K-2. Antimicrobial Resistance: a Focus on Gram- Negative Bacterial Resistant Threats

Infection & Chemotherapy 2019 Sep;51 (Suppl 1):i-x

Infection & Chemotherapy

Journal homepage: www.icjournal.org

Introduction

On behalf of the organizing committee of the joint meeting of 4th ICIC (International Interscience Conference on Infection and Chemotherapy) and 12th ISAAR (International Symposium on Antimicrobial Agents and Resistance), we are very pleased to publish the supplement of the Infection & Chemotherapy (ic) Journal that includes abstracts of the presentations presented from September 26 to 28, 2019 in Gyongju, Korea.

The scientific program of ICIC & ISAAR 2019 is packed with many critical and most updated topics including current status and future perspectives of antimicrobial resistance, new antibiotics and vaccines, infection control, and emerging infectious diseases.

The supplement includes abstracts of 11 keynote plenary lectures, 42 scientific presentations by invited speakers, 24 oral presentations and 285 poster presentations which are presented during two and half exciting days of ICIC & ISAAR 2019. It is our wish that physicians and scientists from four corners of the world can share the state-of-the-art knowledge and information about antimicrobial resistance and emerging infectious disease threats from this joint conference of ICIC & ISAAR 2019.

All members of the organizing committee are grateful to all invited speakers and poster/oral presenters as well as Infection & Chemotherapy Journal and its editorial office helped us to prepare the supplement.

Jae-Hoon Song, MD, PhD Yang Soo Kim, MD, PhD Walter Wilson, MD Co-chair, ICIC & ISAAR 2019 Co-chair, ICIC & ISAAR 2019 Co-chair, ICIC & ISAAR 2019 Founder & Chairman Chairperson, KSID Mayo Clinic, USA APFID, Kore Asan Medical Center, Korea

Infection & Chemotherapy

Journal homepage: www.icjournal.org

Abstracts of the 4th International Interscience Conference of Infection and Chemotherapy and 12th International Symposium on Antimicrobial Agents and Resistance (ICIC & ISAAR 2019) HICO, Gyeongju, Korea, September 26-28, 2019

Speaker Presentations

September 26, 2019

Keynote 13:00 ~ 15:40 Lecture 1 Strategies for overcoming AMR and threatening ID

K-1 Control of seasonal and pandemic influenza Benjamin Cowling The University of Hong Kong, Hong Kong, China

K-2 Antimicrobial Resistance: A focus on Gram-Negative Bacterial Resistant Threats Michael Rybak Wayne State University, USA

K-3 Use of Molecular Epidemiology for Overcoming HIV Drug Resistance Davey Smith University of California San Diego, USA

K-4 Emerging Fungal Threats Monica Slavin Peter MacCallum Cancer Centre, Australia

K-1. Control of seasonal and pandemic influenza

Benjamin J. Cowling WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong, China

Influenza viruses cause considerable morbidity and mortality each year in seasonal epidemics. Influenza pandemics occur from time to time with the potential to cause even greater health and economic impact than typical annual epidemics. Controlling seasonal and pandemic influenza is therefore a public health priority. There are three main classes of interventions to control influenza, namely vaccines, therapeutics, and non-pharmaceutical interventions. In this presentation, I will discuss the evidence supporting their use.

Influenza have moderate effectiveness against seasonal influenza, and one factor that causes the effectiveness to vary from year to year is the degree of difference in the antigenic match between vaccine strains and circulating strains. Because most influenza vaccines are produced in chicken eggs, in a process that can take many months, it is thought that vaccines will not be available to control the next influenza pandemic at least in the earliest stages. Influenza antivirals have an important role to play in treating influenza, but are often reserved for patients with more severe disease or with a greater risk of disease progression, and are not generally used to control transmission in the community.

Thus, efforts to control the next pandemic will rely largely on non-pharmaceutical interventions (NPIs). Most influenza virus infections cause mild and self-limiting disease, with only a small fraction of cases requiring hospitalization, and influenza virus infections therefore spread mainly in the community. Influenza virus is thought to transmit predominantly via respiratory droplets but the size distribution of particles responsible for transmission remains unclear, and in particular there is a lack of consensus on the role of fine particle aerosols in transmission. There are major uncertainties in the effectiveness of simple personal protective measures against influenza, such as hand hygiene and face masks. Influenza virus infections are thought to spread mainly through close contact in the community (e.g. homes, workplaces, schools, public places, etc.), with more frequent and intense contact among children having a particularly important role in transmission. Social distancing measures aim to reduce the frequency of contact and increase physical distance between individuals, thereby reducing the risks of person-to-person transmission. School closures are a good example of a social distancing measure that can reduce influenza transmission in the community, although there are high social costs and ethical issues. A final group of NPIs is measures related to international travel, including entry and exit screening of travelers for infection, travel restrictions or reductions, and border closures. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S3

K-2. Antimicrobial Resistance: A focus on Gram- Negative Bacterial Resistant Threats

Michael J. Rybak1-3 1Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, 2Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, 3Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, USA

Antibiotic resistance continues to be a major threat to public health worldwide. Current expenditures have been calculated to exceed $55 billion per year in the United States alone, and estimates predict that over ten million people will die worldwide by the year 2050 from antimicrobial resistance. The most worrisome pathogens that have the highest dangers are the multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) Gram-negative isolates. The most common mechanisms of Gram- negative resistance include beta-lactamase and antibiotic-modifying enzymes, loss of porins, overexpression of transmembrane efflux pumps, target mutations, ribosomal modification, and/or mutations in lipopolysaccharide structure. The Centers for Disease Control and Prevention (CDC) list carbapenem-resistant Enterobacteriaceae (CRE) as an urgent threat, and MDR Acinetobacter spp., MDR Pseudomonas aeruginosa, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae as serious threats; specifically, these organisms account for an estimated 600, 500, 440, and 1,700 deaths per year, respectively, and these numbers are predicted to rise. Furthermore, the World Health Organization (WHO) lists these four organisms as their highest priority pathogens for research and development (R&D) of new antibiotics. Stepping up the battle against Gram-negative resistance will likely include a combination of strategies such as the application of antimicrobial stewardship (ASP), rapid diagnostic testing (RDT), timely administration of antimicrobials, combination therapy, vaccinations and the use of new novel agents including bacteriophage (phage) therapy. It is also vitally important that the antimicrobial pipeline continues to keep pace with the continuing changing antimicrobial resistance patterns emerging. ASP initiatives have been shown to decrease antibiotic consumption and lower the rates of antibiotic resistance. RDT can help shorten the window to organism identification and susceptibility results and thus can assist in antimicrobial de-escalation and provide support for decreasing the time to appropriate therapy. The main rationale behind utilizing combination antimicrobial therapy is to exploit possible synergy and decrease the emergence of resistance. The majority of vaccinations in our armamentarium provide activity against viruses; however, multiple vaccinations against Gram-negative pathogens are pending approval. Although a narrow pipeline of antimicrobials to target these problem Gram-negative organisms are in pre-clinical development, options that are currently available are extremely limited. The 10 x ’20 initiative is a collaborative program to promote an antibiotic R&D operation to develop ten new antibiotics by the year 2020. Currently approved agents that are promising to help our fight against Gram-negative resistance include ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, plazomicin, and eravacycline. Despite these encouraging therapeutic agents, real-world data to implement these products on a widespread basis is not currently available. Other antimicrobials that are presently in the Gram-negative pipeline include cefiderocol, fosfomycin disodium, sulopenem, aztreonam/avibactam, cefepime/AI101, and LYS228. Bacteriophages are viruses that hijack the machinery within bacteria, replicate within the cell, lyse the organism, and release their offspring to re-initiate the process. Phage monotherapy has been shown to be potent against resistant Gram-negative bacteria. Even more promising is the utilization of phage-antibiotic combinations, as this approach has shown many positive interactions, including the stimulation of phage production, reductions in bacterial growth, enhanced biofilm degradation, and alterations in the emergence of bacterial resistance. Although these steps may assist in the ongoing fight against Gram-negative resistance, the public and healthcare community must work together to make these effective. The purpose of this presentation is to explain current trends in Gram-negative resistance and describe novel approaches to prevent and target Gram- negative infections. S4 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

K-3. Use of Molecular Epidemiology for Overcoming HIV Drug Resistance

Davey Smith University of California San Diego, USA

This talk will discuss the use of molecular epidemiology methods to identify and track HIV networks. These methods use sequence data from standard HIV genotypes that are collected for HIV drug resistance testing. The sequences are then analyzed in real-time to infer ‘clusters’ of highly related HIV infections. These methods can identify ‘hot spots’ of HIV transmission, including the transmission of drug resistant HIV. The demographics, risks and clinical characteristics associated with people with HIV in the identified clusters can be used to efficiently target prevention efforts, like enhanced treatment adherence measures, to stop cluster growth. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S5

K-4. Emerging Fungal Threats

MA Slavin Peter MacCallum Cancer Centre, Royal Melbourne Hospital and National Centre for Infections in Cancer, Melbourne, Australia

The field of mycology continues to evolve. Changes in immunosuppression use result in new patterns of infection. Two of the leading opportunistic infections remain CMV and invasive fungal infection and their occurrence is related. New antifungal drugs are being studied which will have advantages in treatment of azole resistant fungal infections and these drugs are needed with the emergence of Candida auris and mould infections in transplant recipients. Increasing antifungal resistance mandates a strong stewardship response and rapid diagnostic tests are needed to direct therapy in this patient group. Genomics are another tool increasingly applied for epidemiology and infection prevention. The new frontiers for study in this vulnerable patient group are manipulating the microbiome and host immune response to prevent and treat infection. Expertise and collaboration across disciplines is needed to develop and implement these interventions in the immunocompromised population. S6 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 26, 2019

16:10 ~ 17:30 Opening Session

O-1 Middle East Respiratory Syndrome: what we should learned from the 2015 Korea Outbreak Myoung-don Oh Seoul National University College of Medicine, Korea

O-2 75 Years of cephalosporins David Livermore University of East Anglia, UK Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S7

O-1. Middle East Respiratory Syndrome: what we should learned from the 2015 Korea Outbreak

Myoung-don Oh Professor, Dept. of Internal Medicine, Chief, Div of Infectious Diseases, JW Lee Center of Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. Since then, as of June 2019, 2449 cases of MERS-CoV infection were reported to WHO from 27 countries, with a case fatality ratio of 34.5%. The 2015 Korea outbreak of MERS-CoV involved 186 cases, including 38 fatalities. Nosocomial transmission occurred at 16 hospitals, and 4 largest clusters accounted for 82% of the total cases. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. Economic loss was estimated as 8.5 billion US dollars.

The lessons we learned from the 2015 Korea outbreak of MERS are as follows. (1) A single, missed case may trigger a huge, nationwide outbreak. (2) The first line of defense against emerging infection is doctors in the community clinics/hospitals, and they should be well informed about emerging infectious diseases through continuing medical education. (3) Superspreading events may occur in healthcare settings, especially at emergency departments/ICUs, and therefore improving infection prevention and control practices in all health care facilities is required. (4) Early detection and isolation of cases is of critical importance. (5) Aggressive strategy for quarantine is necessary, especially when large number of individuals are exposed in the healthcare settings. (6) Droplet precautions should be added to the standard precautions when providing care to any febrile patients with respiratory symptoms. S8 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

O-2. 75 Years of Cephalosporins

David M Livermore Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.

The deployment of penicillin in the early 1940s spurred a huge search for antibiotic-producing fungi and streptomycetes. Around 1944 Giuseppe Brotzu, a public health doctor in Sardinia (Italy) began to think it strange that children who swam near a sewage outfall rarely caught typhoid despite the disease being prevalent on the island. He speculated that something killed bacteria entering the sea. Whether or not his hypothesis was correct will never be known, but he did isolate an antimicrobial-producing mould – Cephalosporium acremonium – from the outfall. Untroubled by the strictures of modern medicine (or even the ethics of the time) he used crude extracts of this to treat infections, with some apparent success. But Brotzu was no chemist and could take his discovery no further. Instead the mould culture was passed to the Oxford team who had developed penicillin. They found it produced 3 antibiotics – penicillin N, a toxic steroid and, in trace amounts - cephalosporin C. It was almost 20 years after Brotzu’s discovery the first derivatives of this ‘natural cephalosporin’ finally – cephalothin and cephaloridine – finally reached the market. Thereafter, progress was swift. Compared with penicillins of the same era the early cephalosporins had a broader spectrum and were lesser vulnerable to β-lactamases. Even more important, the cephalosporin nucleus proved more manipulable that the penicillin, allowing successive ‘generations’ of molecules in which anti-gram-negative activity was progressively increased, with lower MICs and more species covered. Incorporation of a 7’ oxyimimo-aminothiazolyl increased stability to the b-lactamases prevalent in the 1970s and 80s, and this structure is present in virtually every cephalosporin developed from the late 1970s onwards. By the 1990s cephalosporins had become ‘standard of care’ for many infections. But this proved their undoing. Resistance proliferated, first by the selection of Enterobacteriaceae and P. aeruginosa mutants that hyperproduce AmpC cephalosporinases, then via the spread of extended-spectrum β-lactamases – particularly CTX-M types. Cephalosporins were also strongly implicated in disturbing the gut microbiome so as to select for C. difficile infection. As these problems proliferated and the century turned it seemed that the glory days of the cephalosporins were over; their roles were supplanted by penicillin b-lactamase inhibitor combinations and carbapenems. But now we are seeing a renaissance, fuelled both by the remarkable range of modifications that can be made to the cephalosporin nucleus and by the strategy of combining cephalosporins with β-lactamase inhibitors – something that should have been done decades ago. New cephalosporins and cephalosporin combinations, now reaching the clinic offer new activity, with coverage against many problem bacteria. Thus, ceftaroline and ceftobiprole are the first anti-MRSA-β-lactams. Ceftolozane/ tazobactam is the most active antipseudomonal β-lactam, overcoming efflux and AmpC mediated resistance in the species (though not that due to carbapenemases) as well as most ESBL-producing Enterobacteriaceae. Ceftazidime/avibactam overcomes KPC and OXA-48-like carbapenemases in Enterobacteriaceae, as well as ESBLs and AmpC, though not metallo-carbapenemase. Finally, cefiderocol – which is accumulated via bacterial iron uptake systems, overwhelming bacterial defences – has low MICs for Enterobacteriaceae and non-fermenters with all carbapenemase types. In short, there is considerable life left in the cephalosporins as they enter their fourth quarter century…. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S9

September 27, 2019

09:00 ~ 11:00 Symposium 1 Antimicrobial resistance of Gram positive bacteria

S1-1 Understanding and overcoming persistent staphylococcal infections Andrew Edwards Imperial College London, UK

S1-2 Treating multidrug-resistant S. aureus Vance Fowler Duke Department of Medicine, USA

S1-3 New Approaches to the Management of Gram-Positive Infections Michael Rybak Wayne State University, USA

S1-4 Biofilm formation and antimicrobial resistance in osteoarticular infection by staphylococci: Kyung-Hwa Park Chonnam National University Hospital, Korea S10 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S1-1. Understanding and overcoming persistent staphylococcal infections

Rebecca S. Clarke, Kam Pou Ha, Andrew M. Edwards* MRC Centre for Molecular Bacteriology and Infection, Imperial College London, UK

Staphylococcus aureus is responsible for a raft of different infections, including bacteremia, infective endocarditis and osteomyelitis. These conditions are often hard to treat and frequently lead to chronic or recurrent infections despite high dose antibiotic therapy and a potent host immune response. The long-term persistence of S. aureus in host tissues is typically associated with genotypic and phenotypic changes that reduce bacterial virulence but enhance resistance to host defences and/or antibiotics. For example, small colony variants typically arise via mutations in genes that encode components of biosynthetic pathways and are resistant to, or tolerant of several different antibiotics. However, the factors that drive genotypic diversity and the mechanisms by which these altered phenotypes confer resistance to host defences and antibiotics are largely undetermined. Therefore, the objective of this work was to understand the host and bacterial factors that promote host adaptation and how the resulting phenotypes contribute to staphylococcal survival in the host, with a long-term objective of designing novel therapeutics that prevent these processes. One of the most important host defences against S. aureus is the neutrophil, which targets phagocytosed staphylococci with the oxidative burst, a mixture of reactive oxygen species. Our data show that the phagocytosed S. aureus suffer DNA damage leading to induction of the mutagenic SOS response as shown by recA reporter assays. Subsequent work using a panel of mutants identified specifc DNA repair processes that were essential for survival of S. aureus during interactions with neutrophils and intraperitoneal infection in mice. In addition to enabling staphylococcal survival of host immune defences, the repair of oxidative DNA damage enhanced the emergence of small colony variants, via mutations within genes that encode components of the electron transport chain, via the action of the error prone polymerase UmuC, which is part of the SOS regulon. We subsequently found that one of the advantages of the SCV phenotype for S. aureus is high level resistance to killing by neutrophils, providing an explanation for the association of this phenotypic variant with long-term staphylococcal infections. Recent years have provided evidence that bactericidal antibiotics trigger the production of reactive oxygen species in bacteria, which contributes to the killing activity of these drugs. Multiple distinct classes of antibiotics triggered SOS induction in S. aureus, although this varied in some cases depending on the staphyloccal strain and antibiotic class. For example, the aminoglycoside gentamicin did not trigger recA expression, whilst the bacteriostatic drug chloramphenicol did. Since the majority of antibiotics caused DNA damage in both strains investigated, we determined which repair processes were needed to survive exposure to the antibacterials. This revealed a crucial role for the same repair processes used by S. aureus to survive phagocytosis by neutrophils. Crucially, we also discovered that this repair pathway is required for induction of the mutagenic SOS response. Therefore, a single DNA repair pathway was discovered to promote staphylococcal survival during exposure to neutrophils, antibiotics and induction of the SOS response associated with host adaptation and acquisition of antibiotic resistance (Figure 1). Since inhibition of this DNA repair pathway would be expected to aid immune clearance of infection and promote antibiotic efficacy, we are currently developing small molecule inhibitors. Preliminary data suggest that we have generated a small molecule that potentiates the activity of the antibiotic ciprofloxacin, whilst reducing the SOS response. On- Figure 1. A single DNA repair pathway promotes going work aims to assess whether this molecule also promotes immune- staphylococcal survival during exposure to neutrophils mediated killing of S. aureus and whether the efficiacy of the molecules can and antibiotics, and for induction of the mutagenic be enhanced. In summary, staphylococcal DNA repair processes are central SOS response associated with host adaptation and the to both pathogen survival and host adaptaton by promoting resistance to acquisition of antibiotic resistance. It is anticipated host defences and antibiotics and triggering induction of the SOS response. that inhibition of staphylococcal DNA repair would Pharmacological inhibition of DNA repair could, therefore, provide a useful provide a useful therapeutic approach that sensitises therapeutic approach in the era of widespread antibiotic resistance. S. aureus to host defences and antibiotics. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S11

S1-2. Treating multidrug-resistant S. aureus

Vance Fowler Duke Department of Medicine, USA

Several controversies and advances have arisen in the treatment of infections caused by Multidrug-Resistant Staphylococcus aureus (MRSA). First, new antibiotics are available but are expensive and lack robust data to inform their use in the most needed clinical settings. Second, the use of combination antibiotics to treat MRSA remains controversial. Finally, standardized management strategies for MRSA, treatment algorithms to inform duration of treatment for Staphylococcal bloodstream infection, and new adjunct therapies for MRSA offer exciting advances in the management of this serious, common infection. This talk will summarize recent developments in the treatment of MRSA. S12 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S1-3. New Approaches to the Management of Gram- Positive Infections

Antibiotic resistance continues to increase at alarming rates. According to the Center for Disease Control and Prevention, more the 2 million individuals in the US alone are infected with antibiotic resistant pathogens each year and these infections kill more than 23,000 individuals every year. There has been a void of novel antibiotic discoveries and over the last 30 years and an extreme shortage of new anti-infectives in the pipeline over the last two decades. While there is an urgent need to create new antimicrobials, there is also an urgency to prevent the further spread of antibiotic resistance and to preserve our remaining armamentarium of antimicrobials. One strategy for combating the emergence of resistance is the use of antibiotic combinations. Antibiotic combinations have the potential to improve the time of patient response, improve overall drug performance in the case of providing synergy and lower the target antibiotic exposure threshold needed to improve organism eradication. In addition, antibiotic combinations may facilitate lower daily antibiotic doses, the potential to de-escalate therapy and improve patient safety while lowering the potential for antibiotic resistance. Methicillin-resistant Staphylococcus aureus (MRSA) continues to be one of the most important antibiotic resistant pathogens responsible for high rates of morbidity and mortality worldwide. Case fatality rates for MRSA bloodstream infections is high ranging from 15-45%. Treatment is often challenging due to MRSA’s remarkable ability to evade immunological defenses and antimicrobial killing. Vancomycin has been the mainstay of therapy for many years to treat invasive infections and is still considered the standard of care by many clinicians and experts. However, in recent years, confidence in the effectiveness of this antibiotic has changed due to the ever increasing reports of treatment failure that has been associated with the emergence of strains with reduced susceptibility to vancomycin. Additional characteristics that have been cited to contribute to reduced response to vancomycin include its slower bactericidal rate of killing, susceptibility to the inoculum effect and relatively poorer penetration into a variety of tissues. Daptomycin has gained popularity as a viable treatment option for patients who have failed or are intolerable of vancomycin therapy. While this antibiotic has been shown to have superior invitro activity against MRSA compared to vancomycin, there is limited clinical data to support a true advantage. In addition, the emergence of daptomycin non-susceptibility during therapy has been documented especially following vancomycin therapy. Therefore, combination therapy has been thought to be an important adjunctive treatment option to improve patient outcome and stem the tide of further antimicrobial resistance. Previously, combinations with antibiotics like aminoglycosides and rifampin were very popular to add on to beta-lactams or vancomycin for the treatment of serious gram-positive infections. However, these regimens are no longer recommended due to increased toxicity concerns, harmful drug-drug interactions and lack of clinical data supporting improvement in patient care. Recently, there is data to support novel beta-lactam antibiotic combinations with vancomycin and daptomycin. These combination regimens appear to have the potential to improve patient outcome, may be safer and decrease the potential for antibiotic resistance. This lecture will discuss the proposed mechanisms behind these new and novel antibiotic combinations and present preliminary in vitro and clinical evidence of improved patient outcome. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S13

S1-4. Biofilm formation and antimicrobial resistance in osteoarticular infection by staphylococci:

Kyung-Hwa Park Chonnam National University Hospital, Korea

Staphylococcus aureus and Staphylococcus epidermidis represents the leading cause of osteoarticular infections including orthopedic device related infection. This particular tropism and its ability to cause difficult-to-treat infections lie in the wide panel of staphylococcal virulence factors, which allow host colonization, tissue invasion and host immune system evasion. With regard to osteoarticular infection, three phenotypic mechanisms provide a bacterial reservoir responsible for staphylococcal infection chronicity and relapse. First, osteoarticular infections have associated with biofilm formation and antimicrobial evasions, which emphasize the need of infected tissue removal, especially in cases of orthopedic device associated infections. Biofilms are defined as surface-attached groups of microbial cells encased in an extracellular matrix. Biofilm development can be divided into several key steps including attachment, micro colony formation, biofilm maturation and dispersion; and in each step bacteria may recruit different components and molecules. Second, implications of the ability of staphylococci to invade and persist within bone cells, especially osteoblasts has been suggested for years. Lastly, bacterial phenotype switching to small-colony variant (SCVs) has been associated with persistence of osteoarticular infection. These mechanisms are connected with each other under stringent environmental conditions and result in resistance or tolerance to antimicrobial agents. The mechanism of biofilm-associated antimicrobial resistance seems to be multifactorial. This talk will give an idea about clinical consideration of biofilm formation and antimicrobial resistance mechanism through demonstration of the tough case of orthopedic device related infection by S. aureus. Also, the new innovations in the treatment of biofilm related osteoarticular infections will be introduced. S14 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 27, 2019

09:00 ~ 11:00 Symposium 2 Emerging infectious diseases/Global health

S2-1 Vaccines for Aedes Mosquito-Transmitted Viruses In-Kyu Yoon International Vaccine Institute (IVI)

S2-2 New microbes in humans, a new era Didier Raoult IHU Mediterranee Infection, France

S2-3 GeoSentinel – an unconventional surveillance strategy for emerging infectious diseases David Hamer Boston University Schools of Public Health and Medicine, USA

S2-4 International travel and spread of infectious diseases Joon Sup Yeom Yonsei University College of Medicine, Korea Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S15

S2-1. Vaccines for Aedes Mosquito-Transmitted Viruses

In-Kyu Yoon International Vaccine Institute (IVI)

Over the past several decades, diseases transmitted by Aedes mosquitoes have spread rapidly as both the mosquito vectors and the viruses have expanded their geographic distributions. Population growth, uncontrolled urbanization and skyrocketing international travel have driven epidemics of Aedes-transmitted viruses, most notably dengue, yellow fever, Zika and chikungunya. Dengue is now endemic in more than 120 countries with over half the world’s population at risk. Estimates of approximately 400 million people infected with dengue virus and 100 million symptomatic cases each year vary with the frequency and magnitude of epidemic activity, but are likely conservative. Major dengue epidemics in large tropical urban centers result in significant morbidity and mortality, especially in resource poor countries where they often create chaos and a breakdown in primary health care as hospitals and clinics become overloaded. Yellow fever outbreaks in South America and Africa highlight the continued risk of epidemic yellow fever to global public health, compounded by shortages of yellow fever vaccine supplies, necessitating the large-scale use of fractional-dose yellow fever vaccine. Zika and chikungunya have caused explosive epidemics in the Americas after recent introductions from Asia. Neurological complications from Zika virus infection led to the World Health Organization (WHO) declaring a public health emergency of international concern (PHEIC) in 2016. Co-circulation of different Aedes-transmitted viruses has potential consequences yet to be fully delineated. Fortunately, new tools including vaccines, therapeutics, and novel vector control methods are being developed to add to already existing prevention and control methods. None of these approaches will likely halt the spread of Aedes-transmitted diseases if used alone. For example, vaccines and vector control measures will likely need to complement each other by increasing population level immunity and decreasing transmission intensity, respectively, within the framework of a comprehensive implementation program. Furthermore, complexities in the performance of some of these tools may require additional implementation studies to determine their optimal use. The only licensed dengue vaccine, Sanofi Pasteur’s Dengvaxia®, is a tetravalent live attenuated recombinant vaccine which is effective only in individuals with prior dengue virus infection, and, in fact, increases the risk of severe dengue in some individuals without prior infection. Two other tetravalent live attenuated dengue vaccine candidates, TAK-003 sponsored by Takeda and Butantan-DV sponsored by Butantan, are now undergoing phase III efficacy trials to support possible future licensure. However, concerns remain that these live vaccines may have similar complexities as Dengvaxia®. New vector control tools have shown promise including Wolbachia-infected Aedes mosquitoes which are currently being rolled out in large field efficacy trials and/or implementation projects in several urban centers in Asia and Latin America. Wolbachia-infected Aedes mosquitoes have the theoretical advantage of potentially decreasing vector competence for several different viruses at the same time, including dengue, yellow fever, Zika and chikungunya. The prevention and control landscape for Aedes-transmitted viruses is changing rapidly and will certainly see new and impactful developments within the next few years. S16 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S2-2. New microbes in humans, a new era

Didier Raoult IHU Mediterranean Infection, France

The discovery of microbes has been achieved through optical microscopy, which allows to observe objects with a maximum size of 0.6 to 0.8 μm. This observation made it possible to define the microbes in the XIXth century. Viruses, on the other hand, were defined as elements that could cause diseases but were not visible under the microscope and could be filtered by 0.2 μm filters. Subsequently, the definition of microbes was enriched by the definition of prokaryotes, (without a nucleus) and eukaryotic (with a nucleus) microbes. Later, Woese’s work on the ribosome led to the classification of the microbial world into three branches, bacteria and archaea (that are prokaryotes) and eukaryotes. This classification based on ribosomal RNA analysis remained stable for nearly 40 years. However, the discovery of microbes visible under optic microscope and exhibiting the characteristics of viruses in the 21st century opened the field of giant viruses. The first were mimiviruses, which are visible under optic microscope, and which may contain more than 1000 genes and whose particle contains a DNA chromosome and RNA messengers, more than 500 proteins, and a translation apparatus almost complete for some of them, with the exception of the ribosome. Thus, giant viruses can be considered as microbes without ribosomes, constituting the other branch of life. Since then, systematic sequencing and environmental analyzes have revealed the groups of prokaryotes that are not visible under an optical microscope, which would therefore not meet the definition of microbes. One of these groups seems to have a very distant but common origin with bacteria, commonly called candidatus phylogenetic radiation, that we call “mini-microbes”, which have a size that ranges between 250 and 450 μm. These mini-microbes are present in humans’ mouths and recently we have been able to show them in urine, blood and feces. These microbes are exosymbionts, for the moment, cultured only in the presence of another microbe and are, probably, a new microbial branch. Finally, mini-archaea have also been found in the environment, but not yet in humans to our knowledge. They, probably, also represent an independent branch. It is likely that based on the ribosomal analyzes we will arrive at 5 distinct branches, and if we use other genes, better conserved than the ribosomal rDNA whose RNA polymerase allows to integrate the giant viruses, it is likely that we now have six distinct branches of the living world, of which a large part constitutes obligatory intra or extra cellular parasites. Their role in human pathology is for the moment uncertain given the almost total absence of studies on these emerging areas, as on that of archaea in humans whose first studies are just beginning to appear. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S17

S2-3. GeoSentinel – an unconventional surveillance strategy for emerging infectious diseases

Davidson H. Hamer Professor of Global Health and Medicine, Boston University Schools of Public Health and Medicine, USA

Recent decades have seen increasing outbreaks of emerging and re-emerging infectious diseases in many different regions of the world. While some of these will be identified by national and international surveillance systems, initial signals of potential outbreaks may be missed if local laboratory capacity is restricted in terms of resources and funding or if novel pathogens are not being routinely tracked. There is thus a need for alternative, innovative strategies for the surveillance and detection of emerging infectious diseases (EID).

GeoSentinel is an EID network originally created as a joint project between the International Society of Travel Medicine (ISTM) and the United States Centers for Disease Control and Prevention (US CDC). GeoSentinel has several major objectives including conducting surveillance for EIDs; rapidly sharing novel data on emerging infections with participating sites, internet information services (e.g. ProMED), and public health authorities (e.g. US CDC, European CDC, Public Health Agency of Canada); and analyzing, presenting, and publishing surveillance results collaboratively with CDC, GeoSentinel sites, and GeoSentinel’s two regional subnetworks, CanTravNet and EuroTravNet.

The GeoSentinel surveillance network provides robust data that defines the spectrum of illness and its relation to place of exposure for significant health risks facing travelers and migrants. There are currently 68 GeoSentinel sites in 29 countries and 221 Affiliate Members with a presence on every continent except Antarctica. The GeoSentinel database now contains about 300,000 patient records; these include 54% post-travel visits, 31% seen during travel, and 15% migrants.

GeoSentinel has successfully identified new outbreaks over the last two decades including leptospirosis in participants in the Borneo Ecochallenge (2000); sarcocystis in travelers to Tionan Island, Malaysia (2010); an outbreak of dengue fever in Angola (2013); schistosomiasis in vacationers in Corsica (2014); sentinel cases of Zika virus disease in Costa Rica (2016), and Vietnam (2016); yellow fever in areas of Brazil that were not thought to be at risk (2018); and chikungunya in travelers in southern Thailand (2019).

In summary, GeoSentinel is a vibrant unconventional global surveillance system that has made important contributions to the identification of EID outbreaks and trends in infectious disease epidemiology among travelers and migrants. In addition, GeoSentinel has the potential, through the development of a biobank of clinical samples, to collaborate with high level laboratories in academia and government to identify new pathogens responsible for respiratory, gastrointestinal, and systemic infections. GeoSentinel translates clinical and epidemiological data into meaningful evidence that is of critical importance to the containment of the global spread of infection. S18 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S2-4. International travel and spread of infectious diseases

Joon-Sup Yeom Division of Infectious Diseases, Yonsei University College of Medicine, Korea

International travel is a main force in disease emergence a spread worldwide. As a result, the number of imported infectious diseases is increasing in many parts of the world and they can spread rapidly throughout the world causing significant impact on world economy and health. For example, SARS, pandemic influenza, MERS, Ebola and many other infectious diseases had been spread new geographic area. Factors associated with vulnerability of countries to the importation and spread of infectious diseases include population density, international travel, animal reservoirs, healthcare and public health infrastructures. To proactively respond to various emerging infectious diseases, it is necessary to quickly identify which diseases are occurring and where they occurring. With the development of the Internet, it has become the basis for obtaining various information quickly and easily. There are several services including Pro- med, GPHIN, Medisys, Healthmap, CIDRAP, and WHO DON, provide information on infectious disease outbreaks around the world in different formats but it is impossible to manually monitor all the data collected there. Also in addition to the distance between the origin of outbreak and the relevant countries, the amount of human exchange has to be considered to estimate the risk of importing the disease. Information on air travel can help identify the origin of the importation and predict further geographic spread. Since it is difficult to evaluate or predict the possibility of the introduction of such diseases by simple disease information, recent attempts have been made to overcome limitations by incorporating various technologies such as machine learning and artificial intelligence. In this presentation, Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S19

September 27, 2019

09:00 ~ 11:00 Symposium 3 Infection Prevention and Control

S3-1 How can WGS help in nosocomial outbreak investigations? Stephan Harbarth Geneva University Hospital, Switzerland

S3-2 The role of environmental cleaning to reduce MDROs Anucha Apisarnthannarak Thammasat University Hospital, Thailand

S3-3 Carbapenemase-producing Enterobacteriaceae-The ideal and the Real Jin-Hong Yoo Bucheon St. Mary’s Hospital, Korea

S3-4 Surveillance of surgical site infection: present and future Doo Ryeon Chung Samsung Medical Center, Korea S20 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S3-1. How can WGS help in nosocomial outbreak investigations?

Stephan Harbarth Geneva University Hospitals, Switzerland

Studying hospital outbreaks by using molecular tools, i.e. synthesizing the molecular epidemiology data to its appropriate clinical- epidemiologic context, is crucial in order to identify infection source, infer transmission dynamics, appropriately allocate prevention resources and implement control measures. Whole-genome sequencing (WGS) of pathogens has become the reference standard, as it is becoming more accessible and affordable. Consequently, sequencing of the full pathogen genome via WGS and major progress in fit-for-purpose genomic data analysis tools and interpretation is revolutionizing the field of outbreak investigations in hospitals. Metagenomics is an additional evolving field that might become commonly used in the future for outbreak investigations. Nevertheless, practitioners are frequently limited in terms of WGS or metagenomics, especially for local outbreak analyses, as a result of costs or logistical considerations, reduced or lack of locally available resources and/or expertise. As a result, traditional approaches, including pulsed-field gel electrophoresis and multilocus sequence typing, along with other typing methods, are still widely used. In my presentation, I will summarize current challenges, strengths and limitations of WGS for nosocomial outbreak investigations, using examples from the published litterature as well as from our own experience in Geneva (Switzerland). In addition, I will attempt to provide recommendations (whenever applicable), to clinicians, hospital epidemiologists and microbiologists pertaining to the efficacy of the various typing methodologies available to study the molecular epidemiology of outbreaks caused by the most significant pathogens in nosocomial settings. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S21

S3-2. The role of Environmental cleaning to control MDR-pathogens

Anucha Apisarnthanarak Thammasat University Hospital, Thailand

Over the past decade, there are abundant evidences in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin- resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. In this session, I will discuss an approach to facilitate effective surface cleaning and disinfection in health care facilities. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a “no touch” room decontamination technology and to ensure compliance for patients on contact and enteric precautions. S22 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S3-3. Carbapenemase-producing Enterobacteriaceae- The ideal and the Real

Jin-Hong Yoo Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Bucheon St. Mary’s Hospital, Bucheon, Korea

Carbapenem-resistant Enterobacteriaceae (CRE) including carbapenemase-producing Enterobacteriaceae (CPE) are now spread worldwide. In Korea, the number of CRE isolation is rapidly increasing, and impending endemicity is a concern. Therapeutic options include polymyxin, tigecycline, or the combination of them with carbapenem, which is currently the mainstay of treatment. In addition, various combination regimens with new carbapenemase inhibitors and other classes of antimicrobials are in the process of evaluation. To cope well with CRE/CPE, thorough infection control, such as active surveillance, early detection, strict contact precaution, cleaning the environment, and antibiotic stewardship is very important. In this lecture I would talk about the basics of CRE/CPE, and then I will cover the ideal principles of infection control for the CRE/CPE. In addition, I would also like to present some unexpected hardships that actually occur in the clinical settings. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S23

S3-4. Surveillance of surgical site infection: present and future

Doo Ryeon Chung Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine; Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea

Surgical site infection (SSI) remains one of major surgical complications causing significant morbidity, mortality, and increased cost. Surveillance of SSI has been established as the core component for the prevention of SSI and recent studies have shown the positive impact on reducing rates of SSI. However, conventional SSI surveillance has been dependent upon comprehensive manual review of medical records which are labor-intensive and time-consuming. As the surveillance extended to a wide range of surgical procedures, the need for developing the surveillance methods to overcome these obstacles has increased. Many hospitals worldwide use electronic medical records, and challenge has continued to develop the tools identifying the cases with specific clinical outcomes from the records using the various techniques such as electronic algorithms and machine learning. Recently, there have been increasing reports on successful development of SSI surveillance tools applying the electronic algorithms with prediction model. Although those are still at primitive levels to enable only semi-automated surveillance, it was possible to reduce the work burden on infection preventionists significantly. Rapidly advancing artificial intelligence technology is expected to make fully- automated systems for SSI surveillance possible in the near future. S24 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 27, 2019

11:10 ~ 11:50 Plenary Lecture 1

P1-1 Novel digital technologies in the control of infectious diseases Jae-Hoon Song Asia Pacific Foundation for Infectious Diseases, Korea Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S25

P1-1. Novel digital technologies in the control of infectious diseases

Jae-Hoon Song Asia Pacific Foundation for Infectious Diseases (APFID), Korea

Progress in science and technology has led to breathtaking improvement in medicine in last century. It has transformed how we encounter our patients, make diagnoses, treat illnesses, and prevent diseases. However, no previous historical progress has been as fundamentally transformative as the one we are witnessing now. Novel digital technologies, which has already reshaped our daily living, are now beginning to change the way we understand diseases and practice medicine. Albeit the application of novel technologies has been concentrated on chronic diseases such as cancer, diabetes, or heart diseases, there have been several projects on infectious diseases worthy of note.

