrations were recorded and analysed in WHONET 5.3. For the categorising of the isolates as resistant or susceptible epidemiological cut-off values were applied. Results: The occurrence of resistance in the monitored species and products is in an international perspective low and the results from the first six years of the programme show that the situation is stable. Conclusion: Evaluation of the first six years of the programme has recognized that the relatively low number of isolates of each species and source included complicates the conclusions possible to draw from the data, especially evaluating trends over time. Even though the run costs of the programme has been limited to a minimum, it is still useful for the purpose of monitoring antimicrobial resistance within a country as Norway, where the resistance problem in the animal and food sectors still is at a very low level. It also consists as valuable source for further research of antimicrobial resistance mechanisms and development. However, the use of this source to perform risk assessments is limited as there still is a lack of even more specific data as for instance data on usage at animal or farm level. O26 Comparison of antibiotic susceptibilities of Staphylococcus aureus and S. intermedius isolates from dog owners and their dogs M. Boost, S. Lai, D. Ko, M. O'Donoghue (Kowloon, HK) Objectives: Antibiotic resistance in veterinary isolates has been reported to be higher than in human isolates due to frequent empirical use, and there are concerns about transfer of resistance between staphylococcal species. S. intermedius is the more common colonising species in dogs, but S. aureus, including MRSA, may also be present. Case reports suggest there can be cross-infection between companion animals and man. Increasing concern about MRSA in the community has led to recommendations for surveillance of antibiotic resistance in isolates from companion animals. This study compared antibiotic resistance in isolates of S. aureus and S. intermedius from dogs and their owners. Methods: A cross-sectional study of owners and their dogs was performed using a convenience sample of 800 pairs recruited at six veterinary practices. Nasal swabs were collected from both owner and Resistance surveillance S7 dog, and held at 4ºC in transport medium until culture within 8 h of collection. Subjects completed a questionnaire providing demographic information of owner and dog, and stating if the dog had received antibiotics within the last 3 months. Swabs were inoculated onto blood agar and mannitol salt agar and placed in 5% salt meat broth for enrichment. S. aureus or S. intermedius were identified by means of coagulase, VP, polymyxin susceptibility, and trehalose fermentation. Several colonies of each isolate were tested for susceptibility to methicillin. Antibiotic susceptibilities were determined by disc diffusion and interpreted using CLSI guidelines. Results: S. aureus: 168 owners (25%) and 64 dogs (8.5%) were colonised. 16 owners and their dogs were concurrently colonised. 6 dogs (1.3%) and 4 humans (0.5%) were colonised with MRSA. Resistance to oxacillin, clindamycin, gentamicin, tetracycline and fusidic acid was significantly higher in dog isolates. S. intermedius: 64 dogs (7.9%) and 8 owners (1.1%) carried S. intermedius. Four colonised owners had colonised dogs. Methicillin resistance was not detected. Resistance to chloramphenicol, clindamycin, tetracycline, and cotrimoxazole was higher in dog isolates. Resistance to fluoroquinolones and gentamicin was only displayed by dog isolates. Conclusions: Methicillin resistance was found only in S. aureus, but resistance to other antibiotics was higher in S. intermedius. Dog isolates were more resistant than human for both species. Veterinary use of antibiotics may increase resistance and the risk of transmission of resistant strains. Objectives: Antimicrobial susceptibility to human-use antibiotics was investigated among the commensal bacteria E. coli (Ec) and Enterococcus spp. (Ent) from healthy food animals at slaughter across the EU. Methods: Colon or caecal content was randomly collected at 4 abattoirs per country (n = 5 per host). Each herd/flock was sampled once. Ec and Ent were isolated using standard methods. Antibiotic susceptibility testing was done by agar dilution (CLSI, M31-A2) against 9 (Ec) and 5 (Ent) antibiotics in a central laboratory. Resistance (CLSI, M100-S16) was assessed per drug/organism/country. Results: A total 1465 Ec were recovered (cattle n = 490, pigs n = 494, chickens n = 481). Mean resistance (%) for Ec was: ampicillin (A) 3, 29, 53; cefepime 0, 0, 0; cefotaxime 0, 0, 0.4; ciprofloxacin 1, 0.4, 6; chloramphenicol 2, 16, 15; colistin 0, 0.4, 0; gentamicin (G) 1, 2, 2; tetracycline 8, 66, 65; and trimethoprim-sulfamethoxazole 4, 42, 52 respectively. For Ec, Italy and Spain consistently showed the highest resistance; Denmark showed the lowest. A total of 718 Ent isolates were recovered, comprising 356 E. faecium, 83 E. faecalis and 279 other species including