O616 Rapid identification and antimicrobial-drug resistance of nontuberculous mycobacteria from post-operative chronic non-healing wound patients at tertiary care centre in northern India A.K. Singh*, T.N. Dhole, A.K. Maurya, R.S.K. Marak, A.K. Singh, M. Kumar, J. Umrao, R. Singh, R. Garg, S. Kant (Lucknow, IN)
Objectives: Mycobacterium tuberculosis complex and nontuberculous mycobacteria (NTM) may or may not have same clinical presentations, but the treatment regimens are always different. Previous few reports suggest that the prevalence of NTM has increased particularly in post-operative patients, but population-based data to substantiate this are still lacking. The present study aimed to evaluate the clinical utility of the novel GenoType® Mycobacterium Common Mycobacterial/Additional Species (CM/AS) assay for rapid identification of NTM, their risk factors and antimicrobial drug resistance among clinical isolates of chronic non-healing wound cases at a tertiary care hospital in Northern India. Methods: We conducted a prospective clinico-microbiological analysis of all the patients of having chronic nonhealing post-operative wound infections from January 2009-October 2012. Discharging pus/drains were processed for Ziehl-Neelsen staining, culture by BacT/ALERT® MP and simultaneous identification from clinical specimens by GenoType® CM/AS assay (Hain Lifescience, Nehren, Germany). Antimicrobial sensitivity testing was performed only for rapidly growing mycobacteria (RGM) by broth microdilution method using CLSI guideline. Results: We identified 208 patients who presented or referred to our centre with chronic non healing wound with suspected NTM infection. Among these a total of 41 (19.7%) NTMs were isolated; and identified as Mycobacterium fortuitum (36.6%) the most common species followed by M. ulcerans (14.6%). These types of infection caused by NTMs was significantly higher in patients who had operated with laparoscope (80.5%) and in age group >20-40 years (63.4%) [p<0.05]. Resistance to doxycycline (39.3%), cefoxitin (25.0%), linezolid (21.4%), ciprofloxacin (21.4%), co-trimoxazole (17.9%), clarithromycin (17.9%), ceftriaxone (14.3%), amikacin (10.7%) and imipenem (7.1%) were higher among 28/41 (68.3%) RGM tested. Conclusion: We found NTM was frequently isolated (19.7%) from post-operative chronic non-healing wound cases and represented a true infection. The most common species and risk factor associated with NTM was M. fortuitum (36.6%) and use of laparoscope during surgeries respectively (80.5%; p<0.05). The most common resistance was seen with doxycycline (39.3%) and cefoxitin (25.0%) among RGM. The GenoType® assay makes rapid and accurate identification of NTM even directly from clinical specimens for the definitive management of these NTM infections.
Fluid-Management Strategies in Acute Lung Injury To the Editor: The results of the Fluid and more ventilator-free days and 2.7 more ICU-free Catheter Treatment Trial (FACTT) conducted by days at day 28.1 The investigators’ conclusions the National Heart, Lung, and Blood Institute regarding the management of ARDS with restric- Acute Respiratory Distress Syndrome (ARDS) Clin- tive fluids an
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