1. Web-based digital epidemiology The electronic health record (EHR) system has been widely implemented during the last two decades, but detailed analysis of those vast collection of digitized data became possible with recent development in data management and computing power. As data from individual hospitals harbors significant limitations in volume and generalizability, large datasets from groups of hospitals, local government agencies, regulative bodies, and commercial firms have been used for research of infectious diseases, among innumerable fields. One step further, many groups are building collaborative efforts to collect large-scale, international, standardized collections of healthcare data. The Observational Health Data Sciences and Informatics (OHDSI, pronounced “Odyssey”) is one of the largest such programs. Use of more general concept of “big data,” collected from the internet and social networking services (SNS), has been implemented in the fields of epidemiology and outbreak responses. After the Google Flu Trends spearheaded the emergence of “digital epidemiology,” internet-based surveillance has been applied to monitor the activity of respiratory, and vector-borne infections. Digital resources for infectious disease detection include Pro-MED mail, GPHIN, HealthMap, MedISys, Argus, BioCaster, and EpiSPIDER. HealthMap is an example of such effort, which aggregates information from online news, eyewitness reports, and official reports for monitoring disease outbreak and emerging infectious diseases. Furthermore, ResistanceOpen project provides an online map of antimicrobial resistance, based on publicly available and user contributed resistance data. Big data can provide more expansive information when combined with large scale clinical and genomic data. Information provided by such data could give a valuable insight on the transmission dynamics of infectious diseases, helping find optimal intervention strategies to control them. One such project, PANGEA-HIV 2 is a consortium to identify individuals with higher risk of infection or infecting others using phylogenetic methods. Digital epidemiology using big data has clear advantages in middle- and low-income countries where resources for epidemiologic surveillance are insufficient. However, the closure of Google Flu Trends showed the pitfall of this approach alone, and “hybrid” systems that integrate traditional and digital surveillance have been proposed. Despite such setbacks, big data and digital epidemiology seem to have a promising role in precision public health.

2. Mobile-based surveillance Mobile devices are virtually ubiquitous nowadays. mHealth, a term used for medical and public health measures using mobile devices, are being actively tried in the area of infectious diseases. Classical approach is the use of mobile devices as a channel for the dissemination of health-related information between general public and authorities. The possibility has been studied during the Ebola outbreak in Africa. Mobile phone apps have been used to educate people on transmission methods and common symptoms of Ebola, and to report suspected cases or absence thereof by local officers. Mobile devices can be also used to help patients with chronic conditions adhere to the treatment and respond appropriately to side-effects. Many studies have demonstrated a potential role of mHealth in care for people with HIV/AIDS. Twitter became an alternative data source because anyone with an internet connection can retrieve Twitter data. For instance, a study from 2014 showed that incorporating data from Twitter into CDC influenza- like illness models can reduce forecasting errors.

3. Point-of-care test Recent technological progress enabled the production of diagnostic devices which are small enough to be carried to point-of-care (POC), return results within hours at most, does not require trained professionals, and are economically affordable. Such devices, S26 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

combined with mHealth, will provide POC microbiologic tests where traditional laboratory does not exist. Also, wearable devices have been applied to monitor various information ranging from vital signs to hand hygiene.

4. Artificial intelligence Interest on machine learning (ML) and artificial intelligence has been predominantly concentrated on the interpretation of digitized information (e.g., radiologic imaging or retinal fundus photographs) and clinical decision-making. Regarding infectious diseases, there were studies which used ML to trigger a warning for patients with suspected sepsis or septic shock. Also, ML has been applied to predict risk of Clostridium difficile infection, reservoirs of zoonotic diseases, and clinical outcomes in Ebola virus disease infection. In a broader perspective, there have been studies to use ML for novel drug discovery and pharmacovigilance.

Novel digital technologies will transform medicine and public health in coming days. The field of infectious diseases are not an exception. Big data, digital epidemiology, mobile and ubiquitous devices, and machine learning will provide unforeseen depth of new insight to how we diagnose, treat, and prevent infectious diseases. However, various limitations and hurdles lie ahead. Initiatives and expertise from those who are at the frontline of battle against infectious diseases will be of critical importance. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S27

September 27, 2019

11:50 ~ 12:30 Plenary Lecture 2

P2-1 Paradigm shift in the diagnosis and treatment of tuberculosis Jae-Joon Yim Seoul National University College of Medicine, Korea S28 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

P2-1. Paradigm shift in the diagnosis and treatment of tuberculosis

Jae-Joon Yim Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Seoul National University College of Medicine, South Korea

Globally, 10 million people developed tuberculosis (TB) in 2017. In addition, TB caused 1.3 million deaths among HIV-negative people and an additional 300 000 deaths among HIV-positive people. Early and accurate detection of TB is important for the timely initiation of treatment and prevention of TB transmission. Furthermore, early detection of drug resistance is crucial for early treatment of multi-drug resistant (MDR) TB. Conventional methods for the diagnosis of TB have limitations in terms of early as well as accurate detection. Acid- fast bacilli smears show short turnaround times and high specificity, but lower and variable sensitivity. Confirmation of mycobacterial culture takes a few weeks and conventional drug susceptibility tests based on culture takes another few weeks. To overcome the shortcomings of culture-based TB diagnosis, several methods of molecular diagnosis, which could provide a rapid diagnosis of TB as well as drug susceptibility profiling, was introduced and being adopted more frequently. Among them, the Xpert MTB/RIF assay is being used most frequently. It is an automated, single-cartridge-based nucleic acid amplification test using reverse transcription-polymerase chain reaction detection of the TB-specific rpoB gene. Xpert MTB/RIF assay represents an important advance in the field of rapid molecular diagnosis of TB and drug resistance. The test enables simultaneous identification and detection of TB and rifampicin- resistance to be completed within 2 hours. As rifampicin-resistant M. tuberculosis is also likely to be resistant to isoniazid, the early detection of rifampicin resistance using Xpert MTB/RIF assay prompts the initiation of management of MDR-TB. For the molecular detection of resistance to 2nd line anti-TB drugs, line-probe assay (eg. MTBDRsl assay) is available and the newer version of Xpert MTB/RIF assay (‘ultra’) has been tested. In addition, rapid, reliable, and increasingly affordable whole-genome sequencing of TB bacilli is becoming an option of diagnosis of drug resistance and source investigation of TB outbreak. For the treatment of TB, several repurposed drugs (eg, fluoroquinolones, linezolid) and newly developed anti-TB drugs (eg, bedaquiline, delamanid) became available. To shorten the treatment duration of drug-susceptible pulmonary TB, several 4-month regimens adopting fluoroquinolones instead of isoniazid or ethambutol have been tried. Unfortunately, none of those 4-month treatment regimens showed non-inferiority to the current 6-month regimen. A recent phase 2 trial using linezolid instead of ethambutol failed to show higher rates of culture conversion at 8 weeks of treatment. Several trials testing shorter regimens with high dose rifamycins or new drugs including pretomanid are ongoing. Meanwhile, efforts have been made to shorten treatment for MDR-TB. In 2010, a relapse-free cure rate of 87.9% among 206 patients treated with a 9-month regimen of gatifloxacin, clofazimine, ethambutol, and pyrazinamide throughout the treatment period supplemented with prothionamide, kanamycin, and high-dose isoniazid during an intensive phase of 4 months was reported. These results were replicated in a larger clinical trial (‘STREAM Stage 1’) and the regimen was endorsed by WHO. However, this shorter regimen includes too many drugs, as many as seven, and still includes an injectable agent (kanamycin) for the first 4–6months. Additionally, the number of candidates for this shorter treatment, i.e., patients without resistance to all drugs included in the regimen, could be limited. Based on the proven efficacy of these new anti-TB drugs, several clinical trials using 6–12-month regimens for MDR- TB treatment without an injectable (eg, MDR-END, NeXT, Nix-TB) are on-going. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S29

September 27, 2019

16:00 ~ 17:30 Symposium 4 Antimicrobial Stewardship

S4-1 Core elements for antimicrobial stewardship and CDC’s assessment Arjun Srinivasan Centers for Disease Control and Prevention, USA

S4-2 Management of MRSA bacteremia with antimicrobial stewardship program Tetsuya Yagi Nagoya University Hospital, Japan

S4-3 Evidence-based strategies in antimicrobial stewardship David Lye Tan Tock Seng Hospital, Singapore S30 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S4-1. Core elements for antimicrobial stewardship and CDC’s assessment

Arjun Srinivasan Centers for Diseases Control and Prevention, USA

Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible. The prompt initiation of antibiotics to treat infections has been proven to reduce morbidity and save lives. However, 20-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Like all medications, antibiotics have serious side effects, including adverse drug reactions and Clostridium difficile infection (CDI). Patients who are unnecessarily exposed to antibiotics are placed at risk for serious adverse events with no clinical benefit. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. Unlike other medications, the potential for spread of resistant organisms means that the misuse of antibiotics can adversely impact the health of patients who are not even exposed to them. The Centers for Disease Control and Prevention (CDC) estimates more than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually. Improving the use of antibiotics is an important patient safety and public health issue as well as a national and global priority. In the United States national action plan for addressing antimicrobial resistance calls for improving antibiotic use through antibiotic stewardship. A key challenges to the broad implementation of stewardship programs in US hospitals, and other healthcare settings, has been the lack of a clear definition for what exactly constitutes a stewardship program. Guidance was needed that could be implemented in any healthcare setting and monitored at the local and national level. To address this challenge, the CDC developed the Core Elements of Hospital Antibiotic Stewardship Programs in 2014. This document listed seven key components and actions that were associated with successful stewardship programs. Also starting in 2014, the CDC began assessing implementation of these seven core elements through a national survey completed by almost all acute care hospitals in the country. From 2014 to 2017, the percent of US hospitals indicating that they have implemented all of the core elements has risen from 41% to 76%. The favorable response to the hospital core elements has led CDC to develop similar core elements documents for long term care facilities, nursing homes and resource limited settings, as well as an implementation guide for small hospitals. This lecture will review the development, dissemination and implementation of the core elements, with a focus on the hospital core elements. It will discuss both challenges to and opportunities for expanding and improving implementation. Finally, plans for updating the 2014 hospital core elements will be discussed. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S31

S4-2. Management of MRSA bacteremia with antimicrobial stewardship program

Tetsuya Yagi Nagoya University Hospital, Japan

MRSA bacteremia is a serious infection and can be lethal disease without appropriate therapy. The management of MRSA bacteremia would be one of the important targets of antimicrobial stewardship program (ASP) which focuses not only on dosing and selection of antimicrobial agents, but also appropriate use of clinical microbiological examination and therapies other than antibiotic therapy. Therapeutic outcome of MRSA bacteremia depends on the timing of the institution of appropriate antimicrobial therapy. Application of MALDI-TOF MS or simultaneous multi-items detection for strain identification directly from positive blood culture samples may be useful for institution of early appropriate therapy. Evaluation of entry of MRSA or infection focus of secondary MRSA bacteremia is essential for the choice of antibiotics and source control. Detection of distant metastatic lesions is important determinant for adequate duration of therapy. ASP for MRSA bacteremia in our hospital is based on the 24-hours, 365-days support for blood culture examination so as not to delay the process of the positive samples. On the other hand, AST at the hospital of my outside work (once a week) is lead by pharmacists, and I support them with weekly consultation. For MRSA bacteremia, we developed a bundle consisting of six elements, early institution of anti-MRSA drugs, source control, dose-adjustment using TDM, recheck of blood culture examination, echocardiography, appropriate duration of therapy. After implementation of the bundle, compliance with the elements of the bundle was greatly improved, and 30-day mortality and in- hospital mortality were significantly reduced to be almost half of the pre-intervention period. Multivariate analysis showed sepsis and intervention (introduction of MRSA bacteremia bundle) were two statistically significant factors to influence on the mortality in MRSA bacteremia. S32 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S4-3. Evidence-based strategies in antimicrobial stewardship

David Lye Director, Infectious Disease Research & Training Office, National Centre for Infectious Diseases, Singapore

To combat antimicrobial resistance in hospitals, antimicrobial stewardship program plays a synergistic role with infection prevention and control. Antimicrobial stewardship promotes the optimal use of antibiotics by optimising dosing, route and duration. In this lecture, I will focus on recent evidence base informing practice in the dosing, route and duration of antibiotic use in treating serious bacterial infections. In vitro and in vivo pharmacologic models support prolonged infusion of beta-lactams in target attainment rate. However, randomised clinical trials have so far failed to validate these observations conclusively. Recent observational data supported the role of oral antibiotics in gram negative bacteraemia. However not all oral antibiotics are equal; the role of oral beta-lactams is more controversial. Increasing high-level evidence has reduced the duration of antibiotics in a range of serious bacterial infections, including gram negative bacteraemia. Combination antibiotics are an often proposed strategy for treating highly resistant gram negative bacterial infections. Yet recent evidence including meta-analysis and randomised clinical trials have failed to support its role in MRSA, Pseudomonas and extensively drug resistant gram negative infections. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S33

September 27, 2019

16:00 ~ 17:30 Symposium 5 One health: Human, Animal, and Environment Interfaces in Influenza virus

S5-1 “One Health” strategy to control and prevention of zoonotic influenza threats in humans Woo Joo Kim Korea University College of Medicine, Korea

S5-2 One health: Animal and Influenza Virus Interfaces Youn-Jeong Lee Animal and Plant Quarantine Agency, Korea

S5-3 One health: the Hong Kong experience with influenza Benjamin Cowling The University of Hong Kong, Hong Kong, China S34 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S5-1. “One Health” strategy to control and prevention of zoonotic influenza threats in humans

Woo Joo Kim Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Republic of Korea

Influenza virus infection has been the cause of significant morbidity and mortality in humans through history. Particularly influenza A virus (IAV) causes annual epidemics and infrequent pandemics. IAV is a zoonotic pathogen that is responsible for subclinical or clinical infections in broad host ranges, including wild water-birds, poultry, mammalian animals and humans, etc. IAV infections in human have been limited only to H1, H2, and H3 subtypes. Since the outbreak of H5N1 avian influenza (AI) human infections in Hong Kong in 1997, the episodes of human infections by novel avian or swine influenza viruses have been reported increasingly around the world. H5Ny and H7Ny AI viruses infections among livestock and human populations have occurred in China and Southeast Asian countries since 2003. H1Ny variant swine influenza virus infections have emerged in pig fairs in the United States since 2001. Enzootic AI outbreaks have resulted in huge economic impacts in agricultural sectors. While there is no sustained human to human transmission of zoonotic influenza viruses until now, the emergence and spread of novel animal influenza virus infections in humans is a major concern because of their pandemic potential. With rapid population growth, the rise in poultry and pig breeding, weak farm and animal market biosecurity, and changes in human behaviors, there have been increased risks in the inter-species transmission of animal influenza viruses from wild water-birds to poultry and humans. Lessons learned from experiences of AI outbreaks in agriculture and public health sectors emphasize the One Health (OH) approach to prevent and control of epizootics in poultry and transmissions to humans. Effective OH approach towards zoonotic influenza control and prevention needs to strengthen the intimate collaborations between human, animal and environmental health. This lecture discusses the current situations of animal influenza infections in humans, risk factors and viral determinants for cross-species transmission at the human-animal interface, and the “One Health” strategy for the control and prevention of zoonotic, novel IAV threats. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S35

S5-2. One health: Animal and Influenza Virus Interfaces

Youn-Jeong Lee Avian Influenza Research and Diagnostic Division, Animal and Plant Quarantine Agency (APQA), Korea

Influenza type A viruses are one of the most important agents, which can cause disease in human and animal. Animal influenza viruses can be classified as avian influenza, swine influenza, or other types of influenza viruses depending on their host origin. Wildfowl and shorebirds are thought as natural reservoir of influenza type A viruses. Avian influenza viruses that cause severe disease in poultry are called highly pathogenic avian influenza (HPAI). The cumulative number of HPAI outbreaks in domestic poultry was over 15,467 cases in 68 countries since 2005. The H5 and H7N9 avian influenza viruses persist in some poultry populations and they have caused human infection, sporadically. Human infection with H5N1 avian influenza virus was firstly reported in Hong Kong in 1997. The Goose/Guandong (Gs/Gd) lineage of H5 viruses have spread from Asia to Europe, Africa and North America, and have become endemic in poultry populations in some countries. The cases of inter-countries and inter-continental transmission of H5Nx viruses by wild bird migration have been reported since 2005. The cumulative number of confirmed human cases for avian influenza A(H5N1) was 455 deaths among 861 infected cases in 17 countries during 2003-2019. The Gs/Gd lineage of H5 virus constantly evolves by mutation and reassortment with the emergence of new clade and new subtypes (H5Nx; H5N1, H5N2, H5N3, H5N5, H5N6, H5N8 and H5N9). South Korea also had been affected several times by H5Nx influenza virus since 2003. During 2003-2011, there were four HPAI outbreaks by H5N1 virus. The longest epizootics by clade 2.3.4.4.A H5N8 virus had been occurred during 2014-early 2016. The largest epizootic was caused by clade 2.3.4.4.C H5N6 and clade 2.3.4.4.B H5N8 virus in 16/17 winter season. The last epizootic was occurred in 17/18 winter season by clade 2.3.4.4.B H5N6 virus. From the most cases in each HPAI epizootics in South Korea, genetically closed viruses had been isolated in migratory birds and domestic poultry. It means that the migratory birds were the main source of virus introduction into Korea. Although there was a lot of damage of poultry industry, there was no human infection case in Korea. Korean veterinary authorities have struggled to eradicate HPAI in poultry. The control measures for HPAI are rapid diagnosis, elimination of infected poultry, movement restriction, enhanced surveillance and increasing of biosecurity. In 2013, human infections with H7N9 virus were firstly reported in China. Since then, the virus has spread in poultry of whole country and a total of 615 deaths among 1,567 confirmed human cases have been reported. In China, a H7 vaccine was applied in poultry since September 2017. Although H7 vaccination reduced H7N9 infection case in poultry and human, the risk still exists. Recently, there is new report that some H7N9 and H7N2 viruses, isolated from poultry in China, exhibit the increased virulence and expanded host range to ducks. In Korea, the veterinary authorities have been conducted active surveillance in wild birds, domestic poultry and quarantine process for the monitoring Chinese H7N9. Enhanced active surveillance in animal sectors, including wild birds and domestic poultry, and the effective control measures of influenza outbreaks in poultry sectors can reduce the public health risk. S36 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S5-3. One health: the Hong Kong experience with influenza

Benjamin J. Cowling WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong, China

While human influenza viruses cause a considerable disease burden in our communities each year, avian and swine influenza viruses also cause disease burden in animals, and can pose zoonotic threats to humans. Under the one health framework, control of avian and swine influenza is important. Hong Kong experienced the first outbreak of highly-pathogenic avian influenza A(H5N1) in 1997, with 18 infections of which 6 were fatal. Highly pathogenic influenza A(H5N1) has gone on to cause almost 1000 documented human cases worldwide. Other avian influenza viruses have also spread to humans, including most notably influenza A(H7N9) between 2013 and 2017 in mainland China.

Hong Kong has taken a proactive approach to controlling avian influenza, with a number of measures implemented in farms, wholesale markets and retail markets. These measures have led to major reductions in animal outbreaks, and in the human risk of infection as proxied by influenza A(H9N2) detections in the markets. In the longer term, central slaughtering facilities would be the best way to reduce human risk of zoonotic influenza. A number of the measures adopted in Hong Kong have been implemented in mainland China as a response to the outbreaks of influenza A(H7N9). Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S37

September 27, 2019

16:00 ~ 17:30 Symposium 6 Congenital Infections

S6-1 Updates on congenital CMV infection Yae-Jean Kim Samsung Medical Center, Korea

S6-2 Approach and Management of Perinatal Herpes Virus Infection David Kimberlin University of Alabama at Birmingham, USA

S6-3 Risk and Consequences of Congenital Zika Virus Infection Tawee Chotpitayasunondh Queen Sirikit National Institute of Child Health, Thailand S38 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S6-1. Updates on congenital CMV infection

Yae-Jean Kim Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea

Cytomegalovirus (CMV) is the most frequent cause of congenital infection worldwide, with an estimated incidence in developing countries of 0.6-0.7% of all live births. The burden of disease of congenital CMV infection is significant in the society because it is the leading non-genetic cause of sensorineural hearing loss and an important cause of neurodevelopmental disabilities in children. Recent study suggested that antiviral therapy with 6 months of oral valganciclovir in symptomatic infants, improved hearing and neurodevelopmental outcomes. However, preventive approaches such as use of CMV hyperimmune globulin and development of a maternal vaccine have not shown consistently successful results. Despite its clinical significance, many neonates with congenital CMV infection do not get diagnosed in time because the majority of infected neonates are asymptomatic at the time of birth. Therefore, prenatal detection of newborns at high risk for congenital CMV infection is important. Researchers are trying to find a proper biomarker and best newborn screening method in the field. With efforts, diagnostic, preventive and therapeutic strategies in infants with congenital CMV are evolving. However, there are still needs for the global efforts to increase the awareness among general public, health care providers and health care policy makers. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S39

S6-2. Approach and Management of Perinatal Herpes Virus Infection

David Kimberlin University of Alabama at Birmingham, USA

Approximately 85% of neonatal herpes simplex virus (HSV) cases are perinatally acquired. While disease incidence varies across the world, in the United States the incidence of neonatal HSV has increased to approximately 1 in every 1,900 live births. Diagnostic assessments obtained from neonates suspected of having HSV infection have increasingly utilized molecular technologies, sometimes with strong investigative support of such moves and sometimes because molecular diagnostics have supplanted traditional tissue culture methadologies. Therapeutic advances in the management of neonatal HSV infections have dramatically changed the likelihood that a patient will survive their acute infection. Mortality rates in disseminated HSV disease have decreased from 85% in the pre-antiviral era to 29% today. Mortality rates in neonatal HSV infections involving the central nervous system disease (CNS disease) have been equally dramatic, decreasing from 50% in the pre-antiviral era to 4% today. Improvements in neurologic morbidity have been achieved with use of long-term oral acyclovir suppressive therapy following management of the acute infection. The diagnosis and management of neonatal HSV will be addressed in this session. S40 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S6-3. Risk and Consequences of Congenital Zika Virus Infection

Tawee Chotpitayasunondh Queen Sirikit Nationnal Institute of Child Health, Ministry of Public Health, Thailand

Zika virus (ZIKV) is one member of the Family Flaviviridae, mostly transmitted by biting of infected Aedes mosquitoes. This virus was first isolated from a rhesus monkey in Zika forest, Uganda on 1947 but first human infection were diagnosed on 1952 in Uganda and Tanzania. But the largest human outbreak occurred on 2015-2016 in South, Central and North America. Brazil was hardest hit by wide spread of ZIKV outbreak and had reported newborn babies with microcephaly including other central nervous system malformation which potentially associated to ZIKV. Since then, ZIKV infection have been reported around the world especially from Southeast Asia, Oceania, and parts of Africa. One observational study on 2016-2017 in Thailand found that 21.4% was confirmed ZIKV among symptomatic patients. Study suggest that ZIKV has been circulated at a low but sustained level for at least 16 years as an endemic transmission. Maternal ZIKV infection has been associated with varying degree of fetal, neonatal and infant abnormality outcomes. A congenital Zika syndrome (CZS) has been characterized with microcephaly, brain calcification, abnormal hearing and vision, psychomotor delay, brain stem dysfunction with sucking and swallowing difficulty, seizure, extremities contractures and hypertonia. The risk of microcephaly range from 1% to 15% in confirmed prenatal ZIKV infection. Neurological anomalies including neurodevelopment abnormalities, learning disability which may be late presentation in affected newborn with normal head size or “look-normal” at neonatal period. The greatest risk for CNS damage has been proposed to be maternal infection in the first trimester or 14-17 weeks of gestation. In one largest study of 183 infants which definite or probable diagnosis of CZS with microcephaly found that maternal ZIKV infection had occurred mostly in first trimester 77%, second trimester 18% and third trimester 5%. Pregnancy with ZIKV infection before 7-8 weeks of gestation are at risk of miscarriage of the fetus. The other CNS anomalies of fetus without microcephaly may develop in maternal ZIKV infection after 30 weeks of gestation. The precise mechanism of congenital transmission remain unknown but studies indicate that the placenta and fetal nervous tissues are at risk for ZIKV infection via transplacental transmission. Infant born to ZIKV infection mother should be clinically and laboratory follow up for at least 2 years for the proper management. The definite diagnosis of ZIKV infection especially CZS is solely base on laboratory findings. The gold standard for confirm diagnosis is positive PCR for ZIKV from body fluid specimens while immunological test (IgG or Ig M) have some limitation because of cross reaction with other flaviviruses. But Zika IgM positive in newborn baby blood can be diagnosed as CZS even though PCR for Zika in urine or blood were negative. Pregnant women need to have access to relevant health care system, including contraception, diagnostics and pregnancy-termination services if legally approved. The affected young infants need to have multidisciplinary long term care and support for the better quality of life. Health care provider should identify the timing of the infection during pregnancy which effect on the risk of fetal abnormality in case of symptomatic illness but it is unclear whether asymptomatic poses a risk to the fetus. At present, there is no vaccine for prevention, no antivirals for treatment of ZIKV infection. Preventing mosquito bites are more important by cloths covering, insect repellent, sleep in the mosquito nets and destroying the breeding place. Safe sex for 3-6 months after returning from Zika area is important for sexual transmission of this virus. Conclusion : National surveillance of ZIKV infection among pregnant women , newborn with microcephaly and /or other neurological abnormality will help to better care and management of this maternofetal and neonatal infection. The biomedical and clinical research are necessary for better understanding of new knowledge in providing the appropriate strategies for vaccine development, therapeutic modality. Establishment of prospective cohorts in identifying the risk and consequences of congenital / neonatal Zika syndrome is essential. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S41

September 28, 2019

09:00 ~ 11:00 Symposium 7 Antimicrobial resistance of Gram negative bacteria

S7-1 Global Epidemiology and Clinical Impact of Carbapenem-resistant Acinetobacter Species Po-Ren Hsueh National Taiwan University Hospital, Taipei, Chinese Taipei

S7-2 Global epidemiology and clinical impact of carbapenemase-producing Enterobacteriaceae David Livermore University of East Anglia, UK

S7-3 Prognosis of patients with bacterial bloodstream infection in an aspect of causative pathogens: from the first one-year report of Kor-GLASS Eun-Jeong Yoon Yonsei University College of Medicine, Korea

S7-4 Treatment of Carbapenem-resistant Gram-negative Anucha Apisarnthanarak Thammasat University Hospital, Thailand S42 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S7-1. Global Epidemiology and Clinical Impact of Carbapenem-resistant Acinetobacter Species

Po-Ren Hsueh Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

Acinetobacter baumannii, a member of A. calcoaceticus-Acinetobacter baumannii complex, has risen to prominence particularly because of its ability to cause infections in immunocompromised patients and has become one of the most difficult pathogens to treat. This organism is now a predominant pathogen in many hospitals worldwide as it has acquired resistance genes to virtually all antimicrobial agents capable of treating Gram-negative bacteria. The only conventional remaining treatment options are the carbapenems. In the last decade, carbapenem-resistant A. baumannii (CR-AB) isolates have emerged as important nosocomial pathogens globally. In 2017, the World Health Organization ranked CR-AB among the ﬁrst catalog of antibiotic-resistant pathogens with ”critical priority” because the healthcare-acquired CR-AB strains pose a tremendous threat to human health. A. baumannii possesses an inherent class D β-lactamase gene (blaOXA-51-like) that can have the ability to confer carbapenem resistance. Additionally, mechanisms of carbapenem resistance have emerged due to the importation of the distantly related class D β-lactamase genes blaOXA-23 and blaOXA-58 by mobile promoters carried on ISAba elements. Of the presently available antimicrobials, the most active agents against CR-AB in vitro are polymyxin B or colistin, and tigecycline. Previously in vitro investigations showed that some combination schemes have potential in vitro efﬁcacy against CR-AB isolates, including imipenem or meropenem plus sulbactam or colistin, rifampin plus colistin, and tigecycline in conjunction with colistin. Currently, several novel agents, e.g. cefepime- zidebactam, cefiderocol, and eravacycline, hold promise in the treatment of infections by CR-AB. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S43

S7-2. Global epidemiology and clinical impact of carbapenemase-producing Enterobacteriaceae

David M Livermore Norwich Medical School, University of East Anglia, NORWICH NR4 7TJ, UK

For 20 years after the launch of imipenem in 1985, carbapenemase-producing Enterobacteriaceae remained extremely rare and carbapenems became the ‘go to’ antibiotics for infections due to Enterobacteriaceae resistant to cephalosporins, fluoroquinolones and aminoglycosides. Subsequently the situation worsened dramatically. Klebsiella spp. with VIM carbapenemases caused the first major national problem, spreading in Greece around 2005. This harbinger of coming trouble was followed by proliferations of KPC, OXA-48-like and NDM carbapenemases, to the point where several countries – Italy, Greece, Romania, India, Brazil – now record carbapenem resistance in >25% of K. pneumoniae, which is the most frequent host for acquired carbapenemase genes. Acquired carbapenemases retain strong regional links: KPC types are the predominant types in the Americas, Greece (where they substantially supplanted VIM types) and China. OXA-48-like carbapenemase dominate in most of the rest of Europe, Turkey (where they originated) and the Middle East (excluding Israel). NDM dominates in the Indian subcontinent, Global travel, medical tourism and migration are eroding these associations to some degree, e.g. with substantial import of NDM into the UK, Canada and the Middle East, but they remain strong. KPC carbapenemases are strongly associated with the nosocomial spread of K. pneumoniae ST258 and related clones carrying these enzymes, though there has also been recent and disturbing spread to hyper-virulent strains, often of ST11. Problems with other carbapenemase, besides KPC types, are more often associated with the spread of encoding plasmids among multiple bacterial strains, which complicates tracking by hospital epidemiologists and infection control staff. Classical OXA-48 is often carried by 50/70 kb IncL/ M plasmids whereas the genes for NDM enzymes have spread among diverse plasmids, which – at least in India – are spreading in the community as well as in hospitals. The clinical impact of carbapenemase producers has been substantial. Infection control to prevent their spread has been successful at a national level notably in Israel and – to a degree – in the UK, but adds cost and reduces bed efficiency. Isolates with OXA-48 carbapenemase often have only low-level carbapenem resistance, allowing unnoticed stealth spread. Where infections with carbapenemase-producing Enterobacteriaceae do occur they have forced the use of colistin, an old antibiotic with significant toxicity and very uncertain pharmacodynamics. In severe infection colistin is probably best used in combination, but useful partners are few, given the multi-resistance of many carbapenemase producers and those that are most reliably active in vitro (tigecycline and fosfomycin) carry their own uncertainties. This situation is gradually improving as new diazabicyclooctane- and boronate- based b-lactamase inhibitor combinations become available, with growing data to support the view that these achieve better outcomes than colistin and its combinations at least in the case of isolates with KPC and (for ceftazidime/avibactam) OXA-48 carbapenemases. S44 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S7-3. Prognosis of patients with bacterial bloodstream infection in an aspect of causative pathogens: from the first one-year report of Kor-GLASS

Eun-Jeong YOON1, Dokyun KIM1, Changseung Liu1, Young UH2, Jeong Hwan SHIN3, Kyeong Seob SHIN4, Young Ah KIM5, Jong Hee SHIN6, and Seok Hoon JEONG1* 1Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea, 2Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea, 3Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea, 4Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea, 5Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea, 6Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea

As a part of National Action Plan in 2016 on antimicrobial resistance, a newly established national AMR surveillance system, Kor- GLASS, which is compatible with the Global Antimicrobial Resistance Surveillance System (GLASS) platform proposed by the World Health Organization (WHO), was launched and initiated in May 2016. The system is a prospective cohort study based on the collection of non-duplicate clinical isolates and data by specimen from sentinel hospitals. During the 1-year period between May 2016 and April 2017, six sentinel hospitals sampled 67,803 patients for blood culture and a total of 3,523 (5.2%) target pathogens were recovered. The predominant bacterial species was Escherichia coli (n = 1,536, 43.6%), followed by Klebsiella pneumoniae (n = 597, 16.9%) and Staphylococcus aureus (n = 584, 16.6%), Acinetobacter spp. (n = 229, 6.5%), composed of 188 Acinetobacter baumannii and 41 non- baumannii Acinetobacter spp., Enterococcus faecium (n = 217, 6.2%), Enterococcus faecalis (n = 161, 4.6%), and Pseudomonas aeruginosa (n = 127, 3.6%). Salmonella spp. (n = 44, 1.2%) and Streptococcus pneumoniae (n = 28, 0.8%) were rarely recovered. By eliminating the day-0 death, 30-day mortality was observed in patients with BSI caused by 9.5% (141/1492) of E. coli, 16.8% (96/572) of K. pneumoniae, 15.3% (87/567) of S. aureus, 42.5% (77/181) of A. baumannii, 14.2% (17/120) of P. aeruginosa, 27.6% (40/145) of Ent. faecium, and 14.1% (22/156) of Ent. faecalis. Mortality dynamics were presented a power-law tendency curve of cumulative survival over six weeks after the BSI onset caused by E. coli, A. baumannii, Ent. faecalis, K. pneumoniae, and S. aureus, while those by Ent. faecium presented steep increase of mortality in the fourth week after the BSI onset and a continued tedious mortality, and those by P. aeruginosa presented sharp increase of mortality in the fifth week of the BSI onset, resulting in 20.0% (24/120) of 42-day mortality. The Sequential Organ Failure Assessment (SOFA) score that was calculated using the collected raw data for the day of initial blood culture indicated that the patients with BSIs caused by A. baumannii was in worst conditions (5.9 ± 3.5) and those by K. pneumoniae (4.9 ± 3.6), Ent. faecium (4.5 ± 3.5), Ent. faecalis (4.4 ± 3.8), and S. aureus (4.4 ± 3.8) were followed, while the patients with BSIs caused either by P. aeruginosa (3.9 ± 3.2) or by E. coli (3.6 ± 3.0) had relatively less SOFA scores. The BSIs caused by Ent. faecium and A. baumannii were mostly hospital- originated, 80.0% (116/145) and 88.4%, (117/181), respectively, and more than half of the patients with BSIs caused by A. baumannii (64.6%, 117/181) were hospitalized in intensive care units. Cefotaxime resistance was observed in 35.1% (523/1472) of E. coli and in 28.7% (164/572) of K. pneumoniae, carbapenem resistance in 23.3% (28/120) of P. aeruginosa and in 88.4% (160/181) of A. baumannii, vancomycin resistance in 0.6% (1/156) of Ent. faecalis and in 30.3% (44/145) of Ent. faecium, and cefoxitin resistance was found in 53.4% (303/567) of S. aureus. Antimicrobial resistance and associated failure of the empirical antimicrobial therapy was associated with the mortal of the patients with bacterial BSIs. In addition, strain types, i.e. ST131 H30Rx for E. coli, wzi50 capsular type for K. pneumoniae, ST191 for A. baumannii, and CC5 MRSA for S. aureus were identified as risk factors for 30-day mortality, and resistance determinants, i.e. group 1 CTX-M extended-spectrum beta-lactamases for E. coli, OXA-23 for A. baumannii, and OprD deficiency for P. aeruginosa, and virulence factors, i.e. colibactin for K. pneumoniae and TSST-1 for S. aureus, were also the risk factors of 30-day mortality for the patients with BSIs. The cohort study aiming the antimicrobial resistance surveillance gave a clear snapshot for bacterial BSIs occurred in general hospitals in South Korea and highlighted the importance of national monitoring system for the antimicrobial resistance on the infection-causative pathogens helping the clinicians for an adequate antimicrobial therapy for better outcome of the patients. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S45

S7-4. Treatment of Carbapenem-resistant Gram- negative

Anucha Apisarnthanarak Thammasat University Hospital, Thailand

MDR and XDR Gram-negative are serious causes of healthcare-associated infections worldwide. The common presentations of these particular pathogens include hospital-acquired pneumonia and bloodstream infection. MDR- and XDR infections have become more difficult to treat with the emergence of isolates resistant to commonly available prescribed antibiotics (e.g., carbapenem). This results in poor prognosis, high treatment failure and significantly increased mortality. Currently, a consensus recommendation for the optimal treatment of these infections has not been established. Several antimicrobials have been used to treat MDR- and XDR as well as carbapenem-resistant Gram negative infections, including colistin, sulbactam and tigecycline as monotherapy or combination therapy as well as the introduction of new antibiotic classes. In this session, I will discuss the approaches for treatment of carbapenem-resistant Gram-negatives as well as limitations of each approach. S46 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 28, 2019

09:00 ~ 11:00 Symposium 8 New approaches for fungal infections in immune-compromised host

S8-1 Fungal Epidemiology and Emerging Resistance in Asia Jong Hee Shin Chonnam National University Medical School, Korea

S8-2 ICU & Flu: New Risk Factors for Invasive Aspergillosis Wei-Lun Liu Fu Jen Catholic University Hospital, Chinese Taipei

S8-3 Talaromycosis and mucormycosis: challenges and opportunities Patrick Woo The University of Hong Kong, Hong Kong, China

S8-4 New diagnostic and therapeutic strategies for invasive fungal infection Monica Slavin Peter MacCallum Cancer Centre, Australia Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S47

S8-1. Fungal Epidemiology and Emerging Resistance in Asia

Jong Hee Shin Chonnam National University Medical School, Korea

The epidemiology of invasive fungal infections has changed greatly over the past few decades; however, Candida and Aspergillus remain the main fungal pathogens. Several surveillance programs have documented the emergence of azole resistance among Aspergillus fumigatus and other Aspergillus species worldwide. Azole-resistant A. fumigatus strains with mutations in the Cyp51A gene and its promoter have been identified in several Asian countries. Candida albicans now represents less than 50% of all candidemic cases in Asia, where fluconazole resistance has been observed among bloodstream isolates of the most common non-albicans Candida species such as Candida tropicalis and Candida parapsilosis. Candida auris is an emerging fungal pathogen worldwide. Candida auris isolates are grouped into distinct clades: South Asian, East Asian, African, and South American. A recent report in Korea has revealed the unique nature of the East Asian clade of C. auris. Invasive aspergillosis (IA) is a life-threatening opportunistic infection that has been best described in hematology patients. Increases in IA incidence may be partly associated with the increase in galactomanan testing over the past decade. In recent years, however, serum galactomannan-negative IA has increasingly been observed in populations other than hematology patients. Acquired azole resistance has emerged in A. fumigatus; its most common mechanism involves the modification of Cyp51A and its promoter (TR34/L98H and

TR46/Y121F/T289A), which have been found in environmental and clinical isolates from many countries. This mechanism is thought to be related to the use of fungicides in agriculture. Strains containing these mutations have been identified in several Asian countries, including China, Taiwan, Thailand, Japan, and Korea. Candidemia is the most common form of invasive candidiasis associated with high mortality rates (> 40%); its incidence varies greatly among countries and hospitals. Candida tropicalis is the most common non-albicans Candida species causing fungemia in Asia, except for Korea and Japan. Global surveillance data have shown that the highest rates of fluconazole resistance among C. tropicalis bloodstream isolates occur in Asian countries. The emergence and clonal spread of fluconazole-resistant C. parapsilosis bloodstream isolates harboring a Y132F mutation in Erg11 have been reported in Korean hospitals. Echinicandin resistance was found to be distinctly uncommon among isolates of C. albicans, C. parapsilosis, and C. tropicalis, and most prominent among Candida glabrata isolates worldwide. Increased echinocandin resistance in C. glabrata is often accompanied by azole resistance, resulting in multidrug-resistant strains. Reports from some centers in Asia indicate increasing C. glabrata rates among bloodstream isolates. The global emergence of C. auris raises several serious concerns for public health due to high rates of antifungal drug resistance, organism misidentification, and high transmissibility among hospitalized patients, leading to nosocomial outbreaks and significant patient mortality. Candida auris infections have been reported in at least 30 countries on six continents, including Asian countries such as Korea, Japan, China, Singapore, Malaysia, and Taiwan. A recent report showed lower rates of antifungal susceptibility, lower Erg11 mutation rates in association with fluconazole resistance, and unique genotypes in C. auris isolates from Korea (East Asian clade) compared with those from the other three clades (South Asian, African, and South American). During 2006–2018, C. auris isolates were recovered yearly from ear specimens (mostly) or blood (rarely) in Korea; isolates from both blood and ear cultures were genetically similar. However, apparent nosocomial clusters of fungemia have not yet been detected. S48 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S8-2. ICU & Flu: New Risk Factors for Invasive Aspergillosis

Wei-Lun Liu1,2 1Department of Emergency & Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan (R.O.C.), 2School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan (R.O.C.)