E. durans, E. hirae and E. casseliflavus. All Ent but one bovine isolate, were susceptible to linezolid. For E. faecium resistance to A and G was 0−2%; vancomycin (V) resistance amounted to 1.9 to 3.5%, whereas resistance to quinupristin/dalfopristin (Q/D) combination varied: 8% (cattle), 19% (pigs) and 20% (chickens). Though low prevalence of E. faecalis limited conclusions, particularly in chickens (n = 6), G and V resistance was low in cattle and pigs (0-11%), resistance to Q/D was very high (46 and 83%, respectively). In the other Ent species, resistance among the 3 hosts to G and V was low (0−1.6%). Resistance to A was absent except in chickens: 9.8%. Q/D resistance was among the highest: 5−9% for livestock hosts; 26% in poultry. Striking differences among countries were absent for Ent. Conclusion: This pan-EU survey, with uniform methodology, shows that antimicrobial resistance among enteric commensal bacteria at slaughter was variable. For Ec, prevalence of antimicrobial resistance varied for older antimicrobials and between countries but resistance to newer medically important antimicrobials was absent or very low. With respect to Ent, antimicrobial resistance rates varied for quinupristin/dalfopristin, but resistance was absent or very low for other antimicrobials including linezolid and vancomycin. O28 Demography and antibacterial susceptibility of communityacquired respiratory tract infection pathogens in Year 6 vs Year 5 of the PROTEKT surveillance programme D.J. Farrell, C. Couturier, D. Felmingham (London, UK; Paris, FR) Objectives: Patterns of antibacterial resistance among communityacquired respiratory tract infection (CARTI) pathogens vary among countries. PROTEKT is a global surveillance study monitoring antibacterial resistance among CARTI pathogens. We report here the results of the sixth year of the PROTEKT study (Y6: 2004-2005) and changes compared to Y5 (2003-2004). Methods: Clinical isolates of Streptococcus pneumoniae (SPN) and Haemophilus influenzae (HI) from respiratory samples were submitted from 93 centres from 28 countries. MICs and susceptibilities were determined according to CLSI guidelines. Genotyping was performed to define macrolide resistance mechanisms. Frequencies were compared for Y5-Y6 common sites using c 2 or Fisher's exact tests as appropriate with a = 0.05. Results: In Y6, a total of 5182 SPN and 1609 HI were collected. SPN/HI distribution by site were: sputum & BAL (55%/72%), blood (19%/2%), nasopharynx (10%/13%), ear (10%/7%), sinus (6%/6%). The distribution of specimens by age groups were: 2 y 12%, 3−14 y 14%, 15−64 y 44%, and >64 y 30%. SPN penicillin and erythromycin resistance (PR and ER) prevalences were 19% and 35% respectively [20% erm(B), 9% mef(A), 5% erm(B)+mef(A), and 1% ribosomal mutation]. SPN with both PR and ER was >25% in Far East, South Africa and France and >15% in Hungary, Poland, US and Australia. Significant increases in PR were seen in Poland and China. Falls in PR were seen in Italy, Spain and Japan. Erythromycin resistance was stable in all countries except Germany and Venezuela (decrease). SPN with multiple drug resistance (>2 antibiotic classes) increased in Poland and decreased in Russia. Prevalence of isolates resistant to at least 5 antibiotic classes increased in China. Betalactamase (BL) production in HI was 14% overall, while 2.9% of HI were BL negative and ampicillin resistant (BLNAR). BL production frequencies were stable in all countries except South Africa (increase). Telithromycin showed a sustained activity against both SPN (99.6% susceptible, MIC50/90 0.015/0.25 mg/L) and HI (99.3% susceptible, MIC50/90 1/2 mg/L). Conclusions: Resistance to several first-line antibacterials is a continuing problem worldwide. The last 2 years of PROTEKT indicate changing patterns of resistance in several countries. Telithromycin exhibited significant in vitro activity against the principal CARTI pathogens, including strains resistant to other agents. O29 Community-acquired respiratory tract infections in Europe caused by S. pneumoniae, H. influenzae and Moraxella catarrhalis: report from 10 years of monitoring by the SENTRY Program R. Jones, M. Stilwell, T. Fritsche, H. Sader (North Liberty, US) Objectives: To determine the antimicrobial susceptibility (S) patterns for S. pneumoniae (SPN), H. influenzae (HI) and M. catarrhalis (MCAT) when tested by reference CLSI methods using samples collected from 1997-2006 in 13 European (EUR) nations. Trends in S and the occurrences of well defined resistance (R) mechanisms were assessed. Methods: A collection of community-acquired respiratory tract infections (CA-RTI) pathogens (6,753 SPN; 6,280 HI; and 1,908 MCAT for all years) were annually forwarded to a central reference laboratory for S test processing and confirmation of organism identity. All antimicrobials were tested by CLSI methods, results interpreted by M100-S16 (2006) and quality control rigidly applied to assure accuracy. Analysis of trends used mean S rates by nation for the initial and last 3 years sampled.