Recent advances in medical technologies have increased the survival rate of severely ill patients admitted to intensive care units (ICU). This heterogeneous patient population is highly susceptible to invasive fungal infections. Invasive pulmonary aspergillosis (IPA) is an opportunistic infection that occurs predominantly among severely immunocompromised patients with hematological malignancies, most notably during prolonged neutropenia, but also in those who have undergone allogeneic stem cell transplantation or solid organ transplantation. However, IPA is emerging in non-neutropenic critically ill patients with predisposing conditions, such as corticosteroid treatment, chronic obstructive pulmonary disease and other chronic airway abnormality, solid cancer with or without treatment and HIV infection. Decompensated cirrhosis has been described as a risk factor for IA, and impaired phagocytosis has been proposed as a possible reason for heightened risk in these groups. Diabetes has been observed as another risk factor for IA, possibly due to impaired innate and acquired immunity caused by hyperglycemia. Severe influenza infections are usually defined as patients requiring ICU admission. IPA has been increasingly reported that may occur in the setting of severe influenza even among immunocompetent hosts. More recently, influenza was identified as an independent risk factor for IPA and is associated with high mortality. Why patients with severe influenza are at risk for IPA is not yet clear. The influenza virus alters the bronchial mucosa, resulting in epithelial disruption and mucociliary clearance dysfunction, which may facilitate the invasion of Aspergillus. Another hypothesis proposed to explain a depressed immune response in the apparently immunocompetent patient with severe influenza relates to the biphasic response in which the initial hyperinflammatory phase is followed by immunoparalysis phase. This latter process is characterized by neutrophil deactivation, and may place the patient at risk for developing opportunistic infections, such as IPA. Immunosuppression has been described as a late stage of the biphasic response to sepsis and multiple organ dysfunction syndrome. IPA contribute significantly to morbidity and mortality in critically ill patients. Diagnosis is challenging because the signs and symptoms are non-specific, and initiation of additional diagnostic examinations is often delayed because clinical suspicion is low. Definitions of invasive fungal infections suggested by the European organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) are difficult to apply for identifying IPA in ICU patients. For the ICU setting, an algorithm (AspICU algorithm) was described by Blot and colleagues to distinguish invasive pulmonary aspergillosis from Aspergillus colonization in patients who are critically ill. The Aspergillus galactomannan (GM) test is a commercially available diagnostic tool detecting Aspergillus antigen in serum, bronchoalveolar lavage (BAL) fluid, or cerebrospinal fluid. Serum GM levels in non-neutropenic patients appear to be inaccurate, but GM detection in BAL fluid is a useful tool in establishing the diagnosis of IPA in non-neutropenic critically ill patients. Studies on patients with IPA have similarly shown excessive rates of inappropriate initial therapy and even higher mortality than infections caused by bacterial pathogens in the ICU setting. The importance of prompt identification of IPA through a combination of risk factor analysis and diagnostic assays has been demonstrated to be a key factor affecting IPA-related mortality. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S49

S8-3. Talaromycosis and mucormycosis: challenges and opportunities

Patrick Woo The University of Hong Kong, Hong Kong, China

Talaromyces (Penicillium) marneffei is the most important pathogenic thermally dimorphic fungus causing systemic mycosis in Southeast Asia. T. marneffei infection is endemic in tropical regions, especially Thailand, Vietnam, northeastern India, Southern China, Hong Kong, Taiwan, Laos, Malaysia, Myanmar, Cambodia, and Laos. Bamboo rats (Rhizomys sp. and Cannomys sp.) and soil from their burrows are considered to be important enzootic and environmental reservoirs of T. marneffei, respectively. Historically, T. marneffei infection in human has been considered to be exclusively associated with HIV infection. In some regions such as Hong Kong and southern China, T. marneffei infection has long been considered as one of the top three AIDS-defining opportunistic infections, alongside tuberculosis and cryptococcosis. In recent years, a decline in the incidence of T. marneffei infection among HIV-infected patients was seen in regions with access to highly active antiretroviral therapy and other control measures for HIV. In contrast, T. marneffei infection has been increasingly reported among non-HIV-infected patients with impaired cell-mediated immunity since the 1990’s. Their comorbidities included primary adult-onset immunodeficiency due to anti-interferon-gamma autoantibodies and secondary immunosuppressive conditions including other autoimmune diseases, solid organ and hematopoietic stem cell transplantations, T lymphocyte-depleting immunsuppressive drugs, and novel anti-cancer targeted therapies such as anti-CD20 monoclonal antibodies and kinase inhibitors. Moreover, improved immunological diagnostics identified more primary immunodeficiency syndromes associated with T. marneffei infection in children. Sinopulmonary and rhinocerebral mucormycosis has been increasingly reported in patients with hematological malignancies and bone marrow transplantation, but intestinal mucormycosis remains very rare. A few years ago, we investigated an outbreak of intestinal infection due to Rhizopus microsporus in 12 patients on treatment for hematological malignancies over a period of 6 months in a teaching hospital. The intake of allopurinol during hospitalization (P<0.001) and commercially packaged ready-to-eat food items in the preceding 2 weeks (P<0.001) were found to be independently significant risk factors for the development of intestinal mucormycosis. A total of 709 specimens, including 378 environmental and air samples, 181 food samples and 150 drug samples, were taken for fungal culture. Among them, 16 samples of allopurinol tablets, 3 pre-packaged ready-to-eat food items and 1 pair of wooden chopsticks, were positive for Rhizopus microsporus, which were confirmed by ITS sequencing. The mean viable fungal counts of allopurinol obtained from wards and pharmacy were 4.22 × 103 and 3.24 × 103 cfu/g of tablet respectively, much higher than the mean count of 2 × 102 cfu/g of food. Phylogenetic analysis showed multiple clones from isolates of contaminated allopurinol tablets and ready-to-eat food of which some were identical to patients’ isolates, and with one isolate in the corn starch used as excipient for manufacturing this drug. The primary source of the contaminating fungus was likely to be the corn starch used in the manufacturing of allopurinol tablets or ready- to-eat food. Rhizopus microsporus was thermo-tolerant and could multiply even at 50ºC. The long holding time of the intermediates during the manufacturing process of allopurinol has amplified the fungal load. Microbiological monitoring of drugs manufactured for highly immunosuppressed patients should be performed. S50 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S8-4. New diagnostic and therapeutic strategies for invasive fungal infection

Slavin MA Peter MacCallum Cancer Centre, Melbourne, Australia

Invasive fungal infections remain a major and lethal complication of the immunocompromised. Fungi which are either inherently drug-resistant such as Lomentopora prolificans, Fusarium spp or Candida auris or have selected azole- or echinocandin- resistance are emerging globally. Further, drug-drug interactions and toxicity limit the utility of current drugs. Rapid diagnostics and new antifungal agents are urgently required. These challenges have resulted in the development of rapid diagnostic approaches for resistance testing such as molecular and genomic resistance testing. Standardisation of aspergillus PCR performance now means that it can now be incorporated into EORTC/MSG definitions of infection whilst Candida PCR is becoming more widely used and Mucormycosis PCR is under evaluation. Beyond serological based tests, imaging modalities are also improving. New agents targeting the antifungal cells wall are most developed and examples such as rezafungin (CD101) will be discussed. New agents acting on fungal cell membrane metabolic pathways are being studied including inhibitors of the glycoxylate cycle and pyrimidine synthesis exemplified by the dihdroorotate dehydrogenase inhibitor olorofim (F901318). The potential of inhibiting cell signalling pathways, which control cellular differentiation, mating and filamentous growth such as mitogen-activated protein kinases (MAPK), is being explored. Although conserved between fungi and human cells upstream signalling differences occur. Calcium signalling pathways and transcription factors that regulate gene expression and are important to multiple cellular functions may also be drug targets. Additionally the role of new anti-cancer agents with epigenetic effects such as histone deacetylase (HDAC) inhibitors in combination with antifungal agents is being assessed. Additionally the role of immunotherapy harnessing cytotoxic T-cells or Dectin-1 chimeric antigen receptor (CAR) T-cells is progressing. How the microbiome may be manipulated to prevent or treat fungal infection is a new area for research. These developments in the field mean that earlier detection of fungal infection and antifungal resistance is becoming more feasible and newer antifungal agents are broadening treatment options. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S51

September 28, 2019

09:00 ~ 11:00 Symposium 9 New diagnostics for infectious diseases

S9-1 Advances in “ART” (Antibacterial Resistance Testing) Robin Patel Mayo Clinic, USA

S9-2 Detection methods for mcr and carbapenemase genes Hui Wang Peking University People’s Hospital, PR China

S9-3 Syndromic approach for infectious agents detection Heungsup Sung Asan Medical Center, Korea

S9-4 NGS based diagnosis of infectious diseases Dongeun Yong Yonsei University College of Medicine, Korea S52 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S9-1. Advances in “ART” (Antibacterial Resistance Testing)

Robin Patel Chair, Division of Clinical Microbiology, Director, Infectious Diseases Research Laboratory, Professor of Microbiology, Professor of Medicine, Elizabeth P. and Robert E. Allen Professor of Individualized Medicine, USA

Microbial diagnostics are foundational in the practice of medicine. Outside of making specific diagnoses, they inform selection of correct antimicrobial therapy. In some situations, knowledge of the organism causing infection is sufficient to inform the choice of antimicrobial therapy. As a result of acquired resistance however, many microorganisms - particularly bacteria -, no longer have predictable susceptibility to modern therapeutics. For this reason, beyond identification of pathogens causing infection, it is increasingly important to provide antimicrobial susceptibility. And, these results must be delivered and acted upon as quickly as possible. This permits treatment of patients with active agents, avoiding empirical approaches, which lead to both under- and overtreatment; the latter may select for further resistance, in addition to being associated with toxicity, microbiome disturbances, and, at times, unnecessary cost. Accordingly, assessing antibacterial resistance (and susceptibility) using rapid methods, and rapidly communicating those results - such that they are appropriately acted on -, has become increasingly important in modern medicine. While technology advances have the prospect to provide faster (and sometimes better) results, improvements don’t always come at reduced cost, and, as alluded to above, practical aspects of implementation must be considered, especially how results should be delivered such that they are appropriately and expeditiously responded to. For example, our group has shown that rapid blood culture identification of pathogens and assessment of their susceptibility has the most significant impact on patient outcomes when paired with real-time clinical decision-making support. Specifically, we executed a prospective, randomized, controlled, three-arm trial that appraised clinical and economic outcomes associated with the BioFire® FilmArray® Blood Culture Identification (BCID) Panel— a diagnostic that identifies multiple bacteria, fungi, and common antimicrobial-resistance genes (mecA, vanA/B, blaKPC) in about an hour following organism growth in blood culture bottles. (Other blood culture bottle tests with a more extensive array of analytes are now available, and will be discussed.) Our trial compared standard-of-care testing and reporting with two strategies to guide healthcare providers’ responses to the rapid results - electronic comments with treatment guidance alone or with active antimicrobial stewardship team oversight. Overall, microbial identification was faster in the BCID groups compared with the control group. Although groups did not differ in length of stay, hospitalization costs, mortality, adverse drug events, or Clostrioides difficile infection rates, there was less broad-spectrum antibiotic use, more narrow-spectrum antibiotic use, less treatment of contaminants, and faster antibiotic escalation, in the BCID arms compared with the control group. Notably however, faster antibiotic de-escalation occurred only in the group assigned to BCID plus stewardship. The Accelerate PhenoTest™ BC Kit, performed on the Accelerate Pheno™ System, performs rapid bacterial identification in about 1.5 hours, followed by phenotypic susceptibility testing within approximately 7 hours directly from positive blood cultures. This system uses fluorescence in situ hybridization for bacterial identification and time-lapse microscopy for phenotypic susceptibility determination. Our experience with this system, alongside an assessment of other systems under development, will be presented. Beyond applications of nucleic acid amplification resistance gene detection and rapid phenotypic susceptibility testing, the use of genome sequencing to predict antibiotic susceptibility and resistance is an emerging area. Our experience in this regard will be presented. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S53

S9-2. Detection methods for mcr and carbapenemase genes

Hui Wang Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, 100044, PR China

Multidrug resistance in gram-negative bacteria is one of the most critical public health threats, notably with the description of carbapenemase-producing Enterobacteriaceae. In recent years, significant increases in the prevalence of CRE have been reported in the world. Colistin has become the last resort for carbapenemase-producing Enterobacteriaceae. However, plasmid-mediated colistin resistance gene, mcr-1, has been identified with accelerating incidence in Enterobacteriaceae, isolated from environment, human and animals. The co-existence of mcr and carbapenemase genes has already been detected in clinical settings and resulted in few therapeutic options. There is thus an urgent need to improve the detection of carbapenemase and mcr for infection control and antibiotic stewardship initiatives. Currently, the main methods used to detect carbapenemase and mcr can be classified under phenotypic and genotypic methods. Phenotypic assays performed in clinical practice includes: (i) assays based on growth in the presence of carbapenems or dipicolinic acid, such as modified Hodge test, modified carbapenem inactivation method (mCIM), EDTA mCIM for carbapenemase, and Colistin-MAC for mcr; (ii) detection based on the product of hydrolysis that is catalyzed by carbapenemase, e.g. Carba NP and matrix-assisted laser desorption–ionization time of flight mass spectrometry (MALDI-TOF MS); and (iii) lateral flow immunoassays. Furthermore, the nucleic acid-based approaches, including conventional PCR, real time PCR, microarray, and whole-genome sequencing were also used for carbapenemase and mcr detection. S54 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S9-3. Syndromic approach for infectious agents detection

Heungsup Sung Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

New molecular technologies continue to evolve and improve, cutting the time it takes to diagnose infectious disease. Such rapid results enable better individualized patient management. Molecular diagnostic testing has continuously moved toward a more broad syndromic screening and “sample-in, result-out” format. Yet challenges remain in regulatory barriers and successful clinical practice integrations. I would like to describe several emerging technologies, including multiplex syndromic molecular tests, molecular point-of- care (POC) tests, and other emerging tools, and discuss challenges in integrating these tests into clinical practice. Current diagnostic microbiology is increasingly adopting molecular techniques as front line tests for a variety of samples. This trend holds true for detection of respiratory pathogens, enteric pathogens, and central nervous system (CNS) infectious pathogens where nucleic acid amplification tests (NAAT) are well established as the new gold standard. Since the same clinical symptoms can be the result of different infectious agents in these infections, rapid syndromic NAAT are required. New highly multiplexed cartridge type molecular diagnostics can detect the majority of viral and bacterial pathogens that cause respiratory, gastrointestinal, or CNS infections within 20 minutes to 2 hours. In addition, these systems can detect several antimicrobial resistance genes. As more new innovative technologies are introduced, significant challenges will be faced in interpreting the data. There is sometimes uncertainty of clinical significance when we using the multiplex syndromic tests. NAAT cannot distinguish commensal or colonizing pathogens and true pathogens. They also cannot distinguish viable and non-viable organisms although the disappearance of pathogen nucleic acids suggest the eradication. Therefore, laboratories will require strategies to assist clinicians in the interpretation of the results produced by multiplex NAAT or molecular POC. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S55

S9-4. NGS based diagnosis of infectious diseases

Dongeun Yong Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

Infection is one of the major cause of mortality in patients. Appropriate diagnosis is crucial for the management of infectious disease. In addition to conventional methods, including stain, culture, and immunological methods, currently genomic methods increase the spectrum of diagnosis. Rapidly declining costs for nucleotide sequencing and improvement in the technology will result in greater utilization of whole genome sequencing for infection diagnosis. Bacterial identification and antimicrobial susceptibility testing might be supported with rapidly improved NGS system. Surveillance, virulence determination, and microbiome analysis are also promising tasks to which NGS can contribute. Through the import of these NGS technologies, genomics and whole genome sequencing of microorganisms have been in the scope of the clinical microbiology laboratories. A couple of factors should be considered before the set-up the NGS technologies in the laboratory, such as case, in-house vs. outsourcing, sequencing capacity, adaptability, and data quality, etc. The application of WGS in clinical microbiology would be pathogen identification (1) and detection (2), strain typing (3), resistance detection (4), virulence profiling (5), and metagenomics (6), etc. The limitation of NGS should be recognized. The results are dependent on the quality of sequencing and assembly. And they are affected by the quality of the reference genome, also. The remarkable requirement in time for interpretation is a huddle in a clinical environment. In clinical microbiology laboratories, solid process for data validation, quality control and standardization will be essential. The guideline to determine the similarity between two isolates also is required to infer the transmission. S56 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 28, 2019

11:10 ~ 11:50 Plenary Lecture 3

P3-1 Prosthetic Joint Infection Robin Patel Mayo Clinic, USA Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S57

P3-1. Prosthetic Joint Infection

Rising numbers of prosthetic joint infections are being encountered in clinical practice due to the growing numbers of joint replacement surgeries being performed. As with other implant-associated infections, prosthetic joint infections are biofilm-associated. Some cases may be challenging to diagnose; misdiagnosis can result in mistreatment which may have adverse outcomes on the patient and the healthcare industry. In this presentation, Dr. Patel will review the pathogenesis, microbiology, diagnosis and management of prosthetic joint infection. She will focus on approaches to the diagnosis of prosthetic joint infection pre-operatively and, if not established before surgery, intra-operatively. She will cover novel approaches to prosthetic joint infection diagnosis, including biomarkers, as well as improved culture techniques, such as tissue cultures in blood culture bottles and methods directed at sampling biofilms on implant surfaces. In addition, she will overview her recent experience with and review the literature on molecular diagnostics for prosthetic joint infection, including 16S ribosomal RNA gene polymerase chain reaction/sequencing, panel nucleic acid amplification tests targeting specific microorganisms, and massive parallel sequencing. S58 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 28, 2019

11:50 ~ 12:30 Plenary Lecture 4

P4-1 High priority research areas for infectious diseases and AMR Dennis Dixon National Institutes of Health, USA Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S59

P4-1. High priority research areas for infectious diseases and AMR

Dennis M. Dixon U.S. National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), USA

The U.S. NIH is the leading public funder of biomedical research worldwide. NIAID is the lead Institute of the 27 Institutes and Centers at NIH focused on infectious and immunologic diseases. Setting priorities is especially challenging when having to balance established and daunting diseases in addition to adjusting quickly to newly emerging infectious diseases. The process is based on public health needs and done in consultation with community and discipline-specific experts. Several obvious diseases of global significance rise to the top for attention. These include HIV, TB, malaria, and emerging infectious diseases and general issues such as antimicrobial resistance. Antibacterial resistance in particular has resulted in significant scientific and political actions in the United States and globally. National and international communication, cooperation and collaboration are critical for combating antibiotic- resistant bacteria in these never-ending interactions between humans and microbes. NIH-supported AMR research activities will be summarized and placed into overall context. Future actions to be considered will be suggested. S60 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 28, 2019

15:10 ~ 15:50 Plenary Lecture 5

P5-1 Novel Agents for Emerging Multidrug-Resistant Gram-Negative Organisms Po-Ren Hsueh National Taiwan University Hospital, Taipei, Chinese Taipei Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S61

P5-1. Novel Agents for Emerging Multidrug-Resistant Gram-Negative Organisms

Po-Ren Hsueh Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

A gradual rise in drug-resistant trends among Gram-negative organisms, especially carbapenem-resistant (CR) Enterobacteriaceae (CRE), CR-Pseudomonas aeruginosa, and extensively-drug-resistant (XDR) Acinetobacter baumannii, poses an enormous threat to healthcare systems worldwide. In the last decade, many pharmaceutical companies have devoted enormous resources to the development of new potent antibiotics against XDR Gram-negative pathogens, particularly CRE. Some of these novel antibiotics against CRE strains are β-lactam/β-lactamase-inhibitor combination agents, while others belong to the non-β-lactam class. Most of these antibiotics display good in vitro activity against the producers of Ambler class A, C, and D β-lactamase, although avibactam and vaborbactam are not active in vitro against metallo-β-lactamase (MβL) enzymes. Nevertheless, in vitro efficacy against the producers of some or all class B enzymes (New Delhi MβL, Verona integron-encoded MβL, etc) has been shown with cefepime-zidebactam, aztreonam-avibactam, VNRX-5133, cefiderocol, plazomicin, and eravacycline. As of Feburary 2019, drugs approved for treatment of some CRE-related infections by the US Food and Drug Administration included ceftazidime-avibactam, meropenem-vaborbactam, plazomicin, and eravacycline. Although active against extended-spectrum and AmpC β-lactamase-producing Enterobacteriaceae, delafloxacin does not show in vitro activity against CRE. Murepavadin is shown to be specifically active against CR- and colistin- resistant P. aeruginosa strains. Despite successful development of novel antibiotics, strict implementation of an antibiotic stewardship policy in combination with the use of well-established phenotypic tests and novel multiplex PCR methods for detection of the most commonly encountered β-lactamases/carbapenemases in hospitals is important for prescribing effective antibiotics against CRE and decreasing the resistance burden due to CRE.(Drugs 2019;79:705-714) S62 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

September 28, 2019

16:00 ~ 17:30 Symposium 10 Challenging cases (interactive session)

S10-1 Blood culture negative endocarditis and chronic arthritis Didier Raoult IHU Mediterranee Infection, France

S10-2 Chronic Fever in Diabetic Patient Visanu Thamlikitkul Siriraj Hospital, Thailand

S10-3 Infections in the immunocompromised host: challenging cases Dong-Gun Lee The Catholic University of Korea, Korea Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S63

September 28, 2019

16:00 ~ 17:30 Symposium 11 Strategies for diagnosing and treating Clostridium difficile infection

S11-1 Changes in epidemiology and disease burden of C. difficile infection in Asia Thomas Riley Murdoch University / Edith Cowan University, Australia

S11-2 Diagnostic Algorithms for C. difficile Infection Karen Carroll Johns Hopkins University School of Medicine, USA

S11-3 New therapeutic options for C. difficile infection Hyunjoo Pai Hanyang University Hospital, Korea S64 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S11-1. Changes in epidemiology and disease burden of Clostridium difficile infection in Asia

Thomas V Riley School of Veterinary & Life Sciences, Murdoch University; School of Medical & Health Sciences, Edith Cowan University; Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia

Clostridium difficile is the most common cause of healthcare-related infection in the western world. Its highly resistant spores allow it to persist in healthcare facilities, causing diarrhoea primarily in patients who have recently been treated with antimicrobials. C. difficile infection (CDI) is also increasingly recognised in the community. CDI has been studied in detail in North America and Europe, where large outbreaks have occurred since the early 2000s, and Australia which has mainly been free of such outbreaks. However, the epidemiology of CDI in much of Asia is largely unknown due to a lack of local awareness and testing. Indeed, little is known about the strains of C. difficile circulating in this region of the World. In a recent survey of CDI performed in 13 countries in the Asia-Pacific region, the most common C. difficile strains isolated were ribotype (RT) 017 (16.7%) followed by RTs 014/020 (11.1%), 018 (9.9%), 002 (9.2%), 012 (4.8%) and 369 (4.1%), with wide variation between countries. Binary toxin-positive strains of C. difficile were detected rarely. Overall disease severity appeared milder, and mortality and recurrence were lower than in North America and Europe. Our laboratory has studied CDI and C. difficile carriage extensively in South-East Asia in Indonesia, Malaysia and Thailand. The most common strains isolated were non-toxigenic strains belonging to RTs not previously described, and there was great diversity. C. difficile RT 017 was again often found. There are at least five different clades of C. difficile circulating around the World. It is likely that the predominant molecular types of C. difficile found in Asia differ from other regions of the World. The diversity of RTs found suggests that Asia has its own clade of C. difficile, most likely clade 4. Clade 4 gained its pathogenicity locus quite late in evolutionary history, about 500 years ago, and RTs such as 017 only acquired a tcdB gene. It is possible that non-toxigenic strains are currently fulfilling a protective role in Asia, and the interplay of this feature and much antimicrobial misuse in the region is of great interest. . Some Asian strains like RT 017 have travelled to other parts of the World where they have caused major outbreaks. This movement likely coincides with population movements, either human or animal. Very limited studies of production animals in Asia suggest two patterns of colonisation/disease, one where animals are colonised with strains of C. difficile similar to those found in animals in North America and Europe, and one where animals are colonised by local strains. Continued education about, and surveillance of, CDI in Asia are required to monitor the burden of disease and prevent the emergence of virulent antimicrobial-resistant strains. As with all C. difficile disease, a “One Health” approach may be required to deal with this problem in Asia. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S65

S11-2. Diagnostic Algorithms for C. difficile Infection

Karen C Carroll Professor of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, USA

Clostridioides (Clostridium) difficile, a toxigenic, spore-forming, gram-positive anaerobe, continues to cause significant colitis, especially among the elderly and other vulnerable populations. There has been a steady global increase in C difficile disease along with significant increases in morbidity and mortality caused by the appearance of more virulent strains. Such strains include ribotype 027/ NAP1/BI and newer variants that have mutations in the regulatory genes that control toxin expression concomitant with antimicrobial resistance. The diagnosis of C difficile disease is controversial. It should begin with clinical suspicion in patients with risk factors and true diarrhea, followed by confirmation using a sensitive test. There are two main categories of tests available for detection of C difficile infection—those that detect the organism (toxigenic culture and glutamate dehydrogenase) and those that detect toxin A and or toxin B (cell culture cytotoxicity assay and enzyme immunoassays). Professional societies have published recommendations on diagnosis and treatment. A two-step approach that begins with screening for glutamate dehydrogenase (GDH) followed by a toxin test and/or molecular assay is the recommended approach in Europe. In the USA, toxin enzyme immunoassays are felt by some to be more likely predictors of true disease, although others still believe they are too insensitive to be used as standalone tests. Approximately 50% of the laboratories use a nucleic acid test that detects either the toxin A or toxin B genes, or both. To date, there are more than twelve FDA- approved assays available for the diagnosis of C difficile encompassing a broad range of molecular platforms and methodologies. Some laboratories use a molecular test in a 3-step algorithm to adjudicate GDH positive, toxin negative samples to compensate for the poor analytical sensitivity of available toxin assays. For those laboratories that have chosen a molecular test as a single approach, steps should be taken to improve specificity by rejecting formed stools and eliminating test of cure and repeat testing of negative tests within seven days. Some laboratories are using laboratory information systems to improve best practices. Novel toxin tests for C difficile disease, based upon single molecule array technologies that claim to be “ultrasensitive” are available or on the horizon. These assays have the ability to quantify toxin levels. More studies that are clinical are needed to determine the optimum toxin cut-off values for clinical care. This presentation will briefly review the history of antibiotic associated diarrhea and C difficile. Current algorithms and problems with C difficile testing will reviewed. Literature supporting the use of certain algorithms along with a discussion of the IDSA/SHEA guidelines will be incorporated into the presentation. Strategies to improve the predictive value of molecular assays will be addressed. Finally, a brief summary of novel platforms for toxin testing and how they are being used to understand disease will be included. S66 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S11-3. New therapeutic options for Clostridioides difficile infection

Hyunjoo Pai Hanyang University Hospital, Korea

Clostridioides difficile infection (CDI) is one of the most common hospital infections. During the past decade its incidence has increased markedly worldwide. Age over 65 years, use of antibiotics and prior hospital exposure are some of recognized risk factors for CDI. Current therapies are mainly directed at addressing primary CDIs with the use of antibiotics such as vancomycin, as well as treating recurrent disease with vancomycin or fidaxomicin. In repeatedly recurrent disease, additional current approaches use antibiotic tapers and fecal microbiota transplants (FMTs). Because of heavy burden of CDI in recent hospitals, newer therapies are being developed to reduce initial infection such as probiotics and vaccines. New treatments include narrow spectrum antibiotics, immunotherapies, and microbial replacement therapies. However, even with successful treatment, 20% of patients experience recurrent disease with an increased risk to recur following each recurrence, which implicates the importance of restoring the colonization resistance against C. difficile. For the prevention of CDI, toxin vaccines and oral vaccine are in clinical trial (ACAM-CDIFF formalin inactivated toxin A &B vaccine discontinued phase III clinical trial). Oral β-lactamase which protects gut flora by inactivating theβ -lactam antibiotics secreted into intestine from systemic administration and oral lactoferrin as growth modulator are in phase II clinical trial, and several probiotics mainly consisting of Lactobacillus and Bifidobacterium species are also in the process of clinical trials. New antibiotics against C. difficile which are minimally absorbed and reach high luminal concentrations with high activity against C. difficile without broad activity against other native bacteria are promising for the therapy of CDI: cadazolid, CRS3123, LFF571, MCB3681, nitazoxanide, ramoplanin, ridinilazole, surotomycin, and tigecycline. As for the medication to reduce the recurrence, systemic administration of monoclonal antibody against toxins showed a success in reducing the recurrence, and polyclonal antibodies are in development. Restoration of colonization is important for reducing the CDI recurrence, and can be achieved by supplementing the microbiota with bacterial replacement therapies (SER-109, CBM588, MET-2, RBX2600, and CP101). Nontoxigenic C. difficile (VP20261) to compete with toxigenic C. difficile is in clinical trial with a success. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S67

September 28, 2019

16:00 ~ 17:30 Symposium 12 Current issues on HIV infection

S12-1 Curing HIV Davey Smith University of California San Diego, USA

S12-2 Mental health in people living with HIV (PLHIV): Risk factors, screening and interventions Reena Rajasuriar University of Malaya, Malaysia

S12-3 Pharmacologic Preventive Interventions: U=U, PrEP & STI Bum Sik Chin National Medical Center, Korea S68 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S12-1. Curing HIV

Davey Smith University of California San Diego, USA

This talk will review the latest effort to cure HIV, including broadly neutralization antibodies, genetic modifications with CRISPR and Zinc Fingers, and stem cell transplants. The study will also discuss results from a new peri-mortem cohort of people who participate in HIV research at the end of their life. These altruistic volunteers provide blood and other specimens in the months before they die and their whole bodies for rapid autopsy when they die. Such studies help identify HIV reservoirs throughout the body, which will be needed for cure studies that aim to eradicate all HIV reservoirs in tissues. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70 S69

S12-2. Mental health in people living with HIV (PLHIV): Risk factors, screening and interventions

Reena Rajasuriar University of Malaya, Malaysia S70 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S1-S70

S12-3. Pharmacologic Preventive Interventions: U=U, PrEP & STI

Bum Sik Chin Center for Infectious Diseases, National Medical Center, Korea

The current combination of widespread treatment and prevention against HIV, if effectively implemented, could theoretically end the HIV epidemic in the high income counties. Dr. Fauci laid out the national plan to end the epidemic in Unites States at CROI 2019, with a focus on increasing treatment and prevention in highly concentrated target populations. The four components of the plan are to 1) focus initially on high incidence geographic areas; 2) emphasize early diagnosis, immediate treatment, and engagement in care, with a plan to increase viral suppression from 60% to 90% nationally; 3) expand uptake of PrEP to at least 50% of those who need it; and 4) respond rapidly to emerging clusters of infection. While other measures matter, pharmacologic prevention is focusing on Treatment as prevention (TasP) as population scale, what is undetectable equals untransmittable (U=U) as individual scale, and PrEP. In addition, incidence of sexually transmitted disease (STD) besides HIV is rapidly increasing recently, and it is time to think of the pharmacologic prevention for STIs. U=U was first mentioned by Swiss investigators in 2008 as the statement that persons on ART with suppressed viral load and without STIs were unable to transmit HIV to their partners, based on seeing no cases of documented transmission in this situation. While an UNAIDS Chief Scientific Officer noted about U=U at IAS 2008, Mexico that “we have to be very careful about what we are saying and to whom it applies, because it can have unintended, negative consequences.”, data from HPTN 052, PARTNERS -1 and -2, and the Opposites Attract studies now provide compelling evidence that transmission does not occur when a person is fully virally suppressed on ART. U=U is not just viral phenomenon. U=U campaign has transformed social, sexual, and reproductive lives of people living with HIV/AIDS. It also dismantle stigma and people get tested and remain on treatment, leading to a strong public health argument for the necessity of access to care. While U=U is clear, verification of viral suppression may matter. In one study, 47% of MSM who reported an undetectable viral load had some virus detected on dried blood spots and the role of PrEP is still also clear. While new diagnoses in MSM in Australia, England, and the United States recently declined substantially, increased testing and treatment as well as PrEP coincided with these declines in new diagnoses. Therefore, combination prevention strategy including PrEP may be needed for the substantial declines in incidence across populations. Various PrEP agents are under investigation. TAF/FTC was noninferior to TDF/FTC in preventing HIV infection among men who have sex with men and transgender women with better bone and renal safety outcomes. Rapidly dissolving inserts are being developed for on-demand topical PrEP. They are user-friendly and have a favorable safety profile with low systemic drug exposure. Global epidemic of STIs among MSM is accompanying remarkable progress in HIV epidemic. While PrEP did not cause the STI epidemics among MSM, it has the potential to make the epidemic worse. Best practice clinical interventions should be widely implemented to increase STI testing including extragenital areas for gonorrhea and chlamydial infection. While we need to re- invigorate the efforts to promote condom use in all populations including MSM against STI epidemics, we need scientific innovation such as doxycycline STI pre- and post-exposure prophylaxis, rapid point of care tests for STI, and effective STI vaccines. Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81 S71

Infection & Chemotherapy

Journal homepage: www.icjournal.org

Oral Presentations ARGs laid the foundation for ranking public health risk to mitigate AMR spread.

September 27, 2019 O1-PT02 A comparative analysis of gut microbiomes and antibiotic resistance genes (ARG) from healthy people from Korea, U.S. O1-PT01 and China Resistomes of coastal waters with varied human impact in J Kim1*, M Seo1, B Kim1, M Rho2, H Pai1 the South China Sea 1Department of Internal Medicine, College of Medicine, Hanyang XP Koh*, JKC Kwan, SCK Lau University, Korea, 2Department of Computer Science and Division of Environment and Sustainability, The Hong Kong Engineering and Department of Biomedical Informatics, Hanyang University of Science and Technology, Hong Kong. University, Korea

Antimicrobial resistance (AMR) may be escalated by the pollution Background: Korea is a country with a high rate of antibiotic of water bodies by antimicrobial agents along with clinically resistance and antibiotic consumption. In this work, we relevant AMR genes and bacteria (ARGs and ARB). It is thus investigated the gut microbiome and ARGs in healthy people in crucial to assess the effect of human activities on environmental Korea and compared the abundance and types of ARGs with U.S. resistomes to manage AMR risk. Using metagenomics, we and China. characterized the resistomes of free-living microbial communities Methods: A total of 61 healthy Korean people aged 30–59 years from surface (S) and bottom (B) waters of three sites in the without underlying disease or admission history within the South China Sea, receding from human activities in order of recent 1 year were included. Whole metagenome sequences of F101, F103, and F107. ARGs conferring sulfonamide resistance the gut microbiome were obtained using Illumina HiSeq shotgun were dominant at F101S; those of multidrug efflux pumps sequencing. Existing metagenomic data from healthy Chinese prevailed at the rest. The F107B resistome was typical of less (n=33) and American (n=40) were used for comparison. The polluted environment, with most ARGs encode for multidrug abundance of ARGs is presented as GPM (genes per million). efflux pumps. Source prediction with ARG SourceTracker Results: Dominant genera in Korean are Bifidobacterium indicated strong sewage treatment plant (STP) signature that (12.4%), Ruminococcus (8.7%), Eubacterium (7.8%), and abate with reducing human impact at surface layer (in order, Faecalibacterium (7.7%). When compared with people from U.S. 70%, 33%, and 0%). Bottom STP signature was each at 9%, 30% or China, Bifidobacteriumand Ruminococcus are enhanced while and 0%. Selection forces that are not directly related to antibiotic Bacteroides is three-times less abundant in the Korean population stress altered community structures, and with that resistomes. (p-value < 0.01 for all three factors). The most abundant ARG F101S and F103S had low normalized ARG abundance albeit is aminoglycoside, followed by tetracycline, macrolides- resembling polluted resistomes, partly due to Cyanobacteria lincosamides-streptogramins, and beta-lactam. In the PCA (rarely harbor known ARGs) proliferation amid algal bloom. analysis, Korean, American, and Chinese population are clustered F103B had higher ARG abundance and moderate STP signature, by country. ClassA beta-lactam, tetracycline of ribosomal largely due to enrichment of copiotrophic Gammaproteobacteria protection, and Erm are important factors for such clustering (many are ARB) amid hypoxia. Nonetheless, ARG abundance (p-value < 0.01 for all three factors). Particularly, individuals from and horizontal gene transfer potential were not proportional. In Korea and China possess plasmid-mediated TEM, SHV and short, comprehensive resistome characterization elucidated the CTX-M genes, which are usually present in Enterobacteriaceae in entanglement between AMR and other pollution-induced issues. the gut microbiome. Moreover, insight into the underlying transmission potential of Conclusion: Bacterial composition and ARG distribution of gut

microbiome in healthy Korean people are generally different from FMT. The microbiota composition analysis reviealed increasing those of U.S. or China, however, some ARG and mobile element abundance of Bacteroidetesand decreasing abundance of showed a share among people from different countries. Proteobacteria at 1 month after FMT in responders. However, those changes of microbial composition did not occur in non- responders. O1-PT03 Conclusion: FMT is an effective way to decolonize CPE and VRE Establishing efficacy and safety of fecal microbiota by restoration of the gut microbiome. transplantation for patients with multidrug resistant organism Hye Seong1, Sang Kil Lee2, Jae Hee Cheon2, Dong Eun Yong3, Hong Koh4, Yoon Gu Kang4, Woon Ji Lee1, Jung Ho Kim 1, O1-PT04 Heun Choi1, Jin Young Ahn1, Nam Su Ku1, Su Jin Jeong1, Isolation and Identification of Bacterial Contaminants from Joon Sup Yeom1, Jun Yong Choi1 the Shisha Apparatus used in Public Cafes in Klang Valley, 1Division of Infectious Diseases, Department of Internal Medicine, Malaysia Yonsei University College of Medicine, Seoul, South Korea, J Jeevajothi Nathan1, CK Leong2, YEC Koo 2, SK Low2, 2Division of Gastroenterology, Department of Internal Medicine, J Mohammad2, P Madhavan2, NK Palanisamy3, EH Wong2* Yonsei University College of Medicine, Seoul, South Korea, 1Department of Primary Medicine, Faculty of Medicine, University 3Department of Laboratory Medicine and Research Institute of Malaya, 50603 Kuala Lumpur, Malaysia, 2School of Medicine, of Bacterial Resistance, Yonsei University College of Medicine, Taylor’s University Lakeside Campus, No.1, Jalan Taylor’s, 47500 Seoul, South Korea, 4Division of Gastroenterology, Hepatology Subang Jaya, Selangor Darul Ehsan, Malaysia, 3Faculty of and Nutrition, Department of Pediatrics, Severance Children’s Medicine, Universiti Teknologi MARA (UiTM), 47000 Sg. Buloh, Hospital, Severance Pediatric Liver Disease Research Group, Yonsei Selangor Darul Ehsan, Malaysia University College of Medicine, Seoul, South Korea Background: The presence of bacterial contaminants in shisha Background: Increasing prevalence of multidrug resistant micro- apparatus may pose potential health hazard to shisha smokers. organisms (MDRO) results in poor clinical outcomes, longer hos- Most public cafes do not follow the hygienic procedures for pitalizations and higher healthcare costs for patients with MDRO. equipment sanitation due to lack of sanitary regulations. This While colonization with MDRO does not mean to infection, it is reinforces the need to carry out more research to investigate the likely to lead infections to vulnerable patients. Currently, however, presence of bacterial contaminants on the shisha apparatus. decolonization strategies for MDRO are lacking. The purpose of Despite of many of the same health risks as cigarette smoking, this study was to prove the efficacy of FMT on decolonization of shisha smokers may additionally acquire infections that may be carbapenemase-producing enterobacteriaceae (CPE) and vanco- passed from one to another by sharing a shisha. Hence, this study mycin-resistant enterococci (VRE) carriers. was conducted to examine evidence of bacterial contamination Methods: This study was a prospective, open-label, uncontrolled, in the shisha apparatus. single-center pilot study of FMT for 25 Korean patients with Methods: In this preliminary study, 36 shisha bongs were digestive tract colonization with CPE, VRE or CPE/VRE between sampled from three public cafes in heavily saturated urban areas March 2018 and February 2019. Fecal solution obtained from in Klang Valley, Malaysia. Samples were obtained from four healthy unrelated donors was infused to recipient’s gut via different parts of the shisha bong, thus giving a total of 36 shisha colonoscopy, duodenoscopy, or percutaneous jejunostomy tube. water samples and 108 swab samples from different parts of Fecal samples of recipients were collected before and after FMT the shisha bong. The isolated samples were identified by Gram until 1year. We compared characteristics of subjects who succeed staining and standard biochemical tests. Subsequently, these in decolonization during study period (responders) with subjects microorganisms were further confirmed using API bacteria who failed to decolonize MDRO by FMT (non-responders). identification test kits. Furthermore, microbiome analyses were performed to investigate Results: A total of 14 bacterial genera were identified from the the influence of microbial characteristics of recipients on the shisha water and swab samples. The most predominant bacterial outcome of FMT. genus isolated were Staphylococcus spp. with a total of 31% of Results: Decolonization was achieved in 12/23 (52.2%) during the total number of isolates. Out of this, 13% were identified as study period. Hemoglobin (11.0 vs. 10.0, p=0.018), low density Staphylococcus aureus. The second predominant isolates were lipoprotein cholesterol (102.0 vs. 89.0, p=0.049), and albumin Clostridium spp. with a total of 17%. Random samples were (3.4 vs. 3.2, p=0.006) levels were higher in responders. Antibiotic selected for API 20E testing and the results were consistent with treatment(ATB) within 1week after FMT were less common in the conventional methods. responders (41.7% vs. 90.9%, p=0.027). Patients with no ATB Conclusion: In addition to the health risk contributed by tar approached frequent decolonization at 1(75.0% vs. 26.7%; and nicotinic components of tobacco, shisha itself carries a risk p=0.037) and 3 months (87.5% vs 33.3%; p=0.027). The rates of of bacteria transmission via droplet inhaling and via indirect decolonization were significantly different between CPE, VRE transmission between shisha smokers through the sharing of and CPE/VRE colonizer (75.0% vs. 38.5% vs. 66.7%; p= 0.018). mouthpieces or through unhygienic handling by shisha handlers. Gut microbiome of responders showed a higher richness and The presence of these bacteria in the shisha water as well as its diversity than non-responders before(294 vs 274 by Ace; 2.6 vs 1.8 components, indicates the potential risk for infectious disease by Shannon) and after (345 vs 260 by Ace; 2.9 vs 2.1 by Shannon) among shisha smokers. Through identification of bacteria from Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81 S73

shisha, awareness about health risks resulting from shisha needle stick injury (NSI) incidence rate in Sri Jayewardenepura smoking can be increased. This may further be helpful in the General Hospital (SJGH), Sri Lanka. future surveillance of shishas to monitor for potential human Method: Hospital device utilization data, needle stick injury pathogens. data and total expenditure data including cost of management of needle stick injuries for conventional and safety cannula were collected from the period 01/01/2016 to 30/06/2019. The needle O1-PT05 stick injury incidence rate for every 100,000 devices per year was Alcohol Hand Gel Formulations Reduce an Antimicrobial calculated for conventional and safety cannula and two incidence Activity of Chlorhexidine Gluconate Solution rates were compared statistically to determine the existence P. Uirungroj1*, S. Sirilun2, T. Ouirungroj1,2, C. Saenjum2,3 of statistical difference between them. In addition the cost per 1PoseHealthCare Co., Ltd., 1 Soi Ramintra 107, Ramintra Rd., device inclusive of management of associated needle stick Kannayao, Bangkok, Thailand, 2Department of Pharmaceutical injuries was calculated. Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Results: The total number of conventional and safety cannula Mai, Thailand, 3Cluster of Excellence on Biodiversity based utilized (purchased) during the period of study were 86412 and Economic and Society (B.BES-CMU), Chiang Mai University, 284686 respectively. In total there were 12 NSIs for conventional Chiang Mai, Thailand cannula and 5 NSIs for safety cannula. The incidence rates per 100,000 devices for conventional cannula and safety cannula Chlorhexidine gluconate (CHG) is a cationic bis-biquanide were 13.89 (95% CI 7.18-24.26) and 1.756 (95% CI 0.57-4.099) biocide. Positively charge of CHG molecules bind to negatively respectively. There was a significant reduction in the needle stick charge of phospholipid in bacterial cell wall coursing membrane injury incidence rate with safety cannula use (p<0.0001). The cost disruption. This study was carried out to investigate the in vitro per device inclusive of management of associated needle stick physical, chemical, and biological incompatibilities of marketed injuries for conventional and safety cannula were 73.18 and 83.17 alcohol hand gel with CHG solution. Eight marketed alcohol LKR respectively. hand gel samples containing anionic thickener (Carbomer) Conclusion: This study highlighted the fact that substantial and two marketed alcohol hand rub samples were collected reduction of needle stick injury incidence rate with safety cannula to investigate for in vitro kinetic physical, chemical, and use. Therefore we recommend use of safety cannula in view of its biological incompatibilities with 2%w/v CHG in water. The prevention of occupational risk to health care workers. contact times were 15, 30, 45, 60, 90, 120, 150, and 180 seconds. All of samples were removed alcohol before investigation. The results demonstrated that eight marketed alcohol hand gel O2-PT01 samples containing Carbomer reduced the amount of CHG Extracellular vesicles (EVs) from methicillin-resistant (22.7 – 34.5%) analyzed by reversed-phase HPLC technique and Staphylococcus aureus (MRSA) stressed by ampicillin get other two marketed alcohol hand rub samples maintained the stronger effects to β-lactam antibiotics compared to EVs amount of CHG. The antimicrobial activity revealed that 2%w/ from non-stressed MRSA * v CHG solution achieved the 5.69 and 5.45 log10 reduction for SW Kim, AR Lee, TS Jung S. aureus ATCC25923 and E. coli ATCC25922, respectively. The Laboratory of Aquatic Animal Diseases, Institute of Animal antimicrobial activity was dramatically reduced to the 1.72 – Medicine, College of Veterinary Medicine, Gyeongsang National

2.70 log10 reduction for S. aureus ATCC25923 and 1.52 – 2.11 log10 University, Jinju, 660-701, South Korea reduction for E. coli ATCC25922 after 60 seconds mixed with eight marketed alcohol hand gel samples containing Carbomer. EVs produced by Gram-positive bacteria contain several Two marketed containing nonionic thickener maintained the bacterial compounds and play important roles in interbacterial antimicrobial activity of 2%w/v CHG solution. It can conclude communication to cope with antibiotic condition. here that, anionic thickeners in alcohol hand gel samples may The EVs of methicillin-resistant Staphylococcus aureus (MRSA) neutralize positively charge and reduce the antibacterial activity ST692 were isolated in an environment with no stress and of CHG. with stress by adding ampicillin at a lower concentration than minimum inhibitory concentration (MIC). The isolated EVs were incubated with sensitive S. aureus in the presence of several O1-PT06 β-lactam antibiotics. Then growth curve and colony forming unit Cost effectiveness of safety cannula in reducing needle stick (CFU) of S. aureus were measured over time. The severalβ -lactam injuries antibiotics treated with EVs from stress condition and normal K D S T Abeywardana, W A B N Wijesinghe, G K Iresha, condition were measured with LC-QQQ. Each of EVs were P C L S Buddhadasa, S K Jayatilleke* analyzed using LC-ESI-MS/MS to compre their respective protein Sri Jayewardenepura General Hospital (SJGH), Sri Lanka compositions. We showed that the level of EVs production from MRSA under Background: The decision to support implementation of safety stressed conditions was increased compared with that of EVs cannula in a health care institution requires analysis of its cost under unstressed condition. Our growth kinetics and CFU effectiveness. The aim of this study was to find out the cost counting results revealed that EVs from stressed condition could effectiveness of safety cannula over conventional cannula on protect susceptible S. aureus in the presence of several β-lactam S74 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81

antibiotics (ampicillin, cefoperazone, cefazolin, amoxicillin, Department of Microbiology-Colombo South Teaching Hospital- cephalexin, and cloxacillin) better than EVs from unstressed Sri Lanka conditions. Result of LC-QQQ showed that several β-lactam antibiotics can be degraded by EVs. As a result of protein analysis, Background: Methicillin resistant Staphylococcus aureus (MRSA) several proteins related to resistance of β-lactam antibiotics were is an important pathogen in health care settings causing severe found in EVs. infections. This is a prospective study to compare the incidence In this study, we demonstrated that the presence of ampicillin rate of MRSA positivity in Colombo South Teaching Hospital from could increase the production of EVs. Furthermore, EVs from 2010 to 2018. It is the first study done in a Sri Lankan hospital to MRSA under stressed conditions have intensive ability in evaluate the incidence rate of hospital-onset MRSA over the years. protecting susceptible S. aureus in the presence of β-lactam Objectives: To compare the incidence rate of hospital-onset antibiotics than unstressed conditions. MRSA in Colombo South Teaching Hospital (CSTH) from 2010 to 2018 To compare the incidence rate of hospital-onset MRSA blood O2-PT02 stream infections in CSTH from 2013 to 2018 SCCmec type and MRSA fitness: genotype and biological To compare the incidence rate of hospital-onset MRSA in surgical implications in a tertiary teaching hospital wards, surgical ICU and medical ICU from 2010 to 2018 H Neoh*, R Raja Abd Rahman, M Hatta, N Mohd Yusof, Method: The MRSA incidence rates were calculated according M Abdul Samat, N Kamarudin, A Noordin, H Sapri, T Tan to the MRSA surveillance through the National Healthcare Safety Universiti Kebangsaan Malaysia, Malaysia Network 2008 (CDC) using the standard formulae. Te number of MRSA isolates from each unit were obtained from Background: Genotyping of methicillin-resistant Staphylococcus the register in infection control unit. aureus (MRSA) strains isolated from hospital settings is important Te total patient days for each year and each unit were obtained to understand the pathogen’s transmission dynamics. In this from the department of hospital medical record keeping. study, besides SCCmec typing, tested MRSA strains were also Results: The incidence rate of hospital acquired MRSA in 2010 subjected to fitness assessments to determine their competence was 0.225 while it became 0.215 in 2018 and the rate remained in a hospital environment. static throughout. In 2012 and 2014 the rates exceeded 0.3. Methods: This study was carried out on MRSA strains isolated When the rates of the surgical wards and intensive care units are in 2017 from various wards of UKM Medical Centre, a tertiary compared there are few isolated peaks but no rising trend. teaching hospital in Kuala Lumpur, Malaysia. SCCmec typing Incidence rate of MRSA bacteraemia fluctuates between 0.006 to was carried out via PCR and gel electrophoresis. In addition, 0.037 and in 2018 a significant peak of 0.07 is observed. time required for selected strains of each SCCmec type to reach Conclusions: The incidence rates of hospital-onset MRSA do exponential growth from a sub-inoculum of overnight culture was not have a marked rise compared to high prevalence of MRSA determined. These strains’ survival to desiccation in 24 and 48 in previous Sri Lankan studies. It has a static stage which is hours was also investigated. compatible with some global data. Expansion of renal unit could Results: A total of 222 MRSA strains were included into the study. have increased the incidence of MRSA bacteraemia in 2018 and Majority of the strains (205, 92.3%) were identified as SCCmec relevant protocols and monitoring have to be optimized. type IV, eight (3.6%) as SCCmec type V and only one (0.5%) strain as SCCmec type III-SCCmercury with ccrC. Seven (3.2%) strains were untypable. Interestingly, we found these SCCmec O2-PT04 types to correlate with the strains’ fitness characteristics. The Understanding Determinants of Antibiotic Prescribing SCCmec type IV and type V MRSA strains reached exponential among Junior Physicians in Public Hospitals growth approximately one hour earlier than the SCCmec type III- X. Ong, J. Yeo*, J. Tan, H. Guo, M. Ibrahim, L. Wong, J. Chung, SCCmercury with ccrC strain. In addition, the SCCmec type IV A. Kwa, L. Lum, J. Somani, D. Lye, A. Chow. MRSA strains were also consistently the most resistant to drying, Tan Tock Seng Hospital, Singapore General Hospital & National followed by SCCmec type III-SCCmercury with ccrC MRSA. University Hospital, Singapore SCCmec type V strains were the least resistant to desiccation, despite being able to grow rapidly. Antimicrobial resistance is under increased scrutiny in tertiary Conclusion: The dominant MRSA genotype in UKM Medical hospitals due to associated increased treatment cost and Centre in 2017 was a pathogen which grew rapidly and resisted mortality. Inappropriate prescribing of antibiotics is known to desiccation. SCCmec types of circulating MRSA clones might have be a significant contributor to antimicrobial resistance. This biological implications on hospital infections; further studies will study aims to identify factors determining antibiotic prescribing be required to confirm this. in junior physicians practicing in adult tertiary hospitals. 12 in-depth interviews were conducted with junior physicians across medical and surgical disciplines in 3 largest hospitals in O2-PT03 Singapore. Transcripts were analysed using coding reliability Incidence rate of hospital-acquired MRSA positivity in thematic analysis. Factors influencing junior physicians’ antibiotic Colombo South Teaching Hospital from year 2010 to 2018 prescribing were mapped to intrapersonal, interpersonal, T Ranasinghe*, S Chandrasiri, A Sutharson and organisational levels of Social Ecological Model. At the Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81 S75

intrapersonal level, although junior physicians consider clinical urinary tract infection. 66% had community-acquired infection factors prior to prescribing antibiotics, they perceive themselves (CAI) whereas 34% had HAI. Prevalence of antibiotic resistance as having minor roles in antibiotic prescribing decisions, often was highest in A. baumannii (69%) followed by K. pneumoniae having to abide by their consultants’ decisions. Antibiotic (49%), E. coli (40%), P. aeruginosa (28%), and S. aureus (16%). Stewardship Program (ASP) team’s input were found to influence Consumption of all antibiotics was 18,103 DDD (149 DDD/100 junior physicians’ prescribing practices at the interpersonal patients and 245 DDD/1,000 hospitalization days). Overall level, where ASP inputs serve as helpful reminders to review HAI prevalence was 14% in which 48% of HAI were caused by antibiotic orders. At the organisational level, recommendations antibiotic-resistant bacteria. Length of hospital stay, mortality from computerized decision support systems (CDSS) tend to be and hospitalization cost was high especially patients infected with ignored, as antibiotic prescribing decisions were often made prior antibiotic-resistant bacteria and patients with HAI. to electronic prescribing. Senior physicians, but not antibiotic Conclusions: Integrated 1-day PS on AMU, AMC, AMR, HAI, CDSS, influence junior physicians’ antibiotic prescribing and AMR burden at the same survey in one day in hospitalized practices. Further studies should assess how CDSS can be better patients is feasible and it requires much less time and resources utilised by junior physicians, while antimicrobial stewardship than multiple separate longitudinal surveys. Data from integrated efforts targeting senior doctors could enhance appropriateness 1-day PS could be used to estimate and monitor AMU, AMC, of antibiotic prescription with significant impact on junior AMR, HAI, and AMR burden at facility level and national level physicians. where the resources for performing such surveillances are limited.

O2-PT05 O2-PT06 Integrated One-Day Prevalence Survey (integrated 1-day PS) Implementation of the National Antimicrobial Prescribing on Antimicrobial Use (AMU), Antimicrobial Consumption Survey (NAPS) to assess antimicrobial prescribing in surgical (AMC), Antimicrobial Resistance (AMR), Healthcare- departments at a tertiary teaching hospital in Malaysia Associated Infection (HAI) and AMR Burden in Hospitalized S Ponnampanavalar1, L Loong1, Syed Omar SF1, Raja Azwa RIS1, Patients in Thailand Sohail A1, Wong PL1, Johari BM1, Ng RX1, Tan CH2, Lee CE2, V. Thamlikitkul*, P. Rattaumpawan, R. Sirijatuphat, Lim KY2, Thursky 3K , James R3 W. Wangchinda 1Department of Medicine, University of Malaya, 2Department of Division of Infectious Diseases and Tropical Medicine, Department Pharmacy, University Malaya Medical Centre, Malaysia, of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol 3National Centre for Antimicrobial Stewardship, University of University, Thailand Melbourne and Royal Melbourne Hospital, Australia

Background: One of strategic objectives in global action plan Background: Surgical site infections (SSI) are common and on AMR is strengthen knowledge and evidence base through costly hospital-acquired infections that contribute to additional surveillance. Surveillance related to prevention and containment bed-days and increased mortality. Optimal use of surgical of AMR includes AMU, AMC, AMR, HAI, and AMR burden antimicrobial prophylaxis (SAP) reduces the risk of SSIs. surveillance. These surveillances are usually performed by Aim: To assess appropriateness of surgical antimicrobial multiple separate longitudinal surveys consuming time, prophylaxis using the National Antimicrobial Prescribing Survey personnel and resources that are unavailable in many low- and (NAPS) tool in a a tertiary hospital in Kuala Lumpur, Malaysia. middle-income countries. This study determined feasibility Methods: A prospective point-prevalence survey on antimicrobial and benefit of integrated 1-day PS on AMU, AMC, AMR, HAI, prescribing in surgical wards between 22/4/19 and 3/5/19 and AMR burden at the same survey in one day in hospitalized using the NAPS protocol. The NAPS, developed by National patients in Thailand. Centre for Antimicrobial Stewardship (NCAS), comprises a set Methods: 183 participating hospitals in Thailand were selected by of standardized and validated assessment tools and protocols multistage stratified random sampling to cover all geographical to assess antimicrobial prescribing. All patients prescribed regions of Thailand, capacity, and capability of hospitals. Data on antimicrobials at 8am on the day of the survey were audited by a number of hospitalized patients, demographics, detail on AMU, multidisciplinary team. The appropriateness of each prescription AMC, AMR, HAI, morbidity, mortality and hospitalization cost for was assessed using the structured NAPS appropriateness matrix. each hospitalized patient who received antibiotic on a survey day Data were entered into the online platform and analysed using were collected and analyzed. Microsoft Excel Version 2010. Results: 12,187 patients received systemic antibiotic among Results: The prevalence of antimicrobial use was 47% (159/337). 23,686 hospitalized patients. Overall AMU prevalence was Overall, 66% (97/146) of prescriptions for treatment were 52% (range 8% to 89%). 21% of them received antibiotics for appropriate, whereas only 31% (21/68) of prescriptions for prophylaxis of infection whereas 80% received antibiotics for SAP were appropriate. The majority of prescriptions for SAP treatment of infection. Cefazolin was the most commonly used [55% (29/53)] were assessed as inappropriate due to prolonged agent for surgical prophylaxis. 68% of patients received antibiotics duration (prophylaxis >24 hours). for surgical prophylaxis longer than 2 days. Among patients who Conclusion: In this institution, appropriateness of SAP was lower received antibiotics for treatment of infection, common sites of than benchmarked standards. Therefore, this study has helped infections were pneumonia, skin and soft tissue infection and identify a likely target for antimicrobial stewardship interventions. S76 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81

Oral Presentations contagious health threat and there are more than 100,000 cases reported annually. Dengue virus is classified into four different serotypes known as DENV 1, 2, 3 and 4. Currently, there is no September 28, 2019 effective antiviral agent or a universal vaccine available for dengue infection. Successful virus entry into the host cells is necessary for establishing the infection and recently dengue antiviral agents O3-PT01 has become an attractive therapeutic strategy. The antiviral Differentiating influenza and rhinovirus infections in the agents could specifically block viral entry and fusion with the cell tropics: Performance of influenza-like illness (ILI) case membrane by targeting the structural and non-structural proteins definition of the virus which could contribute towards the development of A Chow*, AA Hein, G Tin, CK Ooi antiviral drugs. Tan Tock Seng Hospital Singapore Methods: We attempted to investigate the efficiency of small molecule peptides that are conserved across the four dengue Background: Influenza-like illness (ILI) is defined by the World serotypes for their efficiency to block the virus entry and Health Organization as an acute respiratory infection with onset infection. Initially, the peptides were screened in Vero cells for within the past 10 days, presenting with cough and a measured their cytotoxic activity and different concentrations of peptides temperature of >=38 degC. We assessed for the performance of were used to treat the cells before infection (attachment assay) ILI in the detection of influenza and rhinovirus infections in a with one of the four dengue virus serotypes. Alternatively, the tropical country where seasonal patterns are less well-defined. viruses were treated either prior to infection (virucidal assay) or Methods: From June 2016 through Nov 2018, 717 consecutive cells treated with the peptides after the infection (post infection adults presenting with uncomplicated upper respiratory tract assay). The viral RNA from infected cells were extracted and RNA infections at the emergency department of a 1600-bed acute copy number was determined by TaqMan Real time qRT-PCR. hospital in Singapore were screened for 15 major respiratory An immunostaining based foci reduction assay was performed to viruses using a multiplex PCR respiratory virus pathogen panel measure the reduction in viral foci formation upon treatment of (Seeplex RV15 ACE Detection), via throat and nasal swabs. antiviral peptides. Demographic, clinical, and epidemiological data were included Results: We have investigated the antiviral activity of small to assess for the performance of ILI in the detection of influenza molecule peptides against the four dengue virus serotypes. and rhinovirus infections respectively, using multivariable logistic Evaluation of the antiviral activity was performed in three regression models. different assay conditions, of which, two peptides were shown to Results: Median age was 36 (IQR 28-51) years and two-thirds possess potential antiviral activity against all four dengue virus (67.8%) had no comorbidities. One-in-five (20.6%) patients serotypes. The peptide B5 showed the maximum antiviral activity tested positive for influenza and 14.4% for rhinovirus. Overall, in terms of reduction in RNA copy number as evaluated by the 14.5% presented with ILI. After adjusting for age, comorbidities, real time qPCR. The antiviral efficiencies were 85.68%, 87.79%, influenza vaccination in the prior 6 months, travel history in past 80.50% and 86.87% against the dengue serotypes 1, 2, 3, and 4 7 days, month and year of illness presentation, patients fulfilling respectively. ILI definition were nearly 7 times as likely to have an influenza Conclusion: Our findings show that the small molecule peptides infection (Adj OR 6.81, 95%CI 4.22-11.00, P<0.001) but 80% less derived from the conserved regions of the dengue viral protein likely to have rhinovirus infection (Adj OR 0.21, 95%CI 0.08-0.60, may serve as a potential antiviral agents and these antiviral P=0.004) than patients not fulfilling ILI criteria. agents selected highly effective in vitro is currently planned to Conclusion: The ILI case definition can be used to differentiate be evaluated in an in vivo animal model. The outcomes of the influenza and rhinovirus infections in the tropics, regardless of current study may help exploit inherent towards the development the month of the year. of a future antiviral agent against dengue.

O3-PT02 O3-PT03 Antiviral activity of small molecule peptides against dengue Varicella zoster virus specific immunity and subclinical virus reactivation of VZV in patients with rheumatoid arthritis B Ramanathan1*, D Gatherer2, CL Poh3 S Choi1*, K-H Lee2, S Lim1, JS Kwon3, S-H Kim3, SY Park1 1Department of Biological Sciences, Sunway University, Malaysia, 1Division of Infectious Diseases, Dongguk University Ilsan Hospital, 2Department of Biomedical and Life Sciences, Lancaster University, Goyang 2Division of Rheumatology, Dongguk University Ilsan UK, 3Centre for Virus and Vaccine Research, Sunway University, Hospital, Goyang 3Department of Infectious Diseases, Asan Malaysia Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Background: Dengue is an endemic mosquito-borne viral disease that is prevalent in most tropical and sub-tropical Backgrounds: The incidence of herpes zoster in patients with regions. Around 390 million dengue cases occur every year, rheumatoid arthritis (RA) is at least twice as high as in healthy where 96 million shows clinical symptoms and 500,000 required people. However, little is known about VZV specific immunity hospitalization. In Malaysia, dengue is considered as a highly and subclinical reactivation of VZV, in particular in patients with Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81 S77

RA. neutralizing potencies in the post-CD4CCR5 format, suggesting Methods: Cross sectional study of VZV specific immunity was the presence of anti-gp41 antibodies. We are in the process of performed at Dongguk University Ilsan Hospitals. A total of 35 RA identifying key epitope(s) in these potent plasma samples. patients and age matched 35 healthy controls were enrolled for Conclusion: Understanding antibody elicited during natural the study. Levels of IgG and IgA antibodies to VZV were measure infection plays a key role not only identifying vulnerable sites on using an glycoprotein enzyme linked immunosorbent assay. Env, but also contributes towards refining Env-based vaccine Cellular response to VZV were determined by interferon-γ (IFNγ) design to elicit these nAbs. enzyme linked immunosorbent assay. To identify subclinical reactivation of VZV, we performed VZV DNA PCR in saliva of study patients. O3-PT05 Results: Median patient age was 50.0 years old and 46 (65.7%) Residual malaria in targeted low transmission settings of patients were female. Median levels of IgG antibodies to VZV Ethiopia: Bottlenecks to malaria elimination. were not different in RA patients as compared to healthy controls Desalegn Nega1*, Adugna Abera1, Bokretsion Gidey1, (582.9 vs 694.7 IU/mL, p = 0.82), and levels of IgA antibodies to Sindew Mekasha1, Abnet Abebe1, Geremew Tasew1, VZV were not different between two groups (2.35 vs 0.89 IU/mL, p Ashenafi Assefa1, Adugna Woyessa1, Dereje Dillu2, = 0.15). In response to stimulation with VZV, decreased numbers Gezahagn Tesfaye5, Honelegn Nahusenay3, Semira Abdulmenan3, of IFNγ spot forming cells (SFCs) were found among RA patients Hiwot Teka6, Worku Bekele7, Ayele Zewdie3, Hailemariam Reda4 as compared to healthy controls (10.0 vs 126.5 SFCs/106 PBMCs, p 1Ethiopia Public Health Institute(EPHI), 2Federal Ministry of < 0.001). VZV DNA was detected in saliva specimens from one of Health; 3Addis continental Institute of Public Health, 4CHAI, 35 RA patients (2.9%), while no VZV DNA was detected in saliva 5 MACEPA/PATH, 6PMI/USAID, 7WHO Ethiopia specimen from healthy controls. Conclusion: RA patients have similar levels of IgG and IgA Background: Malaria elimination from a given targeted setting antibodies against VZV, while cellular immunity is decreased. principally involves draining the residual and asymptomatic These data suggest that increased prevalence of herpes zoster in reservoirs of the parasites to break the ongoing transmission. RA patients is due to poor cellular response. This study determined the prevalence of symptomatic and asymptomatic malaria at elimination setup. Methods: Community based cross-sectional survey was con- O3-PT04 ducted from October to December 2017 at 20 malaria elimination Profiling a panel of plasmas infected with human targeted districts in Ethiopia. GPS enabled Smart Phones pro- immunodeficiency virus type 1 subtype CRF01_AE for anti- grammed with Open Data Kit (EpiSample) were used to collect envelope neutralizing antibodies the data at 9326 households. Q. Ng1, K. Tee2, Y. Tong1* Results: The overall prevalence of malaria was 1.17% (339/2898) 1Department of Biological Science, Sunway University, Malaysia, by Care Start™ Malaria HRP-2/pLDH Tests. The prevalence at 2Department of Medical Microbiology, University Malaya, district level ranged from 0-4.7%. Fever prevalence (axillary temp Malaysia >37.5oc) was 9.2% (2766/29993). Among the febrile individuals, 84(3.35%) were malaria positive. Asymptomatic malaria was 75.2% Background: Broadly neutralizing antibodies (nAbs) are (255/339) among the malaria positives and 0.88%(255/28973) expected to constitute a key component of protective immunity among total study participants. Symptomatic malaria was against human immunodeficiency virus type-1 (HIV-1). Isolating 24.8%(84/339) among the malaria positives and 0.29%(84/28973) nAbs from infected patients is invaluable in identifying vulnerable among the whole study participants. Of the total asymptomatic sites on HIV-1 surface envelope glycoprotein (Env). This is the first malaria, prevalence was 10.2%(26/255) in U5 children and pilot study conducted with the aim to profile the anti-envelope 89.8%(229/255) in above 5 years. nAbs in plasmas from individuals infected with CRF01_AE, which Conclusion: Finding the substantial asymptomatic malaria is the major circulating subtype in Malaysia. reservoirs in the current assessment calls for active case detection Methods: Plasma (n = 21) from the National Blood Center of following the index malaria cases and mass screening of the Kuala Lumpur were evaluated for (1) anti-Env antibodies binding population to break these residual transmission sources in the titre and (2) nAbs titre. Anti-Env antibody titres were quantified elimination targeted settings. by ELISA against HIV-1 recombinant proteins of different subtypes, while nAb titres were determined by incubating HIV-1 pseudovirion bearing different Env subtypes and plasma before infecting cells expressing CD4 and CCR5. Results: All plasmas developed anti-gp120 antibody titre ranging between 102 and 105 against Env recombinant protein derived from subtypes B, C and AE, while anti-gp41 titre was quantified in the range of 103 and 104. Two plasmas were identified to have cross-subtype (A, B, and AE) nAbs with mean IC50 of 69 and 237. Using gp120 absorption method, one plasma was found to contain trimer-specific nAbs. Three plasma have limited S78 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81

O3-PT06 from 12 hospitals were recruited during 2017-2018 and 2010- Synthesis, Antimalarial Activity Evaluation and Molecular 2011, respectively. Among them, 5.9% (54/913) were male. Male Docking Studies of Some Novel Substituted Spiro-1,2,4,5- patients were older (mean 66.0 vs. 55.3, P <0.001), had higher tetraoxane Derivatives Charlson’s comorbidity index (mean 1.3 vs. 0.7, P =0.027), and had M. K. Kumawat1*, D. Chetia2 higher proportion of structural problems on urinary tract (20.4% 1Anand College of Pharmacy, Keetham, Agra-282006, Uttar vs. 4.0%, P <0.001) compared with female patients. Moreover, the Pradesh, India, 2 Department of Pharmaceutical Sciences, total duration of antibiotic treatment for male was longer (mean Dibrugarh University, Dibrugarh-786004, Assam, India 21.8 vs. 17.3, P =0.001) and the proportion of carbapenem usage for male was higher (24.1% vs. 9.5%, P =0.001). Male patients Background: The rapid spread of resistance towards currently spent longer time for admission than female patients (median, 10 available drugs in Plasmodium falciparum (pf) has become a vs. 7, P <0.001). Enterobacteriaceae were less commonly isolated major health concern of the developing world. as causative pathogens for CA-APN in male compared with that Methods: Seven novel substituted spiro-1,2,4,5-tetraoxane in female (82.2% vs. 95.8%, P =0.037). derivatives were synthesized and characterized by a number of Conclusions: Male CA-APN patients were older and had more analytical and spectroscopic techniques. The molecules were co-morbidities compared with female CA-APN patients. Also, subsequently screened for in vitro antimalarial activity against male patients received longer antibiotic treatment compared with chloroquine sensitive (3D7) & chloroquine resistant (RKL-9) female patients. strains of Plasmodium falciparum. Results: Most of the synthesized compounds exhibited moderate to very good activities towards the parasite in comparison to O4-PT02 the standard, chloroquine. Three compounds showed potent Clinical significance of fungi, enterococci and multidrug- antimalarial activity against chloroquine sensitive strain of resistant organisms in the patients with intra-abdominal Plasmodium falciparum (3D7). One compound 5b (3-ethyl- infections 3-methyl-1,2,4,5-tetraoxa-spiro[5.5]undecane) showed a very YK Yoon1*, MS Lee2, C Moon3, J Hur4, JY Kim1, SW Kim5 good activity against both chloroquine sensitive ( 3D7) with 1Korea University Anam Hospital, 2Kyung Hee University Hospital, 3 4 MIC 1.95 µg/ml & IC50 1.95 µg/ml compared to CQ (MIC 0.4 µg/ Busan Paik Hospital, Yeungnam university medical center, 5 ml & IC50 0.04 µg/ml) as well as chloroquine-resistant strains Kyungpook National University Hospital School of Medicine of P. falciparum (RKL-9) with MIC 15.63 µg/ml & IC50 3.906 µg/ ml compared to CQ (MIC 25 µg/ml & IC50 0.393 µg/ml). These Background: The purpose of this study was to evaluate the synthesized compounds were studied by molecular docking clinical implication of enterococci, fungi and multidrug-resistant analysis in the active site of Falcipain-2 as a putative protein. organisms (MDRO) isolated from patients with intra-abdominal Conclusion: Designed molecules have the possibility to introduce infections (IAIs). chemical diversity around the 1,2,4,5-tetraoxane nucleus to Methods: This multicenter study included consecutive patients generate newer and potent molecules. admitted for microbiologically-proven IAIs in 5 university- affiliated hospitals in the Republic of Korea, from 2016 to 2018. Multivariate logistic regression analysis was used to identify risk O4-PT01 factors associated with 28-day mortality. Comparison of clinical characteristics of community- Results: During study periods, a total of 1181 patients enrolled acquired acute pyelonephritis between male and female in our study. The 28-day mortality rate was 6.2%. Enterococcus patients spp. (P=0.013), Candida spp. (P=0.043) and MDRO (P<0.001) Hyun-uk Jo1, Ki Tae Kwon2, Seong-yeol Ryu3, Seong-Heon Wie4, were frequently isolated from non-survivors than from survivors. Jieun Kim5, Se Yoon Park6, Kyung-Wook Hong7, Hye In Kim8, Patients with these pathogens isolated were more likely to receive Hyun ah Kim3, Mi-Hee Kim4, Mi-Hyun Bae5, Yong-Hak Sohn9, inappropriate empirical antibiotic therapy. In the multivariable Jieun Kim6, Yangsoon Lee5, Bongyoung Kim5*, Hyunjoo Pai5 logistic regression analysis, isolation of MDROs (odds ratio 1Eulji University, 2Kyungpook National University, 3Keimyung [OR], 2.64; 95% confidence interval [CI], 1.51–4.63), isolation of University, 4The Catholic University of Korea,5 Hanyang University, Candida spp. (OR, 3.40; 95% CI, 1.09–10.66), hypoalbuminemia 6Soonchunhyang University, 7Gyeongsang National University, (OR, 5.05; 95% CI, 1.77–14.44), and septic shock (OR, 10.63; 95% 8Daegu Fatima Hospital, 9Seegene Medical Foundation CI, 6.11–18.49) were found as independent risk factors for 28-day mortality. But, isolation of Enterococcus spp. was not identified as Background: The aim of this study was to compare the clinical a risk factor (OR, 1.58; 95% CI, 0.85–2.93). characteristics of community-acquired acute pyelonephritis (CA- Conclusion: MDRO-associated IAIs were not uncommon, and APN) between male and female patients. isolation of MDRO or Candida spp. was an independent risk Methods: We prospectively collected the clinical and microbio- factor for the poor outcome. The empirical antibiotic therapy for logical data of hospitalized patients with CA-APN in South Korea MDRO or Candida spp. may be considered in critically-ill patients from Mar 2010 to Feb 2011 and from Sep 2017 to Aug 2018, re- with IAIs, but empiric coverage for enterococci may seldom spectively. Each patient was included for the first episode during needed. the study period. Results: A total of 340 patients from 8 hospitals and 573 patients Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81 S79

O4-PT03 assay (IGRA). However, appropriateness of this strategy has not Multidrug-resistant Acinetobacter baumannii infection in been evaluated in areas with high burden of tuberculosis (TB). TB lung transplant recipients: risk factors and prognosis incidence rate (51.5/100,000) is still high in Korea. In this study, Dong Hyun Oh1, Yong Chan Kim2, Eun Jin Kim2, In Young Jung2, we analyzed risk stratification by not only IGRA but also chest Su Jin Jeong2*, Song Yee Kim3, Moo Suk Park3, Anes Kim4, image. Jin Gu Lee4, Hyo Chae Paik4 Methods: In this retrospective cohort study, LT-Rs who tested for 1Division of Infectious Disease, Department of Internal Medicine, IGRA between May 2008 and December 2017 were included. LT- Seoul Medical Center, Seoul, South Korea, 2Division of Infectious Rs were observed until active TB development, death, and the Disease, Department of Internal Medicine, Yonsei University latest follow-up until December 2018. Chest X-ray or CT showing College of Medicine, Seoul, South Korea, 3Division of Pulmonology, lesions compatible with old stable TB is considered as positive Department of Internal Medicine, Institute of Chest Diseases, Yonsei images. LT-Rs divided into six groups: LT-Rs with previous history University College of Medicine, Seoul, South Korea, 4Department of of TB appropriately treated, Image (+)/IGRA (+), image (+)/IGRA Thoracic and Cardiovascular Surgery, Yonsei University College of (-), Image (-)/IGRA (+), Image (-)/IGRA (-) and LTBI treated. Cox Medicine, Seoul, South Korea regression model was used to analyze risk groups. Results: A total of 717 eligible LT-Rs were observed, and median Backgrounds: Infectious complication is an important cause follow-up period was 1354 days (range 16-3904 days). Chest of poor outcome of lung transplantation. Infections with X-ray and Chest CT were performed in 100% and 72.8% of LT- Acinetobacter baumannii (A. baumannii) are problematic, Rs at least 1 year before transplantation, respectively. 21 patients because of limited therapeutic option due to increasing resistance developed active TB. Incidence of TB were 2261.6, 724.3, and to antibiotics. However, there are few studies on A. baumannii 119.4 cases/100,000 year-person in the first year, 2nd year, and infection in LT recipients. Thus, we aimed to investigate ≥ 3rd year from transplantation, respectively. In the analysis of epidemiology and risk factors for infection with A. baumannii in risk stratification, LT-Rs with previous history of TB appropriately lung transplant recipients.. treated (HR = 8.81; 95% CI = 2.70-28.80) and image (+)/IGRA (+) Methods: Lung transplant recipients ≥ 18 years of age in a (HR = 5.74; 95% CI = 2.16-15.28) were risk groups. Patients with university hospital were enrolled in this retrospective cohort IGRA (+) without radiologic findings were not at a risk (HR0.64; study. Risk factors for infection with multidrug resistant A. 95% CI 0.22-1.90). baumannii and 90-day mortality were analyzed. Conclusions: LT-Rs having previous history of TB were the risk Results: Fifty-one of 96 lung transplant recipients experienced group of developing active TB, even though appropriately treated. A. baumannii infection. Infected patients had a significantly In contrast, IGRA alone cannot validate LT-Rs who have potential higher 90-day mortality rate than uninfected (19.6 % vs. 2.2%, p = for developing active TB in this study. The strategy of treating all 0.009). High BUN before LT (odds ratio [OR] 1.16; p = 0.008), long the IGRA (+) LT-Rs might be associated with overtreatment in TB duration of surgery (OR 1.16; p = 0.029), and hypoalbuminemia endemic area. before LT (OR 4.01; p = 0.037) were independent risk factors for infection with multidrug resistant A. baumannii. On multivariate analysis severe thrombocytopenia (OR 28.69; p = 0.005), high serum creatinine (OR 1.48; p = 0.042), and infection with multidrug resistant A. baumannii (OR 22.58; p = 0.031) were independent risk factors for 90-day mortality. Conclusion: Prolonged surgery, high BUN and hypoalbuminemia before lung transplantation were significant risk factors for infection with multidrug resistant A. baumannii. Severe thrombocytopenia, high serum creatinine, and infection with multidrug resistant A. baumannii infection were independent risk factors for 90-day mortality.

O4-PT04 Risk groups of Developing Active Tuberculosis in Liver Transplant Recipients in Tuberculosis Endemic Area: Risk Stratification by Chest Image and Interferon Gamma Release Assay S-H Kim*, S Oh, K Huh, SY Cho, C-I Kang, DR Chung, KR Peck Division of Infectious Diseases, Samsung Medical Center, O4-PT05 Sungkyunkwan University School of Medicine, Seoul, South Korea The comparison of histomorphologic diagnosis of invasive aspergillosis and invasive mucormycosis with the definite Background: Current guidelines recommend latent tuberculosis diagnosis based on sterile culture and immunohistochemistry infection (LTBI) treatment for all the liver transplantation test results recipients (LT-Rs) showing positive interferon gamma release Hyo-Ju Son1*, Joon Seon Song2*, Jiwon Jung1, Min Jae Kim1, S80 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81

Yong Pil Chong1, Sang-Oh Lee1, Sang-Ho Choi1, Yang Soo Kim1, mucormycosis agents, respectively. However, only 2 (3%) of 62 Jun Hee Woo1, Sung-Han Kim1† patients revealed the different diagnosis based on IHC and sterile Departments of Infectious Diseases1 and Patholgy,2 Asan Medical culture results; 1 (2%) with positive culture of Aspergillus spp., and Center, University of Ulsan College of Medicine, Seoul, Republic of 1 (2%) with positive aspergillosis IHC respectively. Korea Table 1. The comparison of histomorphologic diagnosis with Background: Due to the low sensitivity of mold culture, clinicians the definite diagnosis based on sterile culture results and usually depend on the histomorphologic diagnosis of invasive immunohistochemistry tests. mold infection for targeted antifungal therapy. However, definite Morphologic Morphologic diagnosis is not always possible based on the mold morphology. Aspergillosis Mucormycosis P value (n = 51) (n = 62) We thus evaluated the diagnostic accuracy of histomorphologic Sterile Culture diagnosis by comparing the morphologic diagnosis of invasive Aspergillus spp. 25 (49.0%) 1 (1.6%) < 0.001 mold infection with immunohistochemistry (IHC)- and culture- Mucormycosis 0 (0.0%) 17 (27.4%) < 0.001 based diagnoses. Others 0 (0.0%) 0 (0.0%) NS Methods: All adult patients who underwent tissue biopsy and in Immunohistochemistry (IHC) whom the histomorphologic diagnosis revealed invasive mold Aspergillosis IHC (+) 41 (80.4%) 1 (1.6%) < 0.001 Mucormycosis IHC (+) 7 (13.7%) 60 (96.8%) < 0.001 infection were enrolled at a tertiary hospital, Seoul, South Korea, Both IHC (-) 3 (5.9%) 1 (1.6%) 0.33 between 1992 and 2014 (retrospectively) and 2015 and 2019 Comparison between histology and modified criteria for proven IFD (prospectively). Their morphologic diagnoses were classified as Concordant 46 (90.2%) 60 (96.8) 0.24 ‘morphologic aspergillosis’ and ‘morphologic mucormycosis’. Disconcordant 5 (9.8%)* 2 (3.2%) 0.24 Sterile culture results and IHC tests for aspergillosis and * Among seven cases with mucormycosis IHC (+), two cases were sterile culture proven aspergillosis. We put priority on sterile culture results over IHC results when mucormycosis from formalin-fixed, paraffin-embedded tissue deciding concordance. sections were compared with morphologic classifications. Results: A total of 113 patients were finally analyzed and their Conclusion: The majority of the histomorphologic diagnosis histomorphologic diagnoses were classified as 51 (45%) with appears to be consistent with the definite diagnosis based morphologic aspergillosis and 62 (55%) with morphologic on sterile culture and IHC tests. However, about 10% of the mucormycosis, respectively. Of the 51 patients with morphologic morphologic aspergillosis was mucormycosis misdiagnosed for aspergillosis, 46 (90%) revealed the same diagnosis of aspergillosis aspergillosis. based on IHC and sterile culture results; 25 (49%) positive culture of Aspergillus spp., 41 (80%) with positive aspergillosis IHC results, and 20 (39%) both positive aspergillosis IHC and sterile culture of O4-PT06 Aspergillus spp., respectively. However, 5 (10%) of 51 patients with Performance of a novel fluorogenic assay for the detection morphologic aspergillosis revealed positive mucormycosis IHC of carbapenemases-producing Enterobacteriaceae from results with no fungi documented on sterile culture specimen. bacterial colonies and directly from positive blood cultures. Of the 62 patients with morphologic mucormycosis, 60 (97%) Hoon Seok Kim1, Jung Ok Kim1, Ji Eun Lee1, Kang Gyun Park2, revealed the same diagnosis of mucormycosis based on IHC and Hae Kyung Lee2, Soo-Young Kim3, Sun-Joon Min4, Juhyeon Kim5, sterile culture results; 17 (27%) positive culture of mucormycosis Yeon-Joon Park1# agents, 60 (97%) with positive mucormycosis IHC results, and 1Department of Laboratory Medicine, Seoul St. Mary’s Hospital, 17 (27%) both positive mucormycosis IHC and sterile culture of College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 2Department of Laboratory Medicine, Uijeongbu St. Mary’s hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 3Department of Laboratory Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 4Department of Chemical & Molecular Engineering / Applied Chemistry, Hanyang University, Ansan, Gyeonggi-do, Republic of Korea, 5Department of Chemistry, Korea University, Seoul, Republic of Korea

Background: The rapid and accurate detection of carbapenemases among Enterobacteriaceae is critical for appropriate treatment and infection control. Here, we evaluated a rapid fluorogenic assay using carbapenem-based fluorogenic probe by comparing it with modified carbapenem inactivation method (mCIM), car- baNP (CNP), and carbapenemase inhibition test (CIT). Materials and methods: A total of 217 characterized isolates of Enterobacteriaceae were included: 63 carbapenemase- producing enterobacteriaceae, 48 non-carbapenemase- Figure 1. Study Design producing-carbapenem-resistant enterobacteriaceae (non-CP- Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S71-S81 S81

CRE), 53 extended-spectrum-β-lactamase-producers, and 53 3rd (range, 240–32,009) vs. 804 (range, 36–2,480), P <0.0001,).and generation-cephalosporin-susceptible isolates. For fluorogenic Fluore-direct test (median; 10,355 (range, 1,689-31,463) vs. 1,068 assay using bacterial colonies (Fluore-C), isolates were lysed, (range, 428-2,155), P <0.0001). Overall, the sensitivity/specificity centrifuged and the supernatant was mixed with 100μM of of Fluore-C, mCIM, CNP, CIT and Fluore-direct was 95.2%/99.4%, fluorogenic probe. In addition, for fluorogenic assay using 93.7%/97.4%, 82.5%/100%, 85.7%/99.4%, and 98.4%/100%, spiked blood culture bottles (Fluore-direct), pellets were directly respectively. This fluorogenic assay showed superiority especially obtained through the pretreatment using saponin and sputazyme in detecting OXA, VIM and GES type carbapenemases. which can also be used for direct identification of pathogens with Conclusions: In this study, we included many non-CP-CRE MALDI-TOF. Fluorescent signal was measured over 50 min using isolates to test the specificity with high stringency. Nonetheless, fluorometer (Infinite F200pro, Tecan Group Ltd.). this fluorogenic assay showed excellent sensitivity and specificity Results: The fluorescent signal difference of CPE was significantly not only with bacterial colonies but also directly from positive higher than that of non-CPE in both Fluore-C (median; 5,814 blood culture. Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S83

Infection & Chemotherapy

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Poster Presentations IL-17 and IL-23 compared to other strains. This suggests that H. pylori C8 probably the most potent and invasive strain that can lead to severe infection. However, early stage of infection could September 27, 2019 not determine the IL-23 expression different among the H. pylori strains. Conclusion: Higher expression of the IL-17 determined in P1-BT02 this study postulates that this pro-inflammatory cytokine play Cytokine Interleukin-17 and Interleukin-23 associated a role in enhancing the severity of gastric inflammation and Helicobacter pylori Infection: In-vitro study and Gene enable the bacteria to evade the immune response. Therefore, Expression Analyses targeting Th17cell differentiation and Th17 cell-specific pro- N.M. Jumahat1,3*, N.F. Zaipul-Anuar1,3, Z. Mohd-Zain3, inflammatory mediator production could serve as new strategy P.N. Kumari3, M.A. Chandra3, J. Hussaini2,3 of immunotherapy in ameliorating the H. pylori infection 1Institute of Medical Molecular Biotechnology, Universiti Teknologi occurrence. MARA, Sungai Buloh, Selangor, Malaysia, 2Institute for Pathology, Laboratory and Forencsic Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia, 3Faculty of Medicine, Universiti P1-BT03 Teknologi MARA, Sungai Buloh, Selangor, Malaysia Chryseobacterium indologenes and Chryseobacterium gleum interact and multiply intracellularly of Acanthamoeba Background: Interleukin-17 (IL-17) is a pro-inflammatory castellanii cytokine secreted by Th17 cells and reported to contribute in the W.G. Lim1, T.Y.K. Tong1, J. Chew1* gastric inflammatory response during Helicobacter pylori (H. Department of Biological Sciences, School of Science and pylori) infection. While interleukin-23 (IL-23) that secreted by the Technology, Sunway University Malaysia activated macrophages is a cytokine with important regulatory functions, bridging innate and adaptive immunity and involved in Background: Chryseobacterium spp. are Gram negative differentiation of Th17 cells. The aim of this study is to investigate environmental bacteria commonly found in freshwater and the expression of IL-17 and IL-23 of differentH. pylori strains from soil. Recently, C. indologenes and C. gleum have been reported different sources after in-vitro co-cultured with human stomach to implicate in fatal nosocomial infections, such as bacteremia. epithelial cells. A. castellanii is a free-living protist known to harbour bacterial Methods: H. pylori S3, S5, C7 and C8 (cagA+/cagA-) strains from pathogens, possibly assisting their transmission to susceptible human and cockroaches were inoculated into AGS cells for 6h. hosts. The aim of this study was to determine the interactions The expression of IL-17 and IL-23 were conducted using RT2 between Chryseobacterium spp. and A. castellanii. Profiler PCR array. Fold differences in the gene expression were Methods: C. indologenes ATCC 29897 and environmental C. determined using the 2-ΔΔCt method and Mann-Whitney U test gleum SU201608 were co-cultured with A. castellanii belonging to was used for statistical analysis. the T4 genotype in 10:1 ratio for 1h at 37°C. Following incubation, Results: The colonization of H. pylori cagA+ strains were amoeba trophozoites were counted then lysed allowing bacteria significantly higher in the AGS cells. The expression of IL-17 were enumeration using plating in order to determine association significantly elevated after infection with H. pylori S3, S5, C7 and rate. Bacterial survival within amoeba was determined by C8 at 12.87, 19.63, 18.85 and 27.35 folds, respectively. However, eliminating extracellular bacteria using antibiotic treatment. there was no significant difference in upregulation expression of Harvested amoeba were either lysed immediately or following an IL-23 with the range of 2.42 to 4.48 folds. Remarkably, H. pylori additional 24h incubation. The lysates were plated to determine C8 (cagA+) isolated from cockroach showed higher expression of bacterial numbers retrieved from A. castellanii cytoplasm.

Neuropathogenic Eschierichia coli K1, known to associate and Jong Ik Jeon, Jung Mogg Kim* multiply within A. castellanii, was used as a control. Department of Microbiology, Hanyang University College of Results: In summary, C. indologenes and C. gleum associated with Medicine, Seoul, Korea Acanthamoeba. Also, they survived intracellularly of the amoeba, multiplying following 24h incubation. Nevertheless, when com- Background: TheB. fragilis enterotoxin (BFT), a virulence factor pared to E. coli, the interaction rates between Chryseobacterium of enterotoxigenic B. fragilis (ETBF), interacts with intestinal spp. and A. castellanii were significantly weaker (p<0.05, t-test). epithelial cells and can provoke signals that induce mucosal Conclusion: The ability of Chryseobacterium spp. to interact inflammation. Although β-catenin signaling is known to be and multiply within A. castellanii may reveal the protective roles associated with regulation of inflammatory responses, little is provided by the amoeba in such interactions, assisting in the known about β-catenin induction in ETBF infection. This study survival and transmission of Chryseobacterium spp. to susceptible was conducted to investigate the role of β-catenin on BFT- hosts within a hospital setting. induced inflammatory responses intestinal epithelial cells. Methods: BFT was purified from culture supernatants of a highly toxigenic strain of ETBF. Expression of signaling molecules was P1-BT04 evaluated using immunoblot and ELISA. Chemicals, siRNA, and Detection and characterization of pathogenic Leptospira in over-expressing plasmid were used to block or enhance each small mammals from wet markets signaling in BFT-exposed cells. N.B. Affendy1*, M.N.M. Desa1, F. Amran2, S. N. Masri1 Results: Expression of b-catenin in intestinal epithelial cells 1Department of Medical Microbiology and Parasitology, Faculty of was reduced relatively early after stimulation with BFT and then Medicine and Health Sciences, Universiti Putra Malaysia, 43400 recovered to normal levels relatively late after stimulation. In Serdang, Selangor, Malaysia, 2Bacteriology Unit, Institutes for contrast, phosphorylation of β-catenin in BFT-exposed cells Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia occurred at high levels early in stimulation and decreased as time passed. Concurrently, nuclear levels of β-catenin were Background: Leptospirosis is a worldwide zoonotic disease higher relatively late after stimulation compared to early after caused by the pathogenic species of Leptospira and highly endemic stimulation. Suppression of β-catenin resulted in increased NF- in tropical and sub-tropical countries. Rodents are a well-known kB activity and IL-8 expression in BFT-stimulated cells. However, reservoir and source of leptospirosis transmission. To date, wet suppression or enhancement of β-catenin expression neither market is becoming a potential area to acquire diseases including altered phosphorylated IKKα/β nor activated AP-1 signals. leptospirosis due to its poor sanitation and rodent’s prone Furthermore, inhibition of GSK-3β was associated with increased infestation area. β-catenin expression and attenuated NF-κB activity and IL-8 Objectives: To determine and characterize the pathogenic expression in BFT-exposed intestinal epithelial cells. Leptospira sp. among small mammals captured in selected wet Conclusion: These findings suggest negative regulation of NF- markets. κB-mediated inflammatory responses by β-catenin in intestinal Methodology: A total of 89 small mammals were captured and epithelial cells stimulated with BFT. their kidneys were harvested. The kidneys were cultured into EMJH medium and incubated at 27˚C for 3 months. Positive growth of leptospires was confirmed with the presence of flaβ P1-BT06 gene via PCR and further characterized using MLST Scheme 1. A Can mannitol fermentation replace tube coagulase: A small portion of the kidneys was also subjected to direct flaβ gene comparative study of tube coagulase, mannitol fermentation amplification. and DNase test for the identification of Staphylococcus Results: A total of 31 (34.8%) samples were detected positive for aureus pathogenic Leptospira, with culture was positive in 15 (16.9%) Basanta Tamang*, Rajendra Gurung, Anup Poudyal, Bindira Joshi samples and direct PCR in 28 (31.5%) samples. The sequencing Armed police force Hospital, Balambu, Nepal results of flaβ gene showed that 96.8% (n= 30) is L. interrogans and 3.2% (n=1) is L. borgepetersenii. From the MLST result, L. Background: The ideal identification test of Staphylococcus interrogans serovar Bataviae ST50 and L. borgeptersenii serovar aureus from clinical samples require a battery of tests and it is Javanica ST143 were identified. costly in resource limited settings. Routinely most of the laborato- Conclusion: Direct PCR is a better method than culture for ries perform and consider tube coagulase as confirmatory test. detection of leptospires in tissue samples. L. interrogans and L. Aims: The study was conducted to compare the phenotypic borgepetersenii were the commonly identified Leptospira species tests: tube coagulase, mannitol fermentation and DNase test for and further research on the serovar status is needed for inclusion the identification of Staphylococcus aureus from various clinical in MAT panels to improve diagnosis of leptospirosis. samples. Materials and methods: A total of 146 clinical isolates of staphylococci were subjected to three phenotypic methods for the spe- P1-BT05 cies identification. Bacteroides fragilis enterotoxin regulates β-catenin signals Result: Out of 146 isolates,102(69.9%) were tube coagulase test in intestinal epithelial cells, leading to suppression of NF-kB positive and 44(31.1%) were tube coagulase negative. Among activity and IL-8 expression via GSK-3β signaling the tube coagulase positive isolates 96(94.1%) tested positive for Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S85

mannitol fermentation and only 79(77.5%) produced DNase. risk factors such as diabetes mellitus, hypertension, smoking, Comparitive study in reference to tube caogulase test revealed genetic factors, microorganisms like Chlamydia pneumoniae that mannitol fermentation test was 94% sensitive and 81% are postulated to play a role in pathogenesis of atherosclerosis specific whereas DNase was found to be only 77.5% sensitive but and AMI. The study was carried out to determine the association 86.4% specific. between C. pneumoniae IgG seropositivity and AMI. Conclusion: There is near about equal chances of misinterpreta- Method: The study was carried out using two groups of patients tion of S.aureus using a single phenotypic test. Since DNase test (Group 1 and 2) consisting 100 in each. Groups 1 & 2 were patients is not available in small settings, combined use of tube coagulase with diagnosed AMI and age & sex matched patients without test and mannitol fermentation test can make a remarkable im- AMI respectively. Chlamydia pneumoniae IgG antibodies were provement in identifying S.aureus. Furthermore, the use of man- checked using a commercially available ELISA kit..Demographic nitol instead of plasma can minimize the hazard of blood borne data and risk factors for AMI were gathered using an interviewer diseases. administered questionnaire. Results: Among the total number, 118 (59%) had positive IgG for C. pneumoniae. In Group 1and 2, 62% (n=62) and 56% (n=56) had P1-BT08 positive IgG values for C. pneumoniae respectively. A statistically Clinical characteristics of Raoultella species bacteremia significant association between C. pneumoniae IgG seropositivity compared with Klebsiella pneumoniae bacteremia and AMI (p=0.388) was not found. KW Hong*, OH Cho, SI Hong, BH Ryu, KL Moon, IG Bae Eighty seven percent of Group 1 and 57% of Group 2 had at least Department of Internal Medicine, Gyeongsang National University one traditional risk factor. In those who didn’t have any risk College of Medicine, South Korea factors, in Group 1, 8 (61.5%) and in Group 2, 28 (65.9%) were seropositive for C. pneumoniae. with no statistically significant Background: The aim of this study was to identify the clinical association (p=0.9). characteristics and outcomes of Raoultella bacteremia comparing Conclusion: The seroprevalence of C. pneumoniae IgG in the with Klebsiella pneumoniae bacteremia. studied population was high. C. pneumonia IgG seropositivity Methods: We retrospectively reviewed the medical records on was not associated with AMI even in patients without traditional adult patients with Raoutella and K. pneumoniae bacteremia in a risk factors. tertiary hospital from Jan. 2008 to Dec. 2017. Results: A total of 37 cases of Raoutella bacteremia were identified. We randomly matched the cases of K. pneumoniae P1-BT10 bacteremia (n=160) with 1 to 5 ratio by age and sex. Patients Virulence-related phenotypic traits of Pseudomonas with Raoultella bacteremia were more likely to have underlying aeruginosa isolated from clinical specimens in a tertiary biliary tract disease (54.1% vs. 24.4%, p = 0.0004) and community- teaching hospital in Malaysia. acquired onset (62.2% vs. 43.1%, p = 0.0365) than those with K. K Abdul Jabar1,2*, NA Muhamad Rabuan Isa3, AN Muhamad1, pneumoniae bacteremia. Intra-abdominal infection was the KM Vellasamy1 most common primary focus of both bacteremia groups (83.8% 1Department of Medical Microbiology, Faculty of Medicine, vs. 57.5%, p = 0.0029): Biliary tract infection (64.9% vs. 38.8%, University of Malaya, Kuala Lumpur, Malaysia, 2Microbiology p = 0.0039) and pancreatitis (13.5% vs. 3.8%, p = 0.0350) were Diagnostic Laboratory, Universiti Malaya Medical Centre, Kuala more common foci in Raoultella group. Raoultella exhibited Lumpur, Malaysia, 3Department of Biomedical Sciences, Faculty of significantly higher susceptibility rates to aztreonam, cefepime, Medicine, University of Malaya, Kuala Lumpur, Malaysia cefotaxime, and ceftazidime. The 14-day and 30-day mortality rates did not differ between both groups. Background: Pseudomonas aeruginosa, a Gram-negative Conclusion: Raoultella spp. bacteremia more likely to occur in opportunistic pathogen, causes a wide range of infections. patients with underlying biliary tract disease and in community Methods: In this study, 50 strains of P. aeruginosa isolated from setting compared with K. pneumoniae bacteremia. Biliary tract patients from April to November 2017 were investigated. The infection was the most common primary focus of Raoultella strains were isolated from blood, cerebrospinal fluid, respiratory bacteremia. The clinical outcome of Raoultella bacteremia was and swab/tissue samples. All isolates were initially identified us- not different with that of K. pneumoniae bacteremia. ing VITEK® MS (bioMérieux, France) and re-confirmed using PCR primers according to a previously described protocol (Marhoon et al., 2014). Primer pair of PA-SS-F (5’-GGGGGATCTTCGGACCT- P1-BT09 CA-3’) and PA-SS-R (5’-TCCTTAGAGTGCCCACCCG-3’) targeting Association of Chlamydia pneumoniae IgG seropositivity about 1000bp were used for the identification of P. aeruginosa. We and acute myocardial infarction identified phenotypic characteristic of the strains by measuring B Bolonne, K Jayatilleke* the virulence determinants such as biofilm formation, secretion Sri Jayewardenepura General Hospital, Nugegoda of protease, siderophore assay, pyocyanin assay, mutation frequency analysis and phenotypic analysis of lasR mutants. Background: Non communicable diseases kill 38 million people Results: In this study, we found that 55% of the isolates were each year, among whom acute myocardial infarction (AMI) is found to be high biofilm producers and high siderophore identified as an important cause. In addition to the traditional producers. Eighty percent of the isolates were able to secrete S86 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

protease whereas ten isolates were unable to secrete protease. All aureus. It has been reported that mixed status of two different isolates are pyocyanin producers. Only eight isolates were LasR phenotypes including agr functional and non-functional mutants. No mutation frequency to rifampicin resistance was subpopulations can coexist in vitro and in vivo. However, data on identified in any of the isolates. the natural course and clinical implication of the mixed agr status Conclusion: In summary, we were given an overview of the ep- is limited. We thus investigated the frequency and characteristics idemiology of the virulence of the Pseudomonas aeruginosa iso- of the mixed agr in clinical settings. lates in our centre and hope to further continue the work. Methods: We evaluated isogenic paired MRSA isolates collected from patients with persistent S. aureus bacteremia (SAB) between Oct 2010 and Apr 2016, and then prospectively performed P1-BT11 surveillance for the presence of mixed agr function in MRSA Application for replacement of the ATCC strains with isolates from patients with SAB between May 2016 and Dec 2017. NCCP reference strains in the Korean pharmacopoeia Yewon An, SuYeon Kim, Hyangmin Cheong, Youngsill Choi* National Culture Collection for Pathogens (NCCP), Pathogen Resource Management TF, Center for Infectious Diseases Research, Korea National Institute of Health, 200 Osongsaengmyeong 2-ro, Heungdeok-gu, Cheongju-si, Chungbuk, 28160, Republic of Korea

The National Culture Collection for Pathogens (NCCP) has consistently carried out research to reduce the burden of import procedures and costs of foreign strains to domestic researchers and to activate the NCCP strains use. We conducted several Figure 1. Mixed hemolytic pattern observed in single colony evaluation. A, The equivalence experiments with ATCC strains to find alternative mixed hemolytic phenotypes of ST72-MRSA strain. B, The mixed hemolytic phenotypes of ST5-MRSA strain. All isolates were inoculated onto sheep blood agar strains for three species reference strains (Staphylococcus plates containing RN4220 supernatants (β-hemolysin), and hemolysis phenotype aureus NCCP 16830, Staphylococcus epidermidis NCCP 16828, was evaluated in each single colony after overnight culture. Arrows indicate Micrococcus luteus NCCP 16831) applied to the Microbial Assay hemolytic (black) and non-hemolytic (white) colony. for Antibiotics of the Korean Pharmacopoeia. Their molecular biological and biochemical characteristics were analyzed by MALDI-TOF MS, VITEK-2, and API TEST. 16S rRNA sequencing and MLST analysis were performed to compare genetic similarities. Antibiotic disk diffusion experiments were performed to confirm antibiotic susceptibility. Each result is compared with a reference strain to select a candidate strain. Their 16S rRNA sequences showed same characteristics, and the strains with the highest genetic homology were selected and evaluated for validity. The validity of the Microbial Assay for Antibiotics was evaluated by the Cylinder-plate method, and was selected as a candidate. It is expected that this study provide Korean reference strains that co-labeled in the Korean Pharmacopoeia, which Figure 2. Comparison of the transcriptional expression of genes encoding will enhance the convenience of drug quality control in Korea hemolysins and saeR/saeS two-component regulatory system between hemolytic pharmaceutical manufacturing industries. (H) and non-hemolytic (NH) colonies in four ST72 isolates showing mixed hemolytic pattern. * P < 0.05 by Mann-Whitney U-test. This work was supported by Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare (Project The mixed agr status was evaluated by single colony evaluation Number: 2017- NG45005-00). on sheep blood agar plate containing RN4220 supernatant (β-hemolysin) (Figure 1). Cross-streaking with RN4220 and RNAIII measurement were performed to confirm the agr P1-BT12 functionality of each of hemolytic and non-hemolytic colonies, Mixed subpopulation of hemolytic and non-hemolytic separately. The expression levels of RNAIII, hla, and saeS/saeR phenotype in clinical Staphylococcus aureus blood isolates were measured by real-time reverse transcription polymerase 1* 1 2 2 1 1 SM Bae , ES Kim , HS Sung , MN Kim , JW Jung , MJ Kim , chain reaction. 1 1 1 1 1 1 SH Kim , SO Lee , SH Choi , JH Woo , YS Kim , YP Chong Results: A total of 161 first blood isolates were collected during 1 Department of Infectious Diseases, Asan Medical Center, study period, and 6 isolates (4%) displayed mixed phenotype by University of Ulsan College of Medicine, Seoul, Republic of Korea, single colony test. The mixed hemolytic pattern was observed in 2 Department of Laboratory Medicine, Asan Medical Center, 5 out of 52 ST72 isolates (10%) and 1 out of 82 ST5 isolates (1%) University of Ulsan College of Medicine, Seoul, Republic of Korea (Figure 1). No difference was found in the genotypes between hemolytic and non-hemolytic colonies from each isolate. Of the Background: Agr is a key regulator that controls expression 6 isolates, 3 were collected from patients with persistent SAB and of secreted exoproteins and surface protein in Staphylococcus did not show genetic stability through the serial clinical cultures Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S87

Table 1. Clinical and microbiological characteristics, and treatment outcomes of patients infected by MRSA with mixed hemolytic phenotype Patient Variable 1 2 3 4 5 6 Age (yr)/gender 66/M 65/F 58/M 69/F 66/M 55/F Underlying disease hepatocellular diabetes mellitus end-stage renal disease none mantle cell liver transplant carcinoma on hemodialysis lymphoma recipient Previous use of antibiotics Yes Yes No No No Yes Acquisition hospital-onset hospital-onset hospital-onset community-onset hospital-onset hospital-onset Type of infection infective catheter-related arteriovenous graft infective primary bacteremia primary bacteremia endocarditis infection infection endocarditis Microbiological data MLST ST72 ST5 ST72 ST72 ST72 ST72 Nature of mixed phenotype mixed hla mixed agr function mixed hla expression mixed agr function mixed hla mixed hla expression expression expression Stability of mixed pattern in No - No No - - isogenic strains Vancomycin MIC (mg/L) 1 2 1 1 1 1 Clinical status Treatment Vancomycin Vancomycin Vancomycin Vancomycin Vancomycin Vancomycin Persistent bacteremia (≥7 d) No No Yes Yes No No Outcome improved improved improved improved improved died

(Table 1).One ST72 and one ST5 isolate showed agr mixed pattern intestinal microbiota might be responsible for pharmacokinetic determined by different RNAIII levels, but remaining four ST72 changes of crocin, and that the metabolic system with intestinal isolates had mixed hemolytic pattern due to different expression microbiota could be applied in the development of an alternative of hla correlated with amounts of saeS/saeR rather than RNAIII. toxicity testing. Conclusion: The mixture of agr function status among the clinical blood isolates of MRSA was rarely observed and isolates displaying heterogeneous hemolytic phenotype were largely due P1-BT14 to differential expression of α-hemolysin. Further investigation is Effect of direct rapid antibiotic susceptibility testing on needed to unveil the clinical significance of mixture of different treatment for bacteremia in patients with hematologic hemolytic phenotypes. diseases: a randomized controlled trial Jeong-Han Kim1*, Taek Soo Kim2*, Chang Kyung Kang1, Kang-Il Jun1, Youngil Koh1, Dong-Yeop Shin1, Junshik Hong1, P1-BT13 Nam Joong Kim1, Sung-Soo Yoon1, Myoung-don Oh1, Inho Kim1†, Crocin metabolism to crocetin by intestinal microbiota in Wan Beom Park1† vivo and in vitro 1Department of Internal Medicine, Seoul National University Rajina Shakya, Tae Cheon Jeong College of Medicine, Seoul, Republic of Korea; 2Department College of Pharmacy, Yeungnam University, Gyeongsan, Korea of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea The effect of intestinal microbiota on the pharmacokinetics of crocin was studied following an oral treatment of male SD Background: Antimicrobial stewardship regarding optimal rats with 400 mg/kg crocin. To control the number of intestinal targeted antibiotics in patients with immunocompromised microbiota, antibiotics were pre-treated to animals with mixture condition including severe neutropenia is challenging. We of cefadroxil (100 mg/kg), oxytetracycline (300 mg/kg) and investigated whether implementation of unsolicited antimicrobial erythromycin (300 mg/kg) for three consecutive days. Blood and stewardship using rapid phenotypic antimicrobial susceptibility liver were collected for evaluating pharmacokinetics of crocin test (AST) could increase the proportion of hematologic patients with its metabolite crocetin and other parameters, such as GSH, who received optimal targeted antibiotics in early period of malondialdehyde (MDA), and CYP 2E1. Urine and feces were also bacteremia. collected to investigate the major elimination routes of crocin and Methods: We performed a randomized, controlled, assessor- crocetin. As results, pharmacokinetic parameters for crocin and blinded, single center trial for patients with hematologic crocetin were remarkably changed in antibiotic-treated rats when diseases (ClinicalTrials.gov, registration number NCT03611257). compared with those in control rats. In vitro metabolism studies Patients with confirmed positive blood culture were randomly of crocin to crocetin in the intestinal contents from antibiotic- assigned at a 1:1 ratio into two groups. While patients in the treated animals were also consistent with the in vivo results. control group were managed according to current practice In addition, the protective effects of crocin and its metabolite, (baseline antimicrobial stewardship) using standard AST, in crocetin, were observed against CCl4-induced depletion of GSH the intervention group, unsolicited antimicrobial stewardship and/or elevation of MDA in vitro. The results suggested that the program using rapid phenotypic AST (QMAC-dRAST) was S88 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

applied. The primary outcome was the proportion of patients 27 from total of B. pseudomallei isolates had additional MIC tested receiving optimal targeted antibiotics 72 hours after blood for meropenem and interpretative criteria outlined by the E-test collection for culture. The secondary outcomes included the manufacturer for aerobes were followed as no breakpoint proportion of patients receiving unnecessary broad spectrum interpretation in EUCAST and CLSI. antibiotics. Primary and secondary outcomes were assessed by Results: This study demonstrates allB. pseudomallei isolates were the intention-to-treat analysis. 100% susceptible to ceftazidime while 97.8% were susceptible Results: A total of 100 patients were randomly assigned into to imipenem, amoxicillin–clavulanic acid, tetracycline and co- the control group (n=51) or intervention group (n=49). Mean trimoxazole. One isolate that was intermediately resistant to time from collecting blood culture to reporting AST result was imipenem, also had co-resistance to amoxicillin/clavulanic significantly shorter in the intervention group (49.9 hours) than acid and tetracycline. From our study, one isolate was found in the control group (81.2 hours) (P < 0.001). The proportion of to be resistant to co-trimoxazole alone. There were no resistant patients receiving optimal targeted antibiotics 72 hours after documented from all 27 isolates tested for meropenem. (Table blood collection for culture was 58.8% (30 of 51 patients) in the 1). These findings were comparable with a study from Institute control group and 79.6% (39 of 49 patients) in the intervention of Medical Research, Malaysia which has shown that B. group (adjusted odds ratio 3.10; 95% CI, 1.20-7.96; P = 0.019). The pseudomallei isolates from Malaysia were also highly susceptible. proportion of patients receiving unnecessary broad spectrum Meropenem has been used for patient with severe melioidosis antibiotics at 72 hours was 29.4% (15 of 51 patients) in the control which associated with good outcome. However EUCAST and group and 12.2% (6 of 49 patients) in the intervention group CLSI do not provide a standard for assessing of susceptibility and (adjusted odds ratio 0.23; 95% CI, 0.07-0.74; p=0.013). breakpoint interpretation of B. pseudomallei to meropenem. It Conclusion: The unsolicited antimicrobial stewardship using is important to have clinical breakpoints for meropenem as we rapid phenotypic AST may be more useful than current practice might wrongly interpret the susceptibility as treatment failure with standard AST for inducing optimal targeted antibiotic with meropenem is possible. use in early period of bacteremia in hematologic patients with Conclusion: B. pseudomallei isolates in Negeri Sembilan were immunocompromised condition including neutropenia. still susceptible to all recommended antimicrobial agents used for the treatment of melioidosis. However, regular monitoring is needed to detect any emergence of resistance. P1-BT15 Antibiotic susceptibility pattern of Burkholderia pseudomallei isolates in Negeri Sembilan, Malaysia P1-BT16 Nurhafiza 1I , Marlindawati MA2, Nor Zanariah ZA2 Role of stringent response in fecal shedding of enteropatho- 1Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri genic Escherichia coli from weaning pigs after oral infection Sembilan, Malaysia, 2Hospital Tuanku Ja’afar, Seremban, Negeri WJ Lee*, JB Lee, JW Yoon Sembilan, Malaysia College of Veterinary Medicine & Institute of Veterinary Science, Kangwon National University, Chuncheon, Gangwon 24341, Background: Burkholderia pseudomallei is a causative organism Republic of Korea for melioidosis that has been emerged as major infectious disease in many tropical countries including Malaysia. Antibiotics Enteropathogenic Escherichia coli (EPEC) is a causative agent for resistance of Burkholderia pseudomallei has been reported in few diarrhea in human and pigs. To cause the diarrhea, EPEC must studies and these could affect the treatment outcome. pass through acidic stomach and colonize on the small intestine. Methods: The aim of this study was to determine the in vitro EPEC produces type IV bundle forming pili (BFP) as an initial antibiotic susceptibility patterns of B. pseudomallei isolated in adhesion to small intestine, and expresses the locus of enterocyte Negeri Sembilan. A total of forty-six B. pseudomallei non repeat effacement (LEE) pathogenicity island, which are responsible clinical isolates were isolated from October 2017 until June 2018 for attaching and effacing (A/E) lesions. Our previous study in Negeri Sembilan. All isolates were subjected to Minimum demonstrated that guanosine 3’,5’-bispyrophosphate (ppGpp), a inhibitory concentration (MIC) determination using E-test mediator of bacterial stringent response, regulates the expression method to ceftazidime, imipenem, amoxicillin/clavulanic acid, of BFP and LEE in EPEC. Also, a ppGpp-defective mutant co trimoxazole and tetracycline. The MIC (μg/mL) interpretation (ppGpp0) of EPEC can not survive in acidic conditions compared was carried out following the CLSI guideline M45-A2. In addition, to wildtype strain. To validate the role of stringent response during

Table 1. (P1-BT15) The MIC of antibiotics against Burkholderia pseudomallei isolates No .of Isolates with MIC( µg/mL) % Antibiotics <0.25 0.38 0.5 0.75 1 1.5 2 3 4 6 8 12 16 32 48 128 >256 Ceftazidime 3 14 18 7 2 1 1 100 Amoxicillin/ 1 1 14 24 4 1 1 97.8 clavulanic acid Imipenem 32 11 1 1 1 97.8 Co-trimoxazole 19 7 2 5 6 6 1 97.8 Tetracyline 2 9 13 10 7 4 1 97.8 Meropenem 1 2 17 3 4 100 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S89

gastrointestinal tract (GIT) infection, we infected the 1-week- Results: With the new pattern, single colonies start appearing old weaning pigs with wildtype or ppGpp0 EPEC by oral route, before the halfway line and also gave a higher yield of isolated and compared the duration of fecal shedding of EPEC in 10 days colonies. post-infection (dpi). One gram of each fresh fecal samples was After the pattern change, cases requiring subculture decreased taken aseptically for daily and homogenized with 9 ml of buffered from 62 (14.2%) to 29 (5.9%) and improvements in TAT were peptone water. The presence of EPEC in feces was detected observed. by PCR using the primers targeting bfpA gene. To quantify the Table 1. Result comparison between patterns number of EPEC, the dilluted homogenates were spreaded on Time from inoculation to workup of Old pattern (n) New pattern (n) Luria-Bertani agar media with appropriate antibiotics. After isolated colonies incubation at 37 °C for 19 hours, total 100 colonys in each samples < 24h 129 (29.6%) 187 (38.0%) were randomly selected, and their identity was confirmed by 24–36h 213 (48.9%) 302 (61.4%) PCR using the bfpA-target primers. Results showed that a ppGpp0 36–48h 68 (15.6%) 3 (0.61%) > 48h 26 (5.96%) 0 EPEC was not detected after 2 dpi, whereas the wildtype EPEC was constantly detected during 10 dpi, and the significant number Conclusion: The right streaking pattern helps to save on of bacteria in feces (>2.0x105 CFU/g) were identified until 2 dpi. manpower time and material cost. The timely reporting of AST These observations suggest that stringent response is essential for results allows efficient implementation of infection control the intestine colonization of EPEC during host infection. measures which can be especially crucial in outbreaks, in helping to manage the spread of multidrug-resistant organisms.

P1-CM01 Improvement in Turnaround time (TAT) for MRSA Active P1-CM02 Surveillance Testing (AST) by changing of streaking pattern Poor malaria microscopy in elimination setup: how can we on the BD Kiestra™ InoqulA™ improve this tool? C. Cheng, C. Ong, D. Chan Desalegn Nega1, Adugna Abera1, Bokretsion Gidey1, AbinetAbebe1, Department of Laboratory Medicine, Ng Teng Fong General Abeba G/Tsadik1, Sindew Mekasha1, Lemu Golassa2, Hospital, Singapore Adugna Woyessa1, Geremew Tasew1 1Malaria and Neglected Tropical Diseases Research Team, Background: MRSA AST is routinely conducted in our hospital as Ethiopian Public Health Institute (EPHI). PoBoX 1242; 2Addis part of infection control measures. Plating of screening swabs is Ababa University, Akililu Lemma Institute of Pathobiology performed by BD Kiestra™ InoqulA™ on chromogenic agar. Lack of isolated colonies of interest can often delay results if subculturing Background: Successful malaria elimination calls for rapid is required before workup. Colony growth and dilution can be and accurate tracking of cases with prompt treatment delivery. manipulated by selecting from 12 available streaking patterns. The Therefore, this study assessed the competency of malaria original pattern used mimics the standard 4 quadrant streaking microscopists in health facilities. and we wanted to determine if a pattern change can improve TAT. Method: A cross-sectional study was conducted Feb-June 2018 Methods: A new pattern was chosen based on hypothesis that in 20 malaria elimination districts from 6 regional states in rolling the bead across the full length of the plate instead of only Ethiopia. Maximum of 5 microscopists per facility were included. half the length for each quadrant allows more distance for the Questionnaire interview and 10 Giemsa malaria slide panels were distribution and dilution of the primary inoculum and thus better administered to each microscopist. colony isolation. Result: In this assessment, 17 district hospitals, 71 health All cases which required further workup were analysed 3 months centers(HCs) and 18 private clinics(PCs) were included. Of before (n=436) and after (n=492) the pattern change. Number 1896 malaria positive & 474 negative slides administered to 237 of cases without isolated colonies requiring subculture, and participants, 318 slides reported falsely negative (FN rate:42.7%) time taken from inoculation to the first confirmatory test were & 47 reported falsely positive (FP rate:2.9%). The participants compared. achieved “good” grade [Agreement(A): 84.6%, Kappa(K): 0.6] in parasite detection and “Poor” agreement (A: 43.8%; K: 0.11) in species identification. Agreement is lower in PCs (Detection-A: 77.8%; Identification-A: 37.2%), followed by HCs (Detection-A: 84.14%; Identification-A: 41.64%) and hospitals (Detection-A: 86.7%; Identification-A: 48.1%). No or slight agreement seen on differentiation of P.falciparum from other species (A: 28.41%; K:0.29). Above 95% participants used only plus system of parasite count which is unacceptable per WHO guideline. Conclusion: The competency of malaria microscopists, particularly in species identification, is very low in the current study. Therefore, comprehensive In-service training of Fig. a. Old pattern Fig. b. New pattern professionals is critical not to miss the low but very important cases in elimination settings. S90 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-CM03 and whole-genome sequencing, have been introduced in clinical Clinical usefulness of nested reverse-transcription microbiology laboratories. However, these techniques still require polymerase chain reaction for the diagnosis of severe fever bulky and expensive equipment, and/or skilled personnel. with thrombocytopenia syndrome Herein, we demonstrated a novel and rapid AST method called Choon Mee Kim1†, Dong-Min Kim2, Na-Ra Yun2 fluorescence resonance energy transfer (FRET) probe-based 1Premedical Science, College of Medicine, Chosun University, AST (F-AST), which was designed to detect the nuclease activity Gwangju, South Korea, 2Department of Internal Medicine, College of bacterial nucleases released from bacterial lysates caused by of Medicine, Chosun University, Gwangju, South Korea antibiotic action. Method: We tested three quality control (QC) strains (E. coli, Background: Severe fever with thrombocytopenia syndrome E. faecalis, and P. aeruginosa) to provide reliable antibiotic (SFTS), caused by the SFTS virus (SFTSV) is a tick-borne susceptibility results and also employed two clinically important infectious disease with a high mortality rate. However, few strains (A. baumannii and K. pneumonia). Six antibiotics studies have assessed the clinical usefulness of nested reverse- (ampicillin, colistin, meropenem, penicillin G, piperacillin, transcription polymerase chain reaction (RT-PCR) for SFTS and vancomycin) were chosen to be tested. To validate the diagnosis. accuracy of the F-AST method, we performed F-AST with the Methods: This study performed conventional RT-PCR targeting five strains against 6 reliable antibiotics and verified by the broth the M segment, nested RT-PCR targeting the M and S segments, microdilution (BMD) method. The F-AST method results were and real-time RT-PCR targeting the S segment of SFTSV at obtained within 3–6 h of incubation with a different antibiotics different time points as a confirmatory test for a patient with a tick by measuring the fluorescence signal, while the conventional bite. Additionally, an immunofluorescence assays (IFAs) were culture-based AST system required an overnight incubation time performed to assess SFTSV seroconversion. (16–24 h) for accurate AST results by analyzing the turbidity. Results: Conventional RT-PCR results were negative in a Results: To identify the optimal AST structure, we first compared whole blood sample collected on the day of admission for three different probes (double-stranded, stem-loop, and single- SFTS diagnosis, whereas the real-time RT-PCR results showed stranded probes indicated as DS, SL, and SS, respectively) and a threshold cycle (Ct) value of 38.78. The nested RT-PCR M SL probe with a 5ʹ-overhang of 5 bases was chosen as the optimal segment target results were positive, but the S segment results F-AST probe. Three QC strains and two additional clinically were negative. In whole blood samples collected on day 2 of important strains were tested and the minimum inhibitory hospitalization, the conventional RT-PCR results remained concentration (MIC) values from both gold standard AST method negative, whereas the real-time RT-PCR results showed a Ct value (BMD) and the new F-AST method were compared. The resulting of 37.19, and both the M and S segment-targeted nested RT-PCR fluorescence signals from the F-AST method were obtained results were positive. The PCR-positive products were purified and within 3–6h and were consistent with MIC values obtained sequenced. All samples were positive for SFTSV. Furthermore, the from the BMD method, which took more than 16h. The MIC IFA showed seroconversion of SFTSV antibodies. values obtained by F-AST were compared with those of the BMD Conclusions: The study results indicated that nested RT-PCR method and were similar or two-fold lower than the references, targeting the SFTSV M and S segments could help diagnose SFTS indicating that the accuracy is enough to substitute for the BMD in patients with strongly suspected SFTS who tested negative by method with reduced times. conventional RT-PCR. Conclusion: In summary, we demonstrated the F-AST method, which relies on detecting the activity of bacterial nucleases released from antibiotic-induced bacterial lysates. Compared P1-CM04 to the traditional culture-based AST, BMD, which takes 16-24h, FRET probe based-antibacterial susceptibility testing for our F-AST method provides results, including MIC values, within the rapid detection of antibiotic resistance using bacterial 3-6h. This study indicates that F-AST can rapidly differentiate nuclease released by the antibiotic-induced lysis resistant and susceptible strains in agreement with a standard K., Park1*, S.Y., Yi1, and Y.B., Shin1, 2 AST and provide a basis for novel rapid AST methods. 1BioNano Health Guard Research Center, Daejeon, Korea, 2Bionanotechnology Research Center, Korea Research Institute, of Bioscience and Biotechnology (KRIBB), Daejeon, Korea P1-CM05 Towards effective treatment of complicated bacterial Background: Rapid antibacterial susceptibility testing (AST) respiratory infections with host defence peptides is essential for guiding the clinical treatment of many types of D L Wannigama1,2, *, A Kicic2, C Hurst3, P N Monk4, S M Stick2, bacterial infections, especially with regard to the global health T Chatsuwan1 problem of multidrug-resistant pathogens. However, traditional 1Antimicrobial Resistant and Stewardship research Unit, culture-based AST methods are time-consuming (16–24 h) and Department of Microbiology, Faculty of Medicine, Chulalongkorn labor-intensive. To reduce hands-on and incubation times, a University, King Chulalongkorn Memorial Hospital, Bangkok, variety of automated equipment has been developed that can Thailand,2 School of Medicine, Faculty of Health and Medical provide results in 6–8 h. More recently, novel approaches for Sciences, The University of Western Australia, Perth, Western rapidly detecting resistance, such as polymerase chain reaction- Australia, Australia, 3Department of Statistics, QIMR Berghofer based techniques, mass spectrometry, microarrays, microfluidics, Medical Research Institute, Brisbane, Queensland, Australia, Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S91

4Department of Infection, Immunity & Cardiovascular Disease, Conclusion: Bioinformatics approach helped in identifying University of Sheffield Medical School, United Kingdom specific amino acids involved in binding of drug and ligands. By identifying and targeting those amino acids we can alter the Biofilm infections on respiratory tract are inherently highly chemical composition of proteins which can help in increased antibiotic resistant and may contribute towards enhanced binding affinity of drug with the target molecule and lowering of disease pathogenesis. The action of 30 novel anti-biofilm peptide resistance. This gathered information might be useful in future candidates were firstly evaluated against 450 clinical isolates development of drugs as more potent and versatile inhibitors. The of P. aeruginosa, Nontypeable H. influenza and A. baumannii prediction geometries of this putative protein ligand interaction via a high-throughput novel plate-based assay, coupled with are of increasing importance in the field of structure-based drug confocal microscopy using live/dead bacteria staining. The ability designing. of candidate peptides to eliminate biofilm on human primary airway epithelial cell cultures derived from children with Cystic fibrosis were assessed using an air-liquid interface cell culture P1-CM07 biofilm model. Six candidate peptides were active at eradicating Clinical Evaluation of STANDARD F Strep A Ag FIA Test P. aeruginosa, Nontypeable H. influenza, A. baumannii biofilms and Sofia Strep A FIA Test for Diagnosis of Acute Bacterial at relatively low concentrations (16-128μg/ml). High doses of Pharyngitis current conventional antibiotics (Amikacin, Tobramycin and Sunjoo Kim1, Seungjun Lee1, Won-Hee Choi2, Sang Hyuk Ma3 Ciprofloxacin; (128-1024μg/ml)) were unable to eradicate these 1Departments of Laboratory Medicine, Gyeongsang National biofilms. HDP 102 was the most potent peptide, driving >90% bio- University Changwon Hospital, Changwon, Korea, 2Department volume reduction in airway epithelial cells and a74% reduction of Nursing Science, Kyungsung University, Busan, Korea, 3Depart- of bacterial attachment to these cells. These findings highlight ment of Pediatrics, Changwon Fatima Hospital, Changwon, Korea the potential of host defence peptides as a novel option to treat chronic bacterial biofilm infections and offer targeted approaches Background: Group A streptococci (GAS) is the most common to treat patients with complicated bacterial respiratory infections. cause of bacterial pharyngitis. Rapid and accurate diagnosis of bacterial pharyngitis is essential for optimal antibiotic treatment. Clinical performance of STANDARD F Strep A Ag FIA (SD P1-CM06 Biosensor, Korea), a recently developed rapid antigen detection Molecular characterization and in silico analysis of extended test (RADT), and Sofia Strep A FIA Test (Quidel, USA), a currently spectrum β-lactamase producing multi drug resistant widely used RADT worldwide, was evaluated for patients with diarrheagenic Escherichia coli in children under five years pharyngitis. Taru Singh*, Shukla Das Methods: Two-hundred ninety-two patients with sore throat Department of Microbiology, UCMS & GTBH visiting five pediatric clinics in Changwon, Korea were subjected to throat swabs three times during 2018-2019. Two swabs were used Background: Extended-spectrum β-lactamase producing for both RADTs and the other swab was delivered to Gyeongsang diarrheagenic Escherichia coli (DEC) have emerged as a global National University Changwon Hospital (GNUCH) for bacterial health problem in children under five years of age. Production culture. Bacterial culture was regarded as a standard test. This of antimicrobial resistance by extended-spectrum β-lactamases study was approved by IRB of GNUCH and all participants agreed (ESBLs) is considered to be a major threat. The present study on written consent. deals with the detection and prevalence of ESBL genes from stool Results: Sensitivity, specificity, positive predictive value (PPV), culture using Real Time PCR, and to perform their docking and and negative predictive value of STANDARD F Strep A Ag FIA modeling studies. were 98.2%, 88.1%, 66.7%, and 99.5%, respectively and those Methods: In total, 120 isolates were screened, taken from of Sofia Strep A FIA Test were 100%, 90.8%, 72.7%, and 100%, children of three groups namely diarrheal, non-diarrheal and respectively compared to bacterial culture. Positive agreement healthy controls with 40 isolates from each group. Conventional and negative agreement between two RADTs revealed 96.1% and phenotypic methods were performed. Antibiotic susceptibility 95.9% respectively. testing was done using CLSI guidelines. Bioinformatics work Conclusions: STANDARD F Strep A Ag FIA exhibited an excellent was conducted in order to enhance our understanding of the clinical performance except PPV and relatively a good agreement biological mechanism of resistance by computational analysis. with Sofia Strep A FIA Test. Discrepant result with culture might An attempt was made to identify the 3D structures, active sites be due to spectrum effect, bacterial numbers of GAS, or delayed and binding efficiency between antibiotics and proteins of beta- transport. This is an ongoing clinical study and more collection of lactamases genes by using various tools. data will improve the PPV and positive agreement. Results: ESBL production was seen in 64.16% isolates. Amplification of β-lactamase genes by Real Time PCR showed the presence of ESBL genes; blaCTX-M in 23, blaTEM in 49, blaOXA P1-CM08 in 23 and blaSHV in 39 isolates respectively. Three dimensional Analysis of Sputum Quality and Sputum Culture Requests to (3D) models of β-lactamases namely TEM, SHV, CTX and OXA Improve Quality of Sputum Cultures were predicted and docking was performed with Polymixin B and Sunjoo Kim1, Dong-Hyun Lee1, Won-Hee Choi2 Meropenem to reveal the molecular basis of drug sensitivity. 1Department of Laboratory Medicine, Gyeongsang National S92 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

University College of Medicine, Jinju, Korea, 2Department of cultures. We compared the results with matrix-assisted laser Nursing Science, Kyungsung University, Busan, Korea desorption/ionization time-of-flight mass spectrometry (MALDI- TOF MS). Background: Sputum cultures are the primary test used to detect Results: MALDI-TOF MS revealed 69 microorganisms (66 causative organisms of lower respiratory tract infections and are bacterial and 3 yeast strains) in 60 blood cultures. The FA-BCID routinely performed in microbiological laboratories. Currently, panel identified 70 pathogens with agreement rate of 87.7%; Murray-Washington (MW) grouping system is mainly used for however, 5 bacteria were not detected. Of these 5 bacteria, three evaluating the quality of sputum. This study evaluates the quality isolates are not included in the FA-BCID panel. The remaining two of sputum and the frequency of bacterial growth according to the isolates were coagulase-negative Staphylococcus species, which MW system. And we also analyze the co-ordered blood culture was identified as Staphylococcus aureus in the FA-BCID panel. rates and the antibiotic use before treatment. The FA-BCID panel detected mecA genes in 7 Staphylococcus Methods: From Dec 2016 to Feb 2017, 1523 patients with species, which of 6 cases were confirmed by antimicrobial requesting sputum culture were studied. The collected specimens susceptibility testing, and KPC genes in 1 Escherichia coli and 1 were stained with Gram stain and identified bacterial species. In Klebsiella pneumoniae, although only the latter was in agreement addition, the patient’s electronic medical records were reviewed with antimicrobial susceptibility testing. The median time to to analyze requested blood culture and antibiotic prescription identification was shortened (67.7 [60.6–101.3] hours versus 23.6 history. [20.3–28.9] hours; P<0.0001). Results: In total, 1523 sputum specimens were obtained. The Conclusions: The FA-BCID panel provided a rapid and reliable cases of growth bacteria were 344. Blood cultures were ordered identification result for bloodstream pathogens. This method is together in 302 in sputum culture-positive patients. The cases of effective and beneficial for therapeutic decision making. We are bacterial growth were 27 in co-ordered blood culture, and only planning further analysis to assess the clinical and economic 8 cases were grown same bacteria of sputum culture. The rate of outcome of FA-BCID. antibiotic use before sputum examination was 28.2% and the rate of antibiotic change after reporting sputum culture result was 23.0% in culture positive patients. The cases of samples belonging P1-CM10 to MW groups 1 to 6 were 44, 30, 95, 54, 15, and 867, respectively. Educational Intervention to Improve Blood Volume and Its The cases of specimen in which the significant bacteria growth Effect on Blood Cultures were 14, 7, 32, 24, 9, and 156, respectively. The proportion of Seungjun Lee, Sunjoo Kim specimens that were not belonging anywhere in the MW group Department of Laboratory Medicine, Gyeongsang National system, was 27.5%, and the rate of growth of bacteria was 24.4%. University Changwon Hospital, Changwon, Korea Conclusions: It was very inefficient to request routinely both the sputum test and the blood culture at the same time. Bacterial Background: Blood culture is the most valuable test in diagnosis growth rate was higher in the group 4 and 5, but the number of of bloodstream infection. Periodic monitoring and intervention samples was very small. The rates of specimens that could not of blood culture practice is important on quality improvement of be judged by the MW system was very high. Efforts to modify the blood culture. We provided an educational intervention program current MW system are needed in the future. on phlebotomists and evaluated the impact on blood cultures. Methods: We analyzed 18,651 blood culture bottles obtained between November 2018 and June 2019. Educational intervention P1-CM09 was provided to improve quality of blood cultures since March Clinical Evaluation of the FilmArray Blood Culture Identifi- 2019. We divided the study period as “baseline period” and cation Panel Compared to MALDI-TOF MS in Positive Blood “intervention period” according to educational intervention. Cultures We evaluated true positive rate, contamination rate, blood Sunjoo Kim1, Seungjun Lee1, Byung-Han Ryu2, Sun In Hong2, volume, time to detection, and turnaround time of organism Won-Hee Choi3 identification. 1Departments of Laboratory Medicine and 2Internal Medicine, Results: In baseline period, the true positive rate was 7.9% and Gyeongsang National University Changwon Hospital, Changwon, contamination rate was 0.5%. After intervention, the positive Korea, 3Department of Nursing Science, Kyungsung University, rate decreased to 6.1% and contamination rate was 0.7%. The Busan, Korea blood volume was significantly increased from 5.4 mL to 7.3 mL (P<0.0001) after intervention. Similarly, the proportion of Background: Sepsis is a major cause of morbidity and mortality optimal blood volume (8–12 mL) increased from 9.1% to 39.4% in hospital. An accurate and rapid diagnosis of sepsis allows (P<0.0001). Time to detection (TTD) and turnaround time (TAT) appropriate treatment. The FilmArray blood culture identification of organism identification was improved from 14.9 h to 13.1 h (FA-BCID) panel is multiplex PCR-based system. In addition, (P=0.0478) and 82.4 h and 73.5 h (P=0.0482), respectively. this system can identify 24 pathogens of sepsis and detect 3 Conclusions: Educational intervention of phlebotomy team antimicrobial resistance genes in about 1 hour. In this study, we could influence the quality of blood cultures, especially blood evaluated the accuracy and time to identification of the FA-BCID volume. Accordingly, improved blood volume shortened TTD panel. and TAT of identification. Therefore, educational intervention is a Methods: We performed the FA-BCID panel for 60 positive blood key element in quality improvement of blood cultures. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S93

P1-CM12 Sciences, The University of Western Australia, Perth, Western Antimicrobial Synergy Testing of Extensively Drug Resistant Australia, Australia, 3Department of Statistics, QIMR Berghofer Escherichia coli and Klebsiella pneumoniae isolates at an Medical Research Institute, Brisbane, Queensland, Australia., Organ Transplant Center in Nepal Australia, 4Department of Infection, Immunity & Cardiovascular Rashmi Karki, Bal Awal, Samir Lamichhane, Shyam Mishra Disease, University of Sheffield Medical School, United Kingdom Janamaitri foundation institute of health science, Nepal The bacterial biofilm infections found in respiratory tract share Background: Imprudent use of antibiotics can be attributed to a number of clinical similarities. The most striking of which is the emergence of extensively drug resistant (XDR) microbes. The bacterial persistence despite the use of antibiotics. Unfortunately combination of antimicrobials showing synergistic action can be these infections not show a clinical response to antibiotics an effective strategy to treat the infections caused by such XDR directed based on planktonic bacteria cultures. Therefor, we offers bacteria. a robust and simple experimental platform to monitor the impact Objective: This study was designed to determine in vitro of antimicrobials against biofilm. We postulated that by analyzing synergy of different antimicrobials against XDR Escherichia pretreatment isolates of P. aeruginosa and A. baumannii obtained coli and Klebsiella pneumoniae clinical isolates. from patients who subsequently had a chronic respiratory Method: A descriptive, cross-sectional study was conducted infections, we could determine any correlations between the at Human Organ Transplant Center where clinical specimens minimum biofilm eradication concentration (MBEC) of an received during 6 months period were cultured. Antibiotic antibiotics and the relapse risk after treatment based on minimum sensitivity test of the isolates was done following standard inhibitory concentration (MIC). Results could demonstrate guidelines. The XDR pathogens were further tested for synergy that antibiotic response patterns varied uniquely within biofilm with different antimicrobial combinations by E-strip MIC:MIC formation capacity and MBEC has a significant discriminatory method. The result was interpreted as synergistic, additive, power than MIC to differentiate overall efficiency of antibiotic to indifferent or antagonist. eradicate biofilm. In all cases, the accuracy of antibiotic selection Results: Out of total 1155 clinical samples processed, 308 showed using an MBEC test was superior to MIC. In conclusion, our assay significant growth in culture. Among the total 308 isolates, 46.1% will be simple, cost-effective and ideal platform to unravelling the (n=142) and 24.7% (n=76) were E. coli and K. pneumoniae complex interactions that occur between antibiotic and biofilm respectively. Nearly 9.9% (n=14) of E. coli isolates were XDR under in vitro conditions to pave the way for the better therapy whereas it was 18.4% (n=14) in case of K. pneumoniae. The and warrants clinical trials. antibiotic synergy testing (AST) result is shown in Table 1.

Table 1. AST of XDR E. coli (n=14) and K. pneumoniae (n=14) P1-CM14 Synergy Additive Indifference Antagonism Comparison of molecular detection of Sarcoptes scabiei and Antibiotics Isolates N (%) N (%) N (%) N (%) microscopic examination from a skin scraping for diagnosis Meropenem E. coli 0 (0.0) 4 (28.6) 10 (71.4) 0 (0.0) (Mem) + of scabies K. pneumoniae 2 (14.3) 6 (42.9) 6 (42.9) 0 (0.0) 1* 1* 1† 2 1† Amikacin (Ak) M. Bae , J.Y. Kim , J. Jung , S.E. Chang , S-H. Kim Mem+ E. coli 0 (0.0) 0 (0.0) 14 (100) 0 (0.0) 1Department of Infectious Diseases and 2Dermartology, Asan Ciprofloxacin K. pneumoniae 0 (0.0) 0 (0.0) 14 (100) 0 (0.0) Medical Center, University of Ulsan College of Medicine, Seoul, (Cip) Ak + Colistin E. coli 0 (0.0) 2 (14.3) 10 (71.4) 2 (14.3) Republic of Korea (CL) K. pneumoniae 4 (28.6) 6 (42.9) 4 (28.6) 0 (0.0) Mem + CL E. coli 4 (28.6) 2 (14.3) 4 (28.6) 4 (28.6) Background: Scabies is a highly contagious parasitic disease K. pneumoniae 2 (14.3) 4 (28.6) 8 (57.1) 0 (0.0) associated with long-term residence in nursing homes, causing an important public health burden worldwide. The microscopic Conclusion: Possible beneficial action was seen while combining examination of skin scrapings is widely used in the diagnosis of Mem, Ak and CL with one another in vitro. Such combinations scabies but this test has poor sensitivity. We thus evaluated the can be used in XDR bacterial infections. However, each clinical diagnostic utility of scabies polymerase chain reaction (PCR) from isolate should be tested in our set-up and to develop protocols in skin scraping in patients with suspected scabies. the management of XDR bacterial infections. Methods: Adult patients with suspected scabies were enroll at a tertiary hospital, Seoul, South Korea, from DEC 2017 through OCT 2018. Skin scraping samples were prospectively collected from P1-CM13 patients with clinically suspected signs of scabies, such as severe Simple biofilm-guided antibiotic test for patients with itching without response to standard therapy, a pruritic eruption chronic respiratory infections with characteristic lesions, contact history patients with scabies D L Wannigama1,2, *, C Hurst3, A Kicic2, P N Monk4, S M Stick2, or visiting a nursing home. We performed PCR testing from skin T Chatsuwan1 scraping to target the cytochrome c oxidase subunit 1 (cox1) gene 1Antimicrobial Resistant and Stewardship research Unit, of Sarcoptes scabies var. horminis. Department of Microbiology, Faculty of Medicine, Chulalongkorn Results: We prospectively evaluated 43 patients with suspected University, King Chulalongkorn Memorial Hospital, Bangkok, scabies. Among them, 30 patients were confirmed microbiolog- Thailand,2 School of Medicine, Faculty of Health and Medical ically as scabies using the microscopy, PCR, or skin biopsy. The S94 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

Table 1. (P1-CM14) Diagnostic performance of scabies PCR and microscopy in confirmed scabies patient Composite reference standard* Sensitivity Specificity Composite reference standard* Sensitivity Specificity

PCR Scabies Not Scabies Total (95% CI) (95% CI) Microscopy Scabies Not Scabies Total (95% CI) (95% CI) Positive 26 0 26 87%† 100% Positive 22 0 22 73%† 100% Negative 4 13 17 (69–96) (75–100) Negative 8 13 21 (54–88) (75–100) Total 30 13 43 Total 30 13 43 *Composite reference standard included any positive microscopy, PCR, or skin biopsy. †Difference between the two methods was statistically not significant (p=0.34). median age of the patients at the time of diagnosis was 63±18 P1-CM16 years and 53.3% were male. About two-thirds of patients with Elevated Meropenem MICs observed on VITEK 2 scabies had a history of contact with patients with scabies or had susceptibility testing of Proteus mirabilis visited a nursing home. The most common skin manifestation J Chia*, E Ng, KM Lee, FS Lee, PP De1 was papules (77%) and the most common location was a trunk Department of Laboratory Medicine, Tan Tock Seng Hospital, (87%). Using the composite reference standard, the estimated Singapore sensitivity of scabies PCR testing was 87% (95% CI 69–96; 26/30) compared with 73% (95% CI 54–88; 22/30) for the microscopy. Background: An increase in meropenem non-susceptible isolates Conclusion: The scabies PCR testing could be helpful to improve of Proteus mirabilis, tested on the VITEK 2 automated AST system the sensitivity in the diagnosis of scabies. (bioMérieux), was noted by our hospital microbiology laboratory. This investigation aimed to confirm if this rise represented a true increase in carbapenem-resistant P. mirabilis, and to assess the P1-CM15 reliability of meropenem susceptibility testing by VITEK 2. Correlation of virulence factors and biofilm formation of Materials/Methods: VITEK 2 susceptibility profiles of clinical hypervirulent K. pneumoniae in Korean isolates isolates of P. mirabilis collected between September 2015 and Hyun Ah Kim*, Miri Hyun, Ji yeon Lee, Seong-yeol Ryu Apr 2019 were retrospectively reviewed and compared with Department of Infectious disease, Keimyung University Dongsan those of E. coli and K. pneumoniae tested over the same period. Medical Center, Daegu, South Korea Concurrently, confirmatory meropenem susceptibility testing by disk diffusion and E-test was performed on isolates of non- Background: Recently invasive Klebsiella pneumoniae (K. pneu- susceptible P. mirabilis isolates between October 2018 to May moniae), called hypervirulent K. pneumoniae was emerged in 2019. Asia Pacific region. But there is little known about biofilm forma- Results: 90 out of 3154 (2.9%) P. mirabilis isolates tested non- tion of hypervirulent K. pneumoniae. The aim of this study is to susceptible to meropenem by VITEK 2. MIC values progressively evaluate the biofilm formation of K. pneumoniae and association increased, with 8.6% of P. mirabilis isolates testing non-susceptible with virulence genes. in early 2019. Susceptibility to other beta-lactams varied; only Materials/methods: The study was performed on 345 K. pneu- 7 of the 90 isolates tested non-susceptible to ertapenem. These moniae isolates recovered from different specimens collected findings were not observed inE. coli or K. pneumoniae and could from Keimyung university of Dongsan medical center from De- not be accounted for by changes in laboratory testing protocol. cember 2013 through November 2016. Hypermucoviscous phe- Confirmatory susceptibility testing was performed on 28 isolates notype was confirmed with string test. Capsular serotypes, rmpA, of P. mirabilis. 27 were susceptible when tested by disk diffusion magA, kfu, allS, ybts, mrkD, entB and iutA were identified using and all were susceptible when tested by E-test; E-test MICs were specific primers by polymerase chain reaction. The biofilm mass consistently lower than VITEK MICs by a minimum of three was determined using the microtiter plate assay measured by op- doubling dilutions. tical density (OD, 570nm). Conclusions: A significant proportion of P. mirabilis isolates Results: The interquartile range of the optical density for the exhibited high meropenem MICs when tested on VITEK 2, biofilm mass was 0.3555 to 0.9039, and the average was 0.6982. discordant with results obtained from agar-based susceptibility The hypermucoviscous phenotype was found in 130 isolates testing. Caution should be taken when interpreting VITEK 2 (37.6%). Biofilm mass was similar in hypervirulent and classical results for meropenem in P. mirabilis, and further investigation to K. pneumoniae. But the OD was higher in K1 serotype than non determine the cause of this discrepancy is warranted. K1 serotype (0.9945 vs. 0.6320, p=0.0001). Among the virulence genes, magA, allS, mrkD and kfu related with higher biofilm forming strains. P1-CM17 Conclusions: The biofilm mass were more related to K1 serotype Culture and Biochemical Testing versus 16S rRNA Gene than hypermucoviscose phenotype or hypervirulence. Because Sequencing for Pathogen Identification in the Clinical hypermucovicose phenotype were heterogenous group, only Microbiology Laboratory: Preliminary Findings on Cost 66.9% of string positive isolates were K1/K2 serotype and aerobac- Comparison and Breaking the Bioinformatics Barrier tin positivity were 97 isolates (74.6%). The magA, allS, mrkD and N Muhamad Rizal1, H Neoh1*, R Ramli1, P Periyasamy1, kfu gene is related to biofilm forming isolates. Additional research A Hanafiah1, M Abdul Samat1, T Tan1, K Wong1, S Nathan1, is needed on large number of multicentric K. pneumoniae isolates S Chieng1, S Saw2, B Khor3 for possible links between biofilm formation and hypervirulence. 1Universiti Kebangsaan Malaysia, Malaysia, 2Universiti Tunku Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S95

Abdul Rahman, Malaysia, 3BioEasy Sdn. Bhd., Malaysia Methods: We performed a retrospective study on patients with pertussis diagnosed from May, 2017 to June, 2019 in Yeungnam Background: High cost and technical difficulty in bioinformatics University Hospital. The patients’ nasopharyngeal swab analysis have largely deterred the change from usage of culture specimens were tested with (FilmArray Respiratory Panel [FA- and biochemical testing to 16S rRNA gene sequencing for RP], Biofire, USA). The medical records collected are age, sex, pathogen identification in the clinical microbiology laboratory. symptoms at the time of diagnosis, admission, hospitalization, We investigated the costs of both techniques, and also evaluated isolation, vaccination history, past medical history, and the usefulness of B.E. Patho, a “plug-and-play” bioinformatics accompanying diseases. The collected medical records were suite by BioEasy Sdn. Bhd., for rapid analysis of 16S gene used to identify presenting symptoms of pertussis, initiation sequencing reads for pathogen identification. of treatment, duration of hospitalization, and time needed for Methods: Five bacteria samples (Acinetobacter sp., Haemophilus diagnosis. influenzae, Burkholderia pseudomallei, Staphylococcus aureus, Results: Total 27 patients were diagnosed with pertussis in study Mycobacterium tuberculosis) were subjected to culture and period. The median age of the patients was 48.9 years (3.3-82.2). biochemical testing and 16S rRNA gene sequencing. Raw Nine patients (33.3%) were male. Eleven (40.7%) had fever, 12 sequencing data were uploaded without any further manipulation (44.4%) had dyspnea, 3 (11.1%) had paroxysmal cough, and 9 onto the B.E. Patho suite prior installed in a workstation. A (33.3%) had inspiratory whooping. Seventeen (63.0%) had less notification of completion was received via email once analyses than 8 days of cough and 21 (77.8%) had less than 14 days of were completed. Costs for labour, reagents and disposables for cough. The median time from symptom onset to diagnosis was both techniques were calculated. 8 days (0-30 days), 13 (48.1%) less than 8 days and 24 patients Results: All samples were accurately identified to the genus (88.8%) less than 14 days. All but one patient was prescribed level for both techniques. Species identification was only highly macrolide antibiotics and all patients were isolated. 22 patients accurate for S. aureus (96.9%) in 16S rRNA gene sequencing; (81.5%) were hospitalized and 3 patients (11.1%) received ICU nevertheless, bioinformatics skills was not a prerequisite to run care for ventilator care. All patients survived. the analysis. Identification cost per sample for 16S rRNA gene Conclusion: A rapid multiplex PCR test including pertussis helps sequencing was 416.74 USD, compared to 21.24 USD with the API early diagnosis, isolation and treatment of pertussis. The FA-RP NH strip. testing shortened the time required for diagnosing pertussis in Conclusion: Usage of 16S rRNA gene sequencing for pathogen patients without typical symptoms and also for the isolation and identification was found to be costly. Nevertheless, technical treatment of the patients. difficulty in bioinformatics analysis could be circumvented using end-to-end software such as the B.E. Patho suite. Table 1. Characteristics of Patients Characteristics N (%) Number of patients 27 P1-CM18 Age, median (range) 48.9 (3.3 - 82.2) Efficacy of multiplex PCR for early diagnosis of pertussis Male 9 (33.3) 1* 1 2 3 4 Underlying medical histody SC OH , SM Park , YK KIM , JH LEE , JM LEE Diabetes 4 (14.8) 1 College of Medicine, Yeungnam University, Daegu, Korea, Hypertension 9 (33.3) 2 Department of Laboratory Medicine, Kyungpook National Asthma/COPD 6 (22.2) University Hospital, Daegu, Korea, 3Department of Laboratory Interstitial lung disease 2 (7.4) Medicine, College of Medicine, Yeungnam University, Daegu, Heart disease 10 (37.0) Korea, 4Department of Pediatrics, College of Medicine, Yeungnam Presenting symptom Fever 11 (40.7) University, Daegu, Korea Chill 5 (18.5) Cough 27 (100.0) Background: Pertussis is a highly infectious respiratory disease Sputum 17 (63.0) caused by Bordetella pertussis, which causes airway inflammation Rhinorrhea 7 (25.9) and severe cough. In severe cases, complications such as Dyspnea 12 (44.4) atelectasis and bronchopneumonia may occur. It is characterized Post-tussive vomiting 2 (7.4) Paroxysmal cough 3 (11.1) by persistent cough for 2 weeks or more and characteristic Inspiratory whooping 9 (33.3) coughing (whooping cough). Recently, the prevalence of Cough duration (days), median 7 (2 - 30) pertussis increased in Korea. The reason is that as age increased, (range) the effect of the DTaP vaccination in infants decreased. Culture less than 8 days 17 (63.0) is considered the gold standard test for diagnosing pertussis. 8-13 days 4 (14.8) more than 14 days 4 (14.8) However, Polymerase chain reaction (PCR) method is the most unknown 2 (7.4) commonly used as a pertussis diagnostic test due to the low Time for symptom to diagnosis (days), median (range) 8.0 (0 - 30) sensitivity and long turnaround time of the culture method. less than 8 days 13 (48.1) Recently, a rapid multiplex PCR test has been introduced for the 8-13 days 11 (40.7) comprehensive detection of respiratory pathogens (17 viruses more than 14 days 3 (11.1) and 3 bacteria) including Bordetella pertussis with a turnaround time of 1 hour. S96 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-CM19 Rapid Molecular Tests used for the Detection of Respiratory Pathogens caused a reduction in the use of antibiotics in children SC OH1*, SM Park1, YK KIM2, JH LEE3, JM LEE4 1College of Medicine, Yeungnam University, Daegu, Korea, 2Department of Laboratory Medicine, Kyungpook National University Hospital, Daegu, Korea, 3Department of Laboratory Medicine, College of Medicine, Yeungnam University, Daegu, Figure 1. Duration of antibiotics Korea, 4Department of Pediatrics, College of Medicine, Yeungnam Table 1. Comparison between RV detection and Rapid RP test University, Daegu, Korea Peroid I Period III P-value 2015.11.1 – 2016.6.30 2017.7.1 – 2018.7.31 Background: Multiplex polymerase chain reaction (mPCR) Test RV detection Rapid RP for diagnosis of respiratory pathogens is increasingly used in Number of patients 333 341 pediatric inpatient facilities. mPCR assays now enable detection of Male 186 (55.9) 209 (61.3) a broader array of viruses with higher specificity, sensitivity, and Age (year) 3.4 ± 4.1 3.4 ± 4.0 0.965 Time from Order to Report 35.7 ± 20.2 2.7 ± 1.2 <0.001 faster turnaround time than previous testing using immunoassays (hours) or cultures. Recently we adapted FilmArray Respiratory Panel (FA- TAT (hours) 21.6 ± 18.6 1.6 ± 0.4 <0.001 RP) for diagnosis of respiratory pathogens. FA-RP is a multiplexed Duration (days) 6.3 ± 3.1 5.2 ± 2.5 0.013 in vitro diagnostic PCR test for the simultaneous, rapid (~1h) PO antibiotics detection of 20 pathogens directly from respiratory specimens Duration (days) 1.8 ± 2.2 1.2 ± 2.0 0.001 IV antibiotics with random access. The purpose of this study is to test the Hospital stay (days) 3.3 ± 2.2 3.2 ± 3.1 0.484 clinical efficacy of FA-RP in pediatric patients. TAT; turnaround time, IV; intravenous, PO; per oral Materials/methods: We conducted a retrospective cohort study of children hospitalized at Yeungnam University hospital, who underwent testing for a respiratory pathogen either in the P1-CM20 emergency department prior to admission or within the first 2 Antimicrobial Effect of HEXIM-1 Derived Peptides against days of hospitalization from November 2015 to August 2018. We Antibiotic Resistant Salmonella Serotypes in Singapore excluded patients with chronic disease requiring treatment for Pooi Leng Ho, Hwee Tong Tan, Mazlina Banu, Xuezhi Bi, more than 3 months. In November 2015 to June 2016, mPCR Dave Siak-Wei Ow* testing was performed on nasopharyngeal swabs by using the Microbial Cells and Proteomics Groups, Bioprocessing Technology Anyplex(TM) II RV16 detection kit (RV16; Seegene, Seoul, South Institute, A*STAR (Agency for Science, Technology and Research), Korea)(RV detection). In November 2016 to August 2018, mPCR Singapore testing was performed on nasopharyngeal swabs by using the FilmArray Respiratory Panel (BioFire, Salt Lake City, UT)(FA-RP). Salmonella is a leading cause of foodborne illness, and accounts Results: A total of 333 cases in the RV detection group and for 93.8 million foodborne illnesses and 155,000 deaths per 341 cases in the FA-RP group were included. The clinical year globally. In Singapore, there are around 2,000 reported characteristics and laboratory findings between FA-RP and RV cases of Salmonellosis annually. More than 2,600 serotypes detection group were statistically insignificant. The positive rate have been described for Salmonella, with around 100 of them of RV detection was 70.9% and 84.2% in FA-RP. One virus was being pathogenic and causing illnesses including typhoid fever, positive in 188 (56.5%) RV detection group and 192 (56.3%) in food poisoning, gastroenteritis and enteric fever. In this work, FA-RP group. The two-virus-positive rates were 14.4% in RV and Salmonella serotypes (e.g. Albert, Anatum , Bareilly, Braenderup, 21.7% in FA-RP. There were no three-virus-positive cases in RV Corvallis, Hadar, Javiana, Kentucky, Bovismorbificans, detection group and 19 (5.6%) in the FA-RP. Turn around time Mbandaka, Minnesota, Newport, Potsdam, Rissen, (TAT) was shorter in FA-RP group (p<0.001). Durations of using Schwarzengrund, Senftenberg, Stanley, Tennessee, Virchow, intravenous and oral antibiotics were significantly reduced in FA- Welterevden) classified according to the Kauffmann–White RP group than RV detection (p<0.05). scheme were evaluated for their susceptibility against antibiotics Conclusions: Use of FA-RP significantly decrease TAT and reduce (Chloramphenicol, Tetracycline, Kanamycin, Gentamycin, durations of intravenous and oral antibiotics in hospitalized Vancomycin) using disk diffusion assays. The HEXIM-1 derived pediatric patient. Decreased use of antibiotics is expected to have peptides are new antimicrobial peptides that have been the effect of reducing antibiotic resistance. previously shown to be effective against a broad spectrum of drug-resistant bacterial in our laboratory. We will evaluate the minimum inhibitory concentration and minimum bactericidal concentration of these peptides on antibiotic-resistant Salmonella serotypes and determine unique protein signatures for their identification. Our study will provide useful information for the serotyping and alternative treatment for antibiotic-resistant Salmonella serotypes. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S97

P1-CM21 diversity of PaLoc of CD. Vibrio Pathogens: Surveillance for public health which Method: CD strains from Hanyang university hospital were prevent to sea-water borne disease in South Korea, 2017- collected and sequenced by using Illumina Miseq. After De novo 2018 assembly, phylogenic analysis was performed using multilocus Hee Jung Lee, Seung Hun Lee, Go Eun Myung, Eun Jin Choi, sequence typing (MLST) and single nucleotide polymorphism In A Kim, Sang Moon Soh (SNP) of core genes selected through orthologous gene clustering Yeosu National Quarantine Station, Korea Centers for Disease using CD-HIT. Comparative analysis of PaLoc involving A & B Control & Prevention, Yeosu, South Korea toxin-related genes was performed by MEGA for the de novo assembled sequences and by IGV for reference sequence-based Objectives: Vibrio pathogens which is a water- and food-borne analysis using CD630. pathogen affecting humans and it is a common pathogen in Result: Distribution of the MLST types was as follows; eight Korea found in seawater environment. Vibrio cholerae, Vibrio isolates (25%), sequence type (ST) 17; 4 (12.5%), ST3; 4 (12.5%), vulnificus, and Vibrio parahaemolyticus are the most important ST5; 3 (9.4%), ST53; 3 (9.4%), ST35; 2 (6.3%), ST8; 2 (6.3%), species because they can be a potent human pathogen, as leading ST11; each 1 isolate, ST2, ST14, ST129, ST54, ST192, and ST37, cause of septicemia, wound infections as well as seafood borne respectively. Phylogenic analysis using SNP of core genes showed gastroenteritis. For these reasons, we investigated the pathogenic a similar clustering according to ST and clade by MLST, but Vibrio spp. which their distributions. clustering in the clade1 strains shows a different clustering by Methods: Seawater samples were collected from 145 points of MLST. In term of PaLoc locus, the reference-based study showed coastal areas which bacterium of vibrio spp. live in the aquatic that most of the strains with the same ST have similar altered environment. Four environmental factors were recorded. sequence patterns, while the binary toxin-positive and toxin Seawaters were filtered and incubated in alkaline peptone water A-negative strains were not mapped to the reference sequence. (APW) at 37°C for overnight. Using the species-specific PCR ST5 isolates with binary toxin were confirmed to have a 9kb methods, screening test were performed which gene were hlyA, nucleotide sequence insertion between tcdE and tcdA genes, and ctxA, vvhA, tlh. Pathogenic vibrio spp. were isolated its clones 1.8kb deletion of the tcdA gene in the ST37 strains was identified using three selective plating media. with de novo assembly analysis. Results: The total isolation rates of V. vulnificus, V. cholerae Conclusion: Genetic diversities of PaLoc in CD strains showed (non-pathogenic, non-O1, and non-O139 serogroups), and V. clade and ST-specific tendency, while post-clade divergence parahaemolyticus from seawater were 15.82%, 13.18%, 65.80% observed at some strains. each bacteria within 2017 however, each bacteria were as follow; 21.81%, 19.40%, and 70.05% in 2018, respectively. Although no cases of human infection with non-pathogenic V. cholerae have P1-CM23 been documented, the number of mortality rate from the V. A Six Year Review of Shigella spp. Serodiversity and vulnificus infection was recorded 46.3% during two years. The Antimicrobial Resistance in Diarrheal Outbreak Cases in the number of V. parahaemolyticus infection was occurred 354 cases Philippines in 2017 and 213 cases in 2018, each year. KC Navarro*, RL Banhaw*, RA Cube, JM Bilar, MG Bugayong, Conclusion: The recent emergence of a potential pandemic AP Luis, CD Razonable event; V. cholera serotype O1, and the cholera outbreak in South National Reference Laboratory for Bacterial Enteric Diseases, Korea in 2016 indicates the importance of consistent surveillance Research Institute for Tropical Medicine. Philippines of pathogenic Vibrio genus within coastal area. Due to the changing climate of tropical weather, it is necessary to prepare Background: Shigella species are small, non-encapsulated gram- for the outbreak of human infections caused by abnormal growth negative rods and is the causative agent of bacillary dysentery. of Vibrio spp. Comprehensive monitoring, prevention and Most of the cases of shigellosis occur in developing countries. control efforts will be required to protect the public health from The incidence of Shigella is increased by undernutrition and is foodborne and waterborne mediated diseases. one of the enteric pathogens that is associated with linear growth deficits after infection on children. There a four serogroups of Shigella namely; Group A (Shigella dysenteriae), Group B (Shigella P1-CM22 flexneri), Group C (Shigella boydii) and Group D (Shigella sonnei). Analysis of Pathogenicity Locus Diversity using Whole- This study aimed to review the sero-diversity and antimicrobial Genome Sequencing for Clostridioides difficile isolates resistance pattern of Shigella species in diarrheal outbreak cases Yeonjae Kim1*, Mi-Ran Seo 2, Jieun Kim2, Hyunjoo Pai2 in the Philippines from 2013 to 2018. 1Center for Infectious Disease, National Medical Center, Seoul, Methods: Stool and rectal swab samples from suspected diarrheal Korea, 2Department of Internal Medicine, College of Medicine, outbreaks from different regions in the Philippines, were sent Hanyang University, Seoul, Korea out to the National Reference Laboratory for Bacterial Enteric Diseases at Research Institute for Tropical Medicine for culture Introduction: The major virulence determinants of Clostridioides and antimicrobial susceptibility test for confirmation. Isolates difficile (CD) infection are toxin A (tcdA) and toxin B (tcdB), which were confirmed using conventional biochemical and serologic are encoded within its 19-kb pathogenicity locus (PaLoc) along test using Denka Seiken Co., LTD. Confirmed isolates were with tcdR, tcdE, and tcdC. This study aimed to identify the genetic subjected to antimicrobial susceptibility test using Kirby Bauer S98 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

disc diffusion method. bacterial growth in presence of antibiotics using incubation Results: There were 8,268 samples received from 2013 up to times and specific expertise for results interpretation. Automated 2018 out of these samples, 131 (1.6%) were confirmed as Shigella systems brought many improvements by dramatically reducing species. Among the Shigella isolates found, 55% were Shigella time and using many assays such as turbidity, fluorescence, and flexneri,43.5% were Shigella sonnei and 1.5% were Shigella boydii. colorimetric detection. Emerging technologies gave new insights Initially there were seven (7) isolates of Shigella dysenteriae but using imaging and non-imaging based tools by targeting colonies these were later confirmed as Escherichia coli using Pulse Field or single bacteria by optical microscopy, or other fluidic systems. Gel Electrophoresis and Acetate differential tests that were Although used in many labs, these techniques remain far from conducted at the National Institute of Infectious Diseases in being optimal at the economic level. Herein, we present a high Toyama Japan. throughput AST method targeting specific bacteria with specific The top 3 regions in the Philippines with the highest number of antibiotics. Tests are directly realized on blood culture samples Shigella isolates were as follows; region VI – Western Visayas, detected positive to bacterial growth. We used the tabletop which account to the majority of the total samples (32.1%), scanning electron microscope Hitachi TM4000Plus a new followed by Region IVA - CALABARZON (14.5%), with region IX generation of rapid electron microscopy. We managed to easily - Zamboanga Peninsula (7.6%) and region XI – Davao Region detect many bacterial features and morphological modifications (7.6%) sharing the position as the third region with the most such as density, brightness, detailed cellular division, and volume number of confirmed cases of shigellosis. which are not detectable by conventional optical microscopy. There were 8 serotypes detected from the 72 isolates of Shigella We applied our method on Gram-negative bacilli in order to flexneri:1a, 2a, 2b, 3a, 4a, 6, X and Y. there were also 2 isolates evaluate their sensitivity or resistance toward Imipenem. In a that were untypable. The predominant serotype was 2a which test of 50 clinical isolates, we compared our results to the ones accounted for 45.8%. Follows were 2b (22.2%), 3a (11.1%), 4a obtained by the routinely used AST technique in the lab and all (9.7%), 1a (1.4%), 6 (1.4%) variant Y s(1.4%), variant X (1.4%). For were correctly classified as susceptible or resistant. The total time Shigella sonnei 93% were Phase I and the remaining were Phase II for this method, from sample loading to results readout, is around and lastly, Shigella boydii 2 serotypes were detected namely type 40 minutes, which allows the development of a point-of-care test 14 and type 16. that can guide suitable AST. In all antibiotics tested, ampicillin and co-trimoxazole developed as the highly resistant to almost all serogroups of Shigella. Whereas all the isolates were sensitive to ciprofloxacin and P1-CM26 levofloxacin. For resistance distribution Shigella flexneri has Evaluation of the Scanning Electron Microscope TM4000Plus shown 84.6% resistance to ampicillin and 69.2% resistance to co- in the Rapid Observation of Bacteria in Clinical Microbiology trimoxazole. There were 7 isolates of Shigella flexneri that were Jacques Bou khalil1, Anthony Fontanini1, Yusuke Ominami2, not included on the antimicrobial susceptibility analysis, due to Akiko Hisada3, Didier Raoult1* difficulties in the recovery of the data. 1Institut Hospitalo-Universitaire Méditerranée Infection , France, Discussion: On these review we were able to address the distribu- 2Hitachi High-Technologies Corporation, Nanotechnology tion of Shigella sero-diversity as well as their resistance pattern for Solutions Business Group Japan, 3Hitachi, Ltd., Research & the outbreak isolates in the Philippines. It is show that the major- Development Group, Japan ity of the Shigella species are Shigella flexneri and there were no known Shigella dysenteriae isolates found in the Philippines from Since the 19th century, one of the first steps in bacterial 2013 to 2018. The majority of isolates were found in Region IV – identification has been Gram staining (GS). However, GS is Western Visayas, where most of the household in the region have variable due to many factors, such as culture freshness, or poor access to sanitation facilities and there were no sewerage used dyes. It is also operator dependent, even in an automated systems, instead they rely on stand-alone septic tanks. Also, there manner; where the observation under microscope requires were increased resistance pattern seen ampicillin and co-trimox- technical qualifications together with the observation and azole for all the serogroups of Shigella species. identification approaches that vary between users. Recently, we proposed to replace colony identification by a direct MALDI-TOF test, which is faster than GS and gives higher information level. P1-CM25 Since that we switched to MALDI TOF where only insufficient Rapid Antimicrobial Susceptibility Testing Using Scanning identifications in clinical microbiology or by culturomics are Electron Microscopy switched to GS and eventually molecular identification. In this Jacques Bou khalil1, Yusuke Ominami2, Didier Raoult1* study, we compared the performance and speed of GS and 1Institut Hospitalo-Universitaire Méditerranée Infection, France, MALDI TOF to a new strategy of testing using a new tabletop 2Hitachi High-Technologies Corporation, Nanotechnology scanning electron microscope Hitachi TM4000Plus which is Solutions Business Group Japan extremely fast regarding standard microscopes, and for which bacterial smears, are observed with or without staining. For this Enabling faster Antimicrobial susceptibility testing (AST) is strategy, the observation time is limited to the slide drying time essential for guiding the treatment of many types of bacterial and image acquisition. Under these conditions, the average infections, and improves clinical outcomes. The most common observation time of the sample by GS was of 10 minutes, its methods are culture-based techniques, which rely on measuring identification by MALDI-TOF was of 13 minutes, while the Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S99

TM4000Plus recorded 4 minutes. Finally, the automated image H. influenzae in 18 (7.8%) case, multi-pathogen were detected acquisition and generation, avoids human dependent errors due in 177 (76.3%) cases, with the majority were S. pneumoniae to technical focus and observation. This helps generating images combined with H. influenzae and/or combined with other database that can be analyzed and compared to controls and pathogens, S. pneumoniae combined with other pathogens, other samples. In total, the TM4000Plus, as it is routinely used in and H. influenzae combine with other pathogens. The results our laboratory, will probably replace optical microscope and GS also show that a significant percentage of viral pathogens in the near future. were detected (26.2%) but were usually associated with other pathogens (24.6%) and rarely as single agents. The results of the study also evaluated the effectiveness of culture methods and real-time PCR in the detection of microbial pathogens. The results of the MIC of different antibiotic to 148 H. influenzae strains, 68 S. pneumoniae strains, and 22 K. pneumoniae strains isolated from culture were also reported. Conclusions: This is the first study to apply culture and real-time PCR in the detection of microbial pathogens that cause acute Figure A. Scanning electron Micrographs of Staphylococcus aureus using lower respiratory infections out-patients. This result is a very TM4000Plus. The protocol used for this technique took 4 minutes going from necessary contribution for clinicians to use in the prescription sample preparation until image acquisition and results. B: automated gram staining of of antibiotic treatment and also supply the evidence for the showing Staphylococcus aureus with a technical time of 10 minutes A: MALDI TOF identification datasheet of the same Staphylococcus aureus, where all the process guideline of antibiotic therapy. took 13 minutes.

P1-CM29 P1-CM28 The Reliability of C-Reactive Protein Levels in Predicting Microbial pathogens causing community acquired Dengue Severity: A Systematic Review pneumonia in Vietnamese outpatients V.M. Salud, F.A. Reyes, J. Ricohermoso, L.E. Rubion, A.D. Roman V.H.Pham1,7*, T. V.Nguyen2, N.V.Tran3, D.D.Nguyen4, H.T.T.Le 5, Department of Internal Medicine, Manila Doctors Hospital, T.M.T.Cao6, T.K.T.Le 1, T.H.T.Nguyen1, H.T.Pham8, C.Y.J.Quek9, Philippines S.T.Pham 9 1NK-BIOTEK clinical Laboratory, 2Vietnam Pulmonary Background: The clinical manifestations of dengue fever vary Society, 3Choray Hospital, 4Phamngocthach Hospital, 5NDGD from mild febrile illnesses to shock and organ failure. However, Hospital, 6Cantho Central Hospital, 7Phanchautrinh University, severe symptoms may not be clinically evident until much later, 8Phamngocthach University, 9Sydney University making it difficult for early detection of patients at risk for poor Background: There are currently no data available on outcomes. Several biomarkers, particularly C-reactive protein microbiological pathogens causing acute lower respiratory (CRP), were revealed by many studies to be highly predictive infections in out-patients because they are not indicated for of DHF/DSS. This systematic review aims to determine a microbiological testing, whereas such data are necessary to help relationship between CRP levels and the probability of developing the doctor to prescribe antibiotic treatment correctly DHF/DSS. Main aims: Use of culture methods and real-time PCR to detect Methods: Multiple electronic databases were searched for microbial pathogens present in reliable sputum samples that was literature published in English from January 2007 to August 2017. obtained from patients who were clinically diagnosed with acute Four reviewers independently extracted data from eligible studies lower respiratory tract infection out-patients. using the standardized critical appraisal tool from JBI-MAStARI Objectives and methods: This is a cross-sectional, multicenter, (Joanna Briggs Institute-Meta Analysis of Statistics Assessment prospective study with the participation of four clinical centers and Review Instrument). Five articles that scored six and above in and one central laboratory. Patients aged 16 years and older this tool were included in this review. who were clinically diagnosed with acute lower respiratory Results: Five journals (three cohort studies and two cross- infection were not required to be admitted to the hospital and sectional studies) were reviewed. Sample sizes ranged from were eligible for inclusion as well as consent to participate in the 70 to 235 participants. The three cohort studies measured CRP study. Specimens to be tested are the sputa and the test method is levels at point of diagnosis, but were re-measured at different culture and real-time PCR for the detection of pathogenic micro- time points in the subjects’ admission. However, regardless of organisms. In addition, post-nasal swabs are also collected for the time difference, they all showed that increased CRP levels real-time PCR detection of the virus. The isolates from culture exhibited a trend towards development of DSS/DHF. The studies were carried-out the antibiotic susceptibility testing using also identified a possible “golden period” for measuring CRP microdilution method to detect the MIC according to CLSI 2018. levels that can accurately predict development of DHF/DSS. The Results and discussions: In the period from 1/2017 to 7/2018, two cross-sectional studies also saw a similar trend, but have 232 samples were obtained from 232 patients. Combining both measured this in median values of the CRP levels. culture and real-time PCR results, microbial pathogens were Conclusion: This systematic review showed that increased CRP detected from 218 (94%) cases, with 41 (18.7%) were mono- levels appeared to have a trend towards a higher probability pathogens in which S. pneumoniae was detected in 12 (5.2%) and of developing DHF/DSS. However, a larger population size S100 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

and more studies are needed to further establish a statistically Trinh University significant relationship. Background: Norovirus and Rotavirus are the two most common pathogens causing acute diarrhea in children in Vietnam. To P1-CM30 avoid the overuse of antibiotic, the diagnosis tool to detect the Comparison of ASTA MicroIDSys and VITEK MS Matrix- causative pathogens in stool, especially rotavirus and norovirus is assisted laser desorption/ionization time-of-flight mass necessary. spectrometry for the identification of microorganisms Aims of the study: Compare the RT-PCR and the immunochro- SY Kim1*, YJ Park2, J Jung2 matography in the detection of Rotavirus and Norovirus in the 1Department of Laboratory Medicine, Seoul St. Mary’s Hospital, fecal samples collected from children hospitalized due to acute College of Medicine, The Catholic University of Korea, Seoul, diarrhea Korea, 2Department of Laboratory Medicine, St. Vincent’s Hospital, Materials and Methods: Fecal samples were taken from children College of Medicine, The Catholic University of Korea, Suwon, hospitalized due to acute diarrhea. The fecal samples were kept at Korea. -30oC until carried out the experiments. The IP line® Duo”Noro/ Rota” kit supplied by Immuno Probe Co. LTD were used to detect Background: The ASTA MicroIDSys system (ASTA Inc, South the Norovirus and Rotavirus antigen directly from the fecal Korea) is a newly developed MALDI‐TOF MS system. We samples with the method followed the instruction of the kit. For compare its performance with that of VITEK MS (bioMérieux, RT-PCR to detect Norovirus and Rotavirus, the stool samples France). were diluted to 10% in distilled water then done the viral RNA Methods: From December 2017 to January 2018, a total of 2,057 extraction using QIAamp® Viral RNA Mini Kit. The extracted isolates recovered from the various clinical specimens were RNA from the samples were denatured with 1/10 volume of 50% tested in the study. They include 949 gram-positive cocci, 655 DMSO at 95oC for 5min then were carried out the cDNA synthesis gram-negative bacilli, 144 gram-positive bacilli, 106 anaerobes, using the Transcriptor Universal cDNA of Roche. The multiplex 145 yeasts, and, 58 others. If results from both systems are PCR using 4 primers G1SKF, G1SKR (GI specific), and CO2F and identical and satisfy acceptance criteria of each system (≥60.0% G2SKR (GII specific) for detection of Norovirus. The primers in the Vitek MS system and ≥140 in the ASTA MicroIDSys), we sBeg9 and VP7-1’ were used for PCR detection of Rotavirus considered those results as correct identification. For any isolate group A, and 4 primers ADG9-1F, ADG9-1R (group B specific) that could not be identified by either of the systems or that has and NG8S1, NG8S2 (group C specific) were used for multiplex the discordant result, 16S rDNA gene, or ITS1/ITS2 sequencing PCR detection of Rotavirus Group B and C. The PCR mix were was used. Supplemental testing was performed with traditional prepared from the QIAGEN Multiplex PCR kit. methods such as biochemical tests, API, or the Vitek system. Results and dicussions: From June 2017 to October 2017, 153 Results: Among the 2,057 isolates, identical results from both fecal samples were collected from children hospitalized by acute systems were obtained in 1,987 (96.6%) isolates, and 1,969 (99.1%) diarrhea and examined for detection of Rotavirus and Norovirus. isolates of them satisfied acceptable confidence values of both Among 153 samples, the IP line® Duo”Noro/Rota” detected 69 systems. In each system, results were classified into 4 groups: samples positive with norovirus (45.1%) and 45 with rotavirus correct identification at the species level, correct identification (29.4%). With the RT-PCR, 78 (50.1%) samples positive with at the genus level, misidentification, and no identification. Each norovirus and 45 (29.4%) with rotavirus. All of the Norovirus result groups in the Vitek MS system are 97.3%, 98.5%, 0.1%, and detected by RT-PCR were GII, and all of the Rotavirus were Group 1.4%, respectively. Those in the ASTA MicroIDSys system 97.0%, A. There were 10 samples detected Norovirus and 2 samples 98.1%, 0.2%, and 1.8%, respectively. It is of note that 75% of 27 detected Rotavirus by RT-PCR but the IP line® Duo”Noro/Rota” isolates showing the ASTA MicroIDSys scores between 110 and could not. Controversially, 1 sample detected Norovirus and 2 139 were correctly identified to the species level based on the samples detected Rotavirus by IP line® Duo”Noro/Rota” but the sequencing results. RT-PCR could not. From these observes, the kappa of IP line® Conclusion: The performance of microorganism identification Duo”Noro/Rota” versus RT-PCR in the detection of Rotavirus and of the ASTA MicroIDSys was comparable to the Vitek MS system. Norovirus are 0.97 and 0.93 respectively, then IP line® Duo”Noro/ The ASTA MicroIDSys system MS will be a reliable and useful Rota” results are statistically match well with the RT-PCR results. system for microbial identification in clinical microbiology Conclusions: The RT-PCR seems more sensitive than IP line® laboratories. Duo”Noro/Rota” for the detection of Rotavirus and Norovirus in fecal samples taken from diarrheal patients, however the difference of the results are statistically low and the IP line® P1-CM31 Duo”Noro/Rota” can give the results after 15 mins after sample RT-PCR versus Immuno-chromatography for detection of collection versus over 8 hrs of RT-PCR results. This is the very Rotavirus and Norovirus in fecal samples collected from good point to say that IP line® Duo”Noro/Rota” kit is the suitable children with acute diarrhea diagnostic tool for Norovirus and Rotavirus detection at the S.T. Pham 1, T.A. Nguyen2, P.H. Le2, H. Ushijima3, S.H. Le4, clinical lab as well as at the bedside. N.H.T. Tran4, D.K. Tran4, V.H. Pham4,5* 1University of Sydney, 2Children Hospital No1, 3Aino Health Science Center, Aino University, Tokyo, Japan; 4NK-Biotek Co., 5Phan Chau Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S101

P1-GN01 Navindra Kumari P1*, Aisyah Syakirah2, Noor Masyitah Jumahat2, Identification and Characterization of Novel and Unique Zaini M.Z1, Jamal Hussaini1, Wong Eng Hwa3, N. Parasakthi4 Extended-Spectrum β-Lactamases and carbapenemase from 1Department of Microbiology & Parasitology, Faculty of Medicine, Gram-Negative Pathogens Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jung Hun Lee1,2, Kwang Seung Park1, Jeong Ho Jeon1, Selangor, Malaysia, 2Institute of Medical Molecular Biotechnology, Sang Hee Lee1* Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, 1National Leading Research Laboratory of Drug Resistance Selangor, Malaysia, 3School of Medicine, Taylor’s University Proteomics, Myongji University, Yongin, Republic of Korea, 2Dr. Lakeside Campus, 4School of Medicine and Health Sciences, ProLab Inc., Seongnam, Republic of Korea Monash University Malaysia

Objective: New variants (cephalosporinases and/or Pseudomonas aeruginosa is an organism inhabiting the soil, wa- carbapenemases) driven from AmpC β-lactamases have been ter and human cell surfaces. It causes diseases, commonly in the described in several enterobacterial species. Here, we report a immunocompromised. It establishes persistent infections and novel extended-spectrum class C (AmpC) β-lactamase (cESBL) chronic infections via the formation of biofilms. This contrib- and another carbapenemase identified in Escherichia coli clinical utes to phenotypic variation, altered gene expression, leading to isolates. insensitivity to chemical, physical stress and antibiotics. In this Methods: A total of 375 clinical isolates of E. coli and Klebsiella study, we investigated distribution of PilA, PelB, and RhlI genes. pneumoniae were isolated from pediatric patients at Seoul Fifty-four isolates were used. Strain identification and antibiotic National University Hospital in Republic of Korea. Molecular susceptibility testing was performed. The biofilm assay was car- characterizations of β-lactamases were performed by the large- ried out using the crystal violet assay. Detection of the genes is scaleblaFinder kit (1), DNA sequencing, and next generation by PCR. Five strains were classified as multidrug resistant (R to sequencing. Phylogenetic tree based on amino acid sequences carbapenems, cephalosporin, aminoglycosides and fluoroquino- of all AmpC-EC type β-lactamases was analyzed by the lone). Both susceptible (S) and resistant (R) strains demonstrated neighbor-joining method. MICs of the antimicrobial agents biofilm formation; R strain appeared as stronger biofilm produc- were determined by an agar dilution method (CLSI). The new er. PilA and PelB gene was detected in all 54 strains. RhlI gene was blaAmpC genes were expressed by a pET-30a(+) system and the detected in all except in 2 strains. PilA, type IV pili is important gene products were purified by His-Bind column and Mono S in attachment and twitching motility on surfaces, while PelB column. Steady-state kinetic constants of the purified enzymes promotes cell-cell communication. RhlI is an autoinducer which were determined by fitting the initial rates directly to the Henri- regulate expression of virulence genes. The presence of these Michaelis-Menten equation using nonlinear regression with the genes correlates to the ability of this organism to form biofilm and program DYNAFIT. its increasing trend of resistance to most prescribed antibiotics. Results: Among 375 isolates, three E. coli isolates (E11-036, E14- However, there may be other contributing factors that give rise to 118, and E17-090) were resistant against piperacillin-tazobactam. the emergence of resistance in this organism. Two E. coli isolates (E11-036 and E14-118) were resistant against extended-spectrum cephalosporins and one E. coli isolate (E11- 036) was resistant against carbapenems. Three Amp-EC type P1-GN04 genes from E. coli clinical isolates were detected by the large- VIM-Type Metallo-β-lactamase Producing Acinetobacter scaleblaFinder kit. Sequence analysis revealed one blaAmpC-EC5 baumannii: Its Detection and Spread in Tertiary Hospital, gene and two novel blaAmpC genes, designated as blaAmpC- Malaysia EC81 and blaAmpC-EC82. Phylogenetic tree indicated that Aisyah Syakirah S1, Jamal H2*, Navindra Kumari P2, AmpC-EC81 and AmpC-EC82 are grouped into phylogroup B2, Farah Roslinda M.R2, Zaini M.Z2, Benerdick L.P.K3, which are most closely to AmpC-EC68 and AmpC-EC6 from E. Tuan Suhaila T.S3, Fadzilah M.N2 coli, respectively. Kinetic analysis of AmpC-EC81 suggests that 1Institute of Medical Molecular Biotechnology, Universiti Teknologi the enzyme is a cESBL. Kinetic analysis of AmpC-EC82 revealed MARA Sg. Buloh Campus, Selangor, Malaysia, 2Dept. of Medical that this enzyme shows a broad substrate profile that includes Microbiology & Parasitology, Faculty of Medicine, Universiti carbapenems. Teknologi MARA Sg. Buloh Campus, Selangor, Malaysia, Conclusion: We found two novel AmpC-EC81 (cESBL) and 3Microbiology Unit, Dept. of Pathology, Hospital Sg. Buloh, AmpC-EC82 (carbapenemase) belonged to phylogroup B2 from Selangor, Malaysia E. coli clinical isolates (E11-036 and E14-118). In particular, kinetic data of AmpC-EC82 show carbapenem-hydrolyzing activity and Acinetobacter baumannii (AB) is frequently associated with are consistent with the determined MICs. AmpC-EC82 is the first nosocomial infections. They exhibit high genetic flexibility cESBL and carbapenemase among AmpC-EC type β-lactamases acquiring resistance genes, leading to emergence of multidrug that are encoded by a chromosomal gene. resistance (MDR) that instigates major concern worldwide. The production of carbapenemase in AB has led to many uncertainties in treatment. The aim of this study is to investigate P1-GN03 the role of VIM-type metallo-β-lactamase (MBL) among MDR AB Detection of genes associated to biofilm formation and in our setting. A total of 128 MDR AB isolates were collected from antibiotic resistance in Pseudomonas aeruginosa ICU, CCU, NICU, HDW and general wards of a tertiary hospital S102 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

in Malaysia. Strain identification and antimicrobial susceptibility may cause havoc among this community. We need special testing were performed. The presence of VIM-type genes were techniques for early microbiological detection and access the detected using PCR, in chromosomal and plasmid DNA. The therapeutic challenges related to limited, relatively unproven identity and gene loci were confirmed by sequencing. MDR AB antimicrobial treatment options. was most prevalent in HDW (39.06%), followed by ICU (28.13%) and general wards (30.47%). The occurrence of isolates from CCU and NICU was 0.78% and 1.56% respectively. All isolates were bla- P1-GN06 VIM producers and genes were detected on chromosomal DNA. Ugly bugs, in the guts, enjoying new kidneys: a growing However, there were four variants identified among these isolates menace in transplant community of Nepal termed as A, B, C and D in this study. Their occurrence rate Bindira Joshi*, Bal Krishna Awal, Manju Shakya Hada, was 95.31%, 0.78%, 0.78% and 3.13%. Isolates from all location Sabina Shrestha, Kalpana Kumari Shrestha, were predominantly of VIM-type variant A. However, the other Pukar Chandra Shrestha, Basanta Tamang VIM variant types appeared to be sporadic in the general wards Tri-chandra multiple campus, Nepal and HDW. Therefore, in our setting VIM-type variant A was the predominant circulating variant amongst MDR AB isolates, that Background: Intestinal microbial flora is the main source of contribute to the spread of carbapenem resistant AB. infection in human and globally many studies reported high prevalence of multidrug resistant (MDR) enterobacteriaceae among healthy as well as hospitalized patients. But, there are P1-GN05 only fewer studies on faecal carriage of MDR, extended spectrum Emergence of β-lactamases Producing Uropathogens in betalactamase (ESBL), and metalobetalactamase (MBL) Renal Transplant Recipients of Nepal: Expeditious Operation producing enteric bacteria among renal transplant recipients. is Needed to Defeat These Pesky Superbugs Method: To prevail the scenario of faecal carriage of these Bal Krishna Awal, Rajeshwori Shrestha, Sabina Shrestha, Kalpana superbugs in renal transplant recipients, a study was carried out Kumari Shrestha, Pukar Chandra Shrestha at Sahid Dharma Bhakta national Transplant Center, Bhaktapur. Shahid Dharmabhakta National Transplant Center, Nepal Stool samples were collected from 103 transplant recipients and processed for isolation and identification of enteric bacteria Urinary tract infection (UTI) isthe most common post-renal using standard microbiological methods. Antibiotic susceptibility transplant infectious complication in both developing and testing and screening of ESBL and MBL isolates were carried developed countries. UTI due to drug resistant and beta- out following the guidelines of Clinical Laboratory Standard lactamase producing bacteria are the major challenge and is Institute (CLSI). For the confirmation of ESBL and MBL double associated with chronic graft loss, morbidity and mortality. Renal disc synergy test and combined disc diffusion test was carried out transplantation started just a decade ago in Nepal and no data is respectively. available about the β-lactamases production in uropathogens of Results: Out of 103 stool sample, Escherichia coli was predominate post-transplant UTI. isolate 86.1% followed by Klebsiella spp. (10%), Citrobacter spp. To prevail the current scenario of beta-lactamases producing (1.9%) and Proteus mirabilis (0.9%). MBL production was found uropathogens, a cross-sectional study was conducted from in 24% while 4.6% of isolates were identified as ESBL producers. January 2016 to June 2017 at Sahid Dharmabhakta National Most of the MBL and ESBL producers were MDR. Incidence of Transplant Center, Bhaktapur. A total of 178 renal transplant faecal carriage was high among recipients with recent antibiotic recipients were included in the study. Early morning urine therapy and history of stay in intensive care unit. sample were collected and processed for the isolation and Conclusion: High rate of faecal carriage of ESBL and MBL pro- identification of all the isolates. AST were performed by Kirby ducers were found in transplant recipients that is a growing men- Bauer Disc Diffusion method following the guidelines of Clinical ace in this immunocompromised community. Prior screening is Laboratory Standard Institute (CLSI). ESBL testing was performed necessary to reduce high incidence of infection by these ugly bugs by Combination Disk Diffusion method and for the confirmatory among renal transplant recipients. detection of MBL and AmpC, Ethylene DiamineTetraacetic Acid(EDTA) and Cloxacillin along with Meropenem and Meropenem alone were used respectively. P1-GN08 Among 178 transplant recipients, 83 episodes of UTI were Class D carbapenemase genes profile and potentially new observed in 29.21% (52/178). Klebsiellapneumoniae was the clonal genotypes of carbapenem-resistant Acinetobacter major bacteria, isolated in 41.3% (n=34) of cases, followed by E. baumannii in the Philippines coli 37.3% (n=31). Production of beta-lactamases was found to M Carascal1,2*, R Destura2,3, W Rivera1,4 be high with ESBL 19.6%, MBL 36.2%, and AMPC beta-lactamase 1Institute of Biology, College of Science, University of the Philippines 13.7%. Carbapenem resistance due to carriage of MBL was Diliman, Quezon City, Philippines, 2Clinical and Translational alarmingly high among the isolates of Klebsiellapneumoniae Research Institute, The Medical City, Ortigas Avenue, Pasig City, (73.9%). ESBL production was most common among the strains Philippines, 3Section of Clinical Microbiology and Molecular of E.coli (42.1%). Diagnostics, Department of Laboratory Medicine, The Medical Conclusion: Beta lactamases production is alarmingly high City, Ortigas Avenue, Pasig City, Philippines, 4Natural Sciences among the uropathogens of renal transplant recipients, which Research Institute, University of the Philippines Diliman, Quezon Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S103

City, Philippines new antimicrobial targets for resistance and susceptibility are imperative for clinical practice to treat resistant infections and for Molecular characteristics of carbapenem-resistant Acinetobacter public health efforts to limit the spread of resistance. baumannii (CRAb) remain to be poorly understood in the In this presentation, I introduced a strategy to identify and Philippines. Determining prevalent carbapenem resistance characterize bacterial target genes and pathways involved in the genes and clonality of CRAb help manage and implement antibiotic resistance and susceptibility of target antimicrobials. infection control policies. This study reported the prevalence Then, the identification of genes and pathways associated with of common class D carbapenemase genes (CHDLs) including small RNA-mediated cephalothin resistance and ciclopirox blaOXA-51-like, blaOXA-24-like, blaOXA-58-like, ISAba1-blaOXA-51-like, ISAba1- susceptibility of Escherichia coli using the strategy will be blaOXA-23-like, ISAba1-blaOXA-58-like and fxsA-blaOXA51-like using PCR discussed. Finally, the application of newly obtained data in analysis in 57 characterized A. baumannii clinical isolates from a detecting antimicrobial resistance will be discussed. All above tertiary hospital in the Philippines. This study also presented the data suggest that sequencing-based discovery of determinants preliminary clonal lineage of 15 selected CRAb using blaOXA-51-like- and their correlation to specific antimicrobial resistance and based genotyping. The prevalence of the common CHDLs were susceptibility pathways to antimicrobial treatment outcomes

100% (blaOXA-51-like), 77.2 % (blaOXA-58-like), 33.3% (ISAba1-blaOXA-51- will facilitate personalized approaches to developing treatment like), 49.1% (ISAba1-blaOXA-23-like), and 100% (fxsA-blaOXA-51-like). Some regimens and help to design the new strategies to reduce or isolates possessed combinations of more than two CHDLs while eradicate life-threatening infections. none possess blaOXA-24-like and ISAba1-blaOXA-58-like. Neighbor Joining and Bayesian Inference trees of the blaOXA-51-like gene revealed that most of the genotyped isolates were from worldwide clone P1-GN10 2, while two isolates formed independent, phylogenetically Identification of the multidrug-resistant Escherichia coli supported subclades. This provides evidence of potentially new clinical strain harboring mcr-1 and blaNDM-1 in Seoul, Repub- clonal lineages of CRAb in the Philippines. This study highlights lic of Korea the importance of molecular characterization in the detection Jin Seok Kim*, Young-hee Jin, Sang-Hun Park, Sunghee Han, and management of carbapenem resistance in A. baumannii. Hee Soon Kim, Joo-Hyun Park, Chae-Kyu Hong, Sang-Me Lee, This approach can contribute in controlling the spread of Young-Hee Oh transferable CHDLs and in monitoring clonal expansion of CRAb Seoul metropolitan government research institute of public health in the Philippines. and environment, Republic of Korea

Background: Colistin has been regarded as a last antibiotic P1-GN09 option for the treatment of infections caused by carbapenem- RNA-Sequencing-based identification of determinants for resistant Enterobacteriaceae. An acquisition of mobile colistin the antimicrobial resistance and susceptibility of Escherichia resistance gene (mcr) in carbapenem-resistant strains is a coli particular worrisome and poses a serious public health problem. Hyejin Cho*, Kwang-sun Kim Methods: During January to September 2018, we collected a total Department of Chemistry, Pusan National University, of 171 non-repetitive carbapenem-resistant E. coli isolates from 2, Busandaehak-ro, 63 beon-gil, Geumjeong-gu, Busan 46241, patients in Seoul. All isolates were screened for colistin resistance Korea and for mcr-1 gene by PCR. Colistin-resistant strains were further analyzed for multilocus sequence typing, susceptibility testing, With the advent of antimicrobials, life-threatening diseases acquired antimicrobial resistance gene, plasmid incompatibility caused by infections have essentially been eradicated. Moreover, and plasmid transfer. complicated procedures in clinics that increase our risk of Results: We obtained four colistin- and carbapenem- resistant E. infections have become simple without disturbed by undesired coli isolates (colistin MIC of four isolates, >8 μg/ml), and the mcr-1 infections. However, overuse and misuse of antimicrobials to was detected in one isolate SECR18-0888. This isolate belonged to treat many kinds of infections has accelerated antimicrobial sequence type 156 (phylogenetic group A) and was resistant to all resistant pathogens and worsen the treatment of patients. Recent antibiotics tested except tigecycline. The blaNDM-1, blaCTX-M-55, blaTEM report expected that such infections will skyrocket from 700,000 and rmtB genes were additionally detected in SECR18-0888, and to 10 million of deaths by 2050 without intervention. In the past the IncI2 plasmid carrying the mcr-1 and blaCTX-M-55 genes was years, infections caused by multidrug-resistant Gram-negative successfully transferred to recipient strain by conjugation. bacteria have dramatically increased in all parts of the world Conclusion: As a MCR-1 and NDM-1-positive multidrug-resistant and have become a particularly serious challenge for healthcare E. coli strain was firstly identified in Seoul, continued surveillance professionals. More seriously, last-resort antimicrobials used in is needed to monitor the prevalence of colistin resistance among life-threatening and multidrug-resistant infections. To understand Enterobacteriaceae. the antimicrobial resistance mechanism, researchers have been focused on the identification of a single target or pathway in bacteria by antimicrobial treatments. However, many reports showed that antimicrobial resistance is caused by multiple targets in bacteria. Therefore, identification and understanding the S104 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-GN11 uropathogens identified were E. coli (Inpt-36.75%, Outpt- 47.45%) Identification of NDM-4 and OXA-181 carbapenemase-pro- followed by Klebsiella pneumoniae (Inpt-13.24%, Outpt- 1.69%) ducing Klebsiella pneumoniae in South Korea for both groups. Chae-Kyu Hong*, Sang-Hun Park, Jin Seok Kim, Young-hee Jin, Resistance of 40-60% to trimethoprim-sulfamethoxazole, Sunghee Han, Hee Soon Kim, Joo-Hyun Park, Sang-Me Lee, amoxicillin-clavulanic acid, cefuroxime, cefotaxime, ceftriaxone Young-Hee Oh and norfloxacin, which are among the local recommendations Seoul metropolitan government research institute of public health were observed. Inward patients showed higher degree of and environment, Republic of Korea resistance to all tested antibiotics. Postmenopausal out-patient women showed higher resistance to Background: As carbapenemase-producing Enterobacteriaceae trimethoprim-sulfamethoxazole, amoxicillin-clavulanic acid and has been rapidly spread worldwide, there are several reports cephalosporins than premenopausal women. about two more carbapenemases in a single strain with various combinations of them including New Delhi Metallo (NDM) and OXA-48 like carbapenemases. Methods: In December 2018, we received two carbapenem- resistant Klebsiella pneumoniae strains from a university hospital in Seoul. Antimicrobial susceptibility testing was analyzed using broth microdilution method and carbapenemase genes were screened by multiplex PCR. Whole genome sequencing was performed using the PacBio RSII and Illumina Hiseq X ten platforms. Antimicrobial resistance genes and plasmid profiling were identified using ResFinder and PlasmidFinder online tools, respectively. Results: Two carbapenem-resistant K. pneumoniae strains (SECR18-2374 and SECR18-2494) isolated from hospital inpa- Higher antibiotic resistance was observed in post than tients had identical antibiograms and highly similar XbaI-PFGE premenopausal women for all antibiotics except for nitrofurantoin profiles, and harbored two carbapenemase genes blaNDM-4 and and mecillinam. blaOXA-181. For SECR18-2374, the WGS data revealed multiple resistance determinants for beta-lactam (blaNDM-4, blaOXA-181, blaCTX-M-15, blaOXA-1, blaSHV-26, blaTEM-1B), fluoroquinolone (aac(6’)-Ib-cr, oqx- AB, qnrS1), aminoglycoside (rmtB), macrolide (mphA), penicol

(catB3) and fosfomycin (fosA). The blaNDM-4 was located on an 86- kb conjugative IncFII plasmid, whereas the blaOXA-181 was located within a 51 kb IncX3 plasmid similar to previously reported in Korea. Conclusion: To our knowledge, this study is the first report of NDM-4 and OXA-181 in K. pneumoniae. Continuous monitoring of carbapenemase-producing Enterobacteriaceae is needed to prevent drug-resistant strains.

P1-GN12 Antibiotic resistance pattern of urinary Enterobacteriaceae isolates among premenopausal and postmenopausal women K D S T Abeywardana, S K Jayatilleke* Sri Jayewardenepura General Hospital (SJGH), Sri Lanka

Background: Selection of appropriate antibiotics is a necessity for proper management of UTI, while minimising the risk of Klebsiella pneumoniae isolated from postmenopausal inward resistance development. The aim of this study was to elicit the patients had resistance of >75% to cephalosporins, 40-60% to common uropathogens and the degree of antibiotic resistance to amoxycillin-clavulanic acid, gentamicin and norfloxacin while Enterobacteriaceae seen among adult females. resistance to amikacin was low (6.5%). Method: Urine isolates with colony count of > 105 cfu/ml Conclusion: >75% of urinary isolates of adult females were (n=375:Inpatient =306,Outpatient =69) derived from the urine Enterobacteriaceae. Isolates of post-menopausal women samples of adult females received at Microbiology laboratory, showed higher degree of antibiotic resistance. Nitrofurantoin SJGH from 01/01/2018 to 30/06/2019 were included in the study. for outpatients and amikacin for inward patients seems to be Results: Enterobacteriaceae were isolated from 85.5% of the out- effective. patients and 76.47% of the inward patients. The most common Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S105

P1-GN13 Background: P. aeruginosa continues to be a major pathogen in Carbapenem resistant Gram negative organisms in a Tertiary nosocomial pneumonia but there is currently limited published Care hospital in Sri Lanka data on susceptibility of these isolates from respiratory tract in K. Jayatilleke* Malaysia. This study reports the susceptibility of ceftolozane/ Sri Jayewardenepura General Hospital (SJGH), Sri Lanka tazobactam (C/T) and other antibiotics against P. aeruginosa isolates from respiratory tract samples from four major hospitals Background: Carbapenem resistance in gram negative organisms in Malaysia between 2017 to 2018. Since resistant P. aeruginosa (GNO) has become a common problem in Sri Lankan Hospitals. continues to be a worldwide threat and carbapenem-resistant Method: Data of meropenem (which was the commonly P. aeruginosa is listed as one of the 3 critical pathogens by WHO, tested carbapenem in the laboratory) resistant gram negative this study analysed the sensitivity of these antibiotics against organisms isolated from January 2018 to end of June 2019 in the meropenem-resistant strains and their molecular profiles. microbiology laboratory of Sri Jayewardenepura General Hospital Methods: A total of 191 isolates from the SMART study were was analysed using WHONET software. collected between 2017 to 2018 from respiratory tract samples Results: One thousand fifty five patients had carbapenem and analysed for susceptibility against a wide range of antibiotics resistant GNOs during this period. In 348 patients the isolate was (amikacin, cefepime, C/T, imipenem, meropenem, piperacillin/ a coliform but not identified to species level. tazobactam, ceftazidime, aztreonam, ciprofloxacin, levofloxacin Hundred and thirty-six isolates of Klebsiella pneumoniae from and colistin) followed by molecular profiling of resistant P. hundred and four patients were analysed. 88/104 patients were aeruginosa. over 45 years of age. Twenty three (23) patients had it positive in Results: Of all the antibiotics tested, the only three antibiotics that the blood culture of which 14 were from intensive care unit (ICU) showed sustained levels of susceptibility above 90% across both s, 4 were from the cardio thoracic unit and 2 from the renal unit. years were amikacin, C/T and colistin. Analysis of sensitivity of Two hundred and thirty one patients had meropenem resistant these antibiotics against meropenem-resistant strains exhibited Pseudomonas spp. Majority were in wounds. Only 38/231 patients highest susceptibility rates to amikacin, C/T and colistin at 87.5%, were from ICUs. 75.0% and 100.0% respectively as cumulated from both years. The Three hundred and forty four patients had Acinetobacter spp. Of resistant mechanism was assessed by determining the types of them 291 (84.6%) were over 45 years of age. Forty eight patients carbapenemase produced by these isolates. had it in blood of which more than half were in ICUs. Conclusion: C/T seems to be an appropriate choice of antibiotic Conclusion: Meropenem resistant coliforms , Acinetobacter spp for meropenem-resistant P. aeruginosa in pneumonia, and and Pseudomonas spp are common in this hospital. Most of the continuous national surveillance and local antibiogram collection patients were over 45 years of age. Klebsiella pneumoniae was are necessary to guide early appropriate empirical treatment for commonly isolated in blood and urine cultures while most of the serious infections like nosocomial pneumonia.

P1-GN15 Molecular analysis of genes coding for outer membrane protein 35(Omp35) and outer membrane protein 36 (Omp36) of 13 urinary isolates of carbapenem-resistant Klebsiella pneumoniae in Sri Lanka V Perera1, S Gamage1, S de Silva2, K Jayatilleke2*, E Corea1, N de Silva3 1Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo, 2Sri Jayewardenapura General Hospital, Nugegoda, 3 Neville Fernando Teaching Hospital, Malabe

Background: Studies have shown that two major porins, Omp35 Pseudomonas species were from the wound swabs. Acinetobacter and Omp36, and their mutations result in resistance or reduced species was commonly isolated from respiratory and wound susceptibility to carbapenems in Enterobacteriaceae that produce specimens. extended spectrum beta-lactamase (ESBL) or AmpC beta-lactamases (AmpC). Studies to evaluate these porins in carbapenem resistant organisms in Sri Lanka are limited. This study shows the P1-GN14 molecular analysis of the genes coding for Omp35 and Omp36 in In vitro susceptibility and molecular profiling of P. 13 clinically significant urinary isolates of Klebsiella pneumoniae aeruginosa from respiratory tract isolates against isolated in hospitals in Sri Lanka. ceftolozane/tazobactam in Malaysia – SMART 2017-2018 Methods: Thirteen urinary isolates of Klebsiella pneumoniae that N Umur1*, S Mustakim2, Y Khoo3, S Baharuddin4, A Mohmad5 showed reduced susceptibility for carbapenems were subjected 1Hospital Kuala Lumpur, Malaysia, 2Hospital Tengku Ampuan to PCR to detect beta- lactamase genes and genes coding for Rahimah Klang, Malaysia, 3MSD Malaysia, 4Hospital Melaka, Omp35 and Omp36 porins. The Omp35 and Omp36 genes Malaysia, 5Hospital Sultanah Aminah Johor Bahru, Malaysia were sequenced. Sequences were analyzed using the SeqMan S106 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

(Lasergene 6) software tool. Variation in any nucleotide was plus carbapenem versus colistin monotherapy taken into consideration only when it was observed in sequences HyeJin Shi1*, Jin Seo Lee2*, So Yeon Park2, Yousang-Ko2, in both directions. Sequences were submitted to BLAST for Hyeah Choi1, Joong-sik Eom1 determination of identities in the GenBank sequence database 1Division of Infectious Diseases, Gil Medical Center, Gachon of the National Center for Biotechnology Information (NCBI, University College of Medicine, Incheon, Republic of Korea, USA). Deduced protein sequences for Omps were aligned against 2Division of Infectious Diseases, Kangdong Sacred Heart Hospital, the reference sequences using ClustalW sequence alignment Hallym University School of Medicine, Seoul, Republic of Korea software. Phylogenic and molecular evolutionary analysis was conducted implementing the Tamura-Nei model using MEGA X Background: Colistin alone may not be sufficient for treating software. CRAB; there were efforts to increase treatment success rates. We Results: Of the 13 isolates, 9 carried genes coding for carbapene- compared the colistin plus carbapenem therapy versus colistin mase with a combination of genes coding for ESBL and AmpC : 4 monotherapy in treating pneumonia caused by CRAB and isolates (isolate 6,8,10&13) with blaTEM, blaSHV, blaCTX-M and attempted to identify specific populations that could benefit. blaNDM; 1 isolate with blaTEM, blaSHV, blaCTX-M, blaNDM and Methods: We retrospectively collected data on cases of CRAB blaIMP (isolate 9); 1 isolate with blaCTX-M and blaNDM (isolate pneumonia. The patients were divided into colistin plus 11); 1 isolate with blaCTX-M, blaDHA, blaACC, blaEBC and bla carbapenem therapy and colistin monotherapy groups. The NDM (isolate 12), 1 isolate with blaTEM, blaSHV, blaCTX-M and primary outcome was 14-day mortality. The secondary outcomes blaOXA-48 (isolate 3) and 1 isolate with blaTEM, blaSHV, and were in-hospital mortality, clinical improvement at days 2 and 14, blaOXA-48 (isolate 2).Four isolates carried combinations of ESBL and microbiological improvement at day 14. and AmpC genes but did not carry genes coding for carbapen- Results: Of 160 cases of pneumonia with sputum CRAB, 83 (52%) emases: 1 isolate with blaTEM ,blaSHV, blaCIT, blaDHA and and 77 (48.0%) were treated with carbapenem combination blaFOX (isolate 1), 1 with blaTEM and blaFOX (isolate 4), 1 with therapy and colistin monotherapy, respectively. 50 (63.3%) in the blaTEM and blaCTX-M (isolate 5) and 1 isolates with blaTEM, combination group and 27 (39.7%) in the monotherapy group had blaSHV and blaCTX-M (isolate 7).PCR results showed ampli- APACHE II scores >24 points (p=0.010). There was no significant con of the expected size (approximately 1.1 kb) in all isolates for difference in 14-day mortality between two groups (24.1% vs. Omp35 and Omp36. Insertional inactivation of the porin genes 20.8%, respectively, p=0.616). was not observed. However, a large number of variations were After adjusting for disease severity according to APACHE II score, observed in the deduced protein sequences in Omp36 when the 14-day mortality was significantly lower in the combination compared with the wild-type K. pneumoniae strain ATCC 13883 group than in the monotherapy group (9.1% vs. 53.8%, P=0.020) (accession number Z33506). These variations included additions, among patients with APACHE II scores of 25–29 points. deletions, and substitutions. The hot spot for Omp 36 variations Conclusions: Despite more severe conditions, colistin plus in isolates 6, 9, 10, 11 and 13 was the L4 region. In isolates 1, 2, 3, carbapenem combination therapy showed equivalent primary 4, 5, 7, 8 and 12 Omp 36 variation was observed in all extracellular mortality outcome in treating CRAB pneumonia compared with loops. A normal Omp35 sequence was observed in all isolates. colistin monotherapy. Combination therapy was more effective in The maximum likelihood phylogenetic tree of the isolates based patients with APACHE II score from 25 to 29 points. on Omp36 sequence similarities showed four major clusters. The largest cluster comprising 8 isolates (1, 6, 7, 9, 10, 11, 12 and 13) Table. Subgroup analysis of primary outcome (14-day mortality) was closely related to Klebsiella pneumoniae 17829 Omp36 porin by APACHE II score. (Genbank accession number GQ433374). Two isolates (4 and 5) APACHE II Score 14-day Group (N. of patients) P-value were closely related to K.pneumoniae (C3) ompK36 gene (Gen- (N. of patients) mortality (%) bank accession number Z33506), two isolates (3 and 8) with Kleb- 0-4 (1) Combination group (0) NA NA Monotherapy group (1) 0 (0%) siella pneumoniae strain WH307 OmpK36 porin gene (Genbank 5-9 (14) Combination group (8) 1(12.5%) 0.369 accession number: FJ577674) and one isolate with (2) Klebsiella Monotherapy group (6) 0 (0%) pneumoniae strain KP24/08 OmpK36 gene (Genbank accession 10-14 (25) Combination group (8) 0 (0%) 0.312 number: HM000042). Monotherapy group (17) 2 (11.8%) Conclusion: Mutations in Omp36 genes in Klebsiella pneumoniae 15-19 (30) Combination group (13) 5 (38.5%) 0.087 have been shown to cause major changes in porin function Monotherapy group (17) 2 (11.8%) 20-24 (41) Combination group (32) 10 (31.3%) 0.228 causing decreased susceptibility to carbapenem in isolates Monotherapy group (9) 1 (11.1%) producing ESBL and AmpC. The four isolates in the study 25-29 (24) Combination group (11) 1 (9.1%) 0.020 that did not harbor major genes coding for carbapenemases Monotherapy group (13) 7 (53.8%) showed a large number of variations in all the functional loops. 30-34 (11) Combination group (6) 3 (50.0%) 0.740 However functional studies needed to confirm the effects of these Monotherapy group (5) 3 (60.0%) variations. >34 (1) Combination group (1) 0 (0%) NA Monotherapy group (0) NA APACHE = Acute Physiologic Assessment and Chronic Health Evaluation; N. = number. P1-GN16 Effect of combination therapy for the treatment of carbapenem-resistant Acinetobacter baumannii pneumonia: colistin Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S107

P1-GN17 colistin resistance (mcr) genes (mcr-1 to mcr-8) were detected Fosfomycin resistance mechanisms in carbapenem-resistant by multiplex-PCR. The results showed that the prevalence of

Klebsiella pneumoniae isolated in Thailand colistin resistance in CRKP was 16%. The colistin MIC50 and 1,2* 3 Uthaibhorn Singkham-in , Netchanok Muhummudaree , MIC90 were 2 and 32 mg/L, respectively. The MIC50 and MIC90 Tanittha Chatsuwan1,2 of imipenem and meropenem were 64 and 128 mg/L and 128 1Department of Microbiology, Faculty of Medicine, Chulalongkorn and 256 mg/L, respectively. The CRKP isolates harbored at least 2 University, Bangkok, Thailand, Antimicrobial Resistance and one carbapenemase gene. The blaNDM-like plus blaOXA-48-like were the

Stewardship Research Unit, Chulalongkorn University, Bangkok, most common carbapenemase genes (64%), followed by blaNDM- 3 Thailand, Interdisciplinary Program of Medical Microbiology, like (18%), blaOXA-48-like (16%), and blaIMP-like (2%). The mcr-1 to mcr- Graduate School, Chulalongkorn University, Bangkok, Thailand 8 genes were not detected, suggesting that other mechanisms of resistance, especially chromosomal-mediated colistin resistance, The emergence of carbapenem-resistant Klebsiella pneumoniae must be involved in the resistance. This study showed high poses a major public health threat worldwide. The treatment prevalence of colistin resistance which were mediated by non- options are very limited. An old antibiotic, fosfomycin has mcr genes and the blaNDM-like plus blaOXA-48-like were the most become another option for treatment. The aims of this study prevalent carbapenemase genes in CRKP isolates. were to determine fosfomycin susceptibility and to characterize fosfomycin resistance mechanisms in carbapenem-resistant K. pneumoniae. Eighteen NDM-producing K. pneumoniae were P1-GN19 isolated from patients at King Chulalongkorn Memorial Hospital, Investigation on heteroresistance to colistin in Klebsiella Bangkok, Thailand during 2017-2018. The minimal inhibitory pneumoniae blood isolates concentrations (MICs) were determined by agar dilution Hae Suk Cheong1 , So Yeon Kim2, Kwan Soo Ko2, Kyong Ran Peck3 method. Mutations of MurA, GlpT, and UhpT were investigated 1Division of Infectious Disease, Department of Internal Medicine, by PCR and DNA sequencing. Among 18 NDM-producing K. Kangbuk Samsung Hospital; 2Department of Molecular Cell pneumoniae, 1 and 2 isolates were resistant (MIC≥256 mg/ Biology and Division of Infectious Disease, 3Department of Internal L) and intermediate resistant (MIC=128 mg/L) to fosfomycin, Medicine, Samsung Medical Center, Sungkyunkwan University respectively. All isolates carried fosA5 while 11 isolates carried School of Medicine fosA3. Although no difference of amino acid sequences of MurA, GlpT, and UhpT between fosfomycin-susceptible and fosfomycin- Background & Objectives: Klebsiella pneumoniae is emerging resistant strains was found, fosfomycin-resistant strain had as an important pathogen that causes severe and life-threatening higher fosA3 expression than fosfomycin-susceptible isolate. infections due to its rapidly increasing multidrug resistance, Our data suggests that fosfomycin resistance is associated with which has generated an interest in polymyxins such as colistin as fosA3 expression. Moreover, silence of fosA3 gene in fosfomycin- antibiotics of last resort. However, recent studies have reported susceptible K. pneumoniae was found indicating that fosfomycin several cases of heteroresistance to colistin. Heteroresistance may alone may inadequate for treatment of carbapenem-resistant K. thus be an obstacle to the effectiveness of colistin treatment in pneumoniae infection. patients. In this study, we investigated heteroresistance to colistin among K. pneumoniae blood isolates. Methods: In total, 252 K. pneumoniae blood isolates were P1-GN18 collected from Jan 2017 to Dec 2017. Heteroresistance to colistin High prevalence of colistin resistance in carbapenem- was determined using population analysis profiles (PAPs) and resistant Klebsiella pneumoniae isolates from Thailand colistin disk diffusion & E-test strips. Genomic sequencing N. Muhummudaree 1* , T. Chatsuwan2,3 was used to identify mutations associated with the emergence 1Medical Microbiology, Interdisciplinary Program, Graduate of colistin resistance in these K. pneumoniae blood isolates. School, Chulalongkorn University, Bangkok, Thailand,2 We also investigated the clinical data of patients with colistin Department of Microbiology, Faculty of Medicine, Chulalongkorn heteroresistant K. pneumoniae bacteremia. Time-kill kinetics University, 3Antimicrobial Resistance and Stewardship Research of colistin and/or meropenem against colistin-heteroresistant Unit, Faculty of Medicine, Chulalongkorn University isolates were also studied. Results: Of 252 K. pneumoniae blood isolates, 3 (1.2%) were Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been colistin-heteroresistant isolates. We found six heteroresistant increasingly reported worldwide. Colistin is considered a last- subpopulations from three heteroresistant isolates with colistin resort antibiotic for the treatment of CRKP infection. The aims of MICs ranging from 64 to 128 mg/L, which were derived from this study were to determine the prevalence of colistin resistance phenotypically colistin-susceptible clinical isolates. Three patients in CRKP and to investigate the plasmid-mediated colistin who were infected with colistin-heteroresistant isolates had no resistance and carbapenemase genes. Fifty CRKP clinical isolates history of previous colistin use within 3 months. Gene sequencing were isolated from patients at King Chulalongkorn Memorial related to colistin resistance showed the presence of mutations Hospital, Bangkok, Thailand, during 2016-2018. The minimal in pmrA, pmrB, phoP, and phoQ genes in colistin-heteroresistant inhibitory concentrations (MICs) were determined by agar subpopulations. In time-kill assays, meropenem alone and dilution method for carbapenems and by broth microdilution colistin combined with meropenem showed bactericidal activity method for colistin. The carbapenemase genes and mobilized at ≥ 1X the MIC in colistin-heteroresistant isolates. S108 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

Conclusions: At present, the rate of colistin heteroresistance in Collaborating Centre for Gonorrhoea and other STIs, Örebro K. pneumoniae blood isolates is not high. Multiple mutations University, Örebro, Sweden in genes coding for lipopolysaccharide modification have been observed in colistin-heteroresistant isolates. Mutation profiles Background: Zoliflodacin (topoisomerase II inhibitor) and were observed to be divergent. Monotherapy with colistin may solithromycin (first fluoroketolide) are new drugs which are in thus be problematic for the treatment of infections caused clinical development for treatment of uncomplicated gonorrhea. by colistin-heteroresistant K. pneumoniae and meropenem In this study, we determined the in vitro activity of zoliflodacin combined with colistin might be a therapeutic option for and solithromycin in gonococcal isolates from Republic of Korea. infections caused by these isolates. Methods: A total of 250 isolates of N. gonorrhoeae collected throughout Republic of Korea from 2016 to 2018 were tested to determine MIC of therapeutic antimicrobials using CLSI agar P1-GN20 dilution method. Emergence of azithromycin-resistant Neisseria gonorrhoeae Results: Most isolates (86.4%, 234/250) were non-susceptible to isolated in Korea penicillin G, tetracycline and ciprofloxacin, but all isolates were 1* 1 2 3 4 1 H. Lee , Y. H. Suh , E. Park , J. H. Shin , S-J Lee , K. Lee susceptible to ceftriaxone and spectinomycin. The MIC range 1Yonsei University College of Medicine, Seoul, Korea, 2Dr. Park’s for zoliflodacin and solithromycin were ≤0.015–0.12 mg/L and 3 Urologic Clinic, Busan, Korea, Inje University College of Medicine, ≤0.015–0.5 mg/L, respectively. MIC50 and MIC90 were 0.03 and 0.06 Busan, Korea, 4The Catholic University of Korea, Seoul, Korea mg/L for zoliflodacin and 0.06 and 0.12 mg/L for solithromycin. All isolates belonged to the wild-type MIC distribution for Background: The emergence of antimicrobial resistance in N. zoliflodacin and there were no cross-resistance between gonorrhoeae limit the spectrum of useful antimicrobial agents and zoliflodacin and ciprofloxacin (also a topoisomerase II inhibitor). combination of ceftriaxone and azithromycin is recommended to The azithromycin-resistant isolate with the highest MIC of prevent from occurrence of resistance. In this study, we aimed to azithromycin (32 mg/L) had the highest MIC of solithromycin (0.5 determine the azithromycin susceptibility against N. gonorrhoeae mg/L), illustrating cross-resistance between azithromycin and isolated in Korea solithromycin at higher MICs. Methods: A total of 374 isolates collected throughout South Korea Conclusion: Zoliflodacin and solithromycin showed potent during 2014 and 2018 were tested to determine azithromycin antimicrobial activity against contemporary multidrug- susceptibility using Clinical & Laboratory Standards Institute resistant N. gonorrhoeae isolates in Republic of Korea. However, (CLSI) agar dilution methods. For azithromycin-resistant isolates, the recently finished phase III clinical trial for solithromycin penA, mtrR and four 23S rRNA genes were sequenced to uncover identified relatively many treatment failures. Zoliflodacin remains the resistance mechanisms. NG-MAST and MLST were also more promising and a multi-continental phase III clinical trial performed to determine the molecular epidemiology. will be initiated in 2019. Results: The azithromycin resistance rates varied from 0% to 14% by years. However, the annual highest MIC values ranged from 0.5 to 1 mg/L, whereas one isolate showed azithromycin MIC P1-GN22 value of 32 mg/L isolated in 2018. The isolate was collected from Emergence of colistin resistance in carbapenem-resistant Busan city where have the largest port and second largest airport. Acinetobacter baumannii-calcoaceticus complex isolates The isolate was resistant to penicillin G, tetracycline, ciprofloxacin from Thailand but susceptible to ceftriaxone and spectinomycin. In sequencing S. Srisakul1, T. Chatsuwan2 analysis, penA-109.001 with A502V alteration and -35A deletion 1Interdisciplinary Program of Medical Microbiology, Graduate in mtrR gene were found. In 23S rRNA gene sequencing, C2611T School, Chulalongkorn University, Thailand,2 Antimicrobial mutation was noted in all four sites. The isolate belonged to Resistance and Stewardship Research Unit, Department of ST1600 (126-39-67-78-148-153-65) by MLST and novel ST Microbiology, Faculty of Medicine, Chulalongkorn University, (por4380 and tbpB831) by NG-MAST. Thailand Conclusion: High-level azithromycin resistance emerged in N. gonorrhoeae isolated from Korea and possibility of subsequent Increasing of carbapenem-resistance in Acinetobacter bauman- emergence due to increasing selective pressure can require nii-calcoaceticus (Abc) complex has been a serious threat for further continuous surveillance for azithromycin resistance in N. public health. Colistin is a drug of last resort for treatment against gonorrhoeae. carbapenem-resistant Abc complex. However, colistin-resistant Abc complex isolates are rapidly emerging after re-beginning of colistin therapy. This study aimed to determine the prevalence of P1-GN21 colistin resistance in carbapenem-resistant Abc complex and to In Vitro Susceptibility of Zoliflodacin and Solithromycin in investigate the plasmid-mediated colistin resistance and carbap- Neisseria gonorrhoeae Isolated in Republic of Korea from enem resistance genes. A total of 106 carbapenem-resistant Abc 2016 to 2018 complex isolates from King Chulalongkorn Memorial Hospital, L. N. Dinh1, H. Lee1, Y. H. Suh1, S-J. Lee2, M. Unemo3, K. Lee1 collected from January to April, 2016 and October, 2017, were 1Yonsei University College of Medicine, Seoul, Korea, 2The Catholic included in this study. Two genospecies of Abc complex, identi- University of Korea, Seoul, Korea, 3World Health Organization fied by gyrB multiplex PCR were A. baumannii (102, 96.2%) and Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S109

A. pittii (4, 3.7%). The colistin susceptibility was performed by 1Medical Microbiology, Interdisciplinary Program, Graduate broth microdilution. The result showed that the MIC50 and MIC90 School, Chulalongkorn University, Bangkok, Thailand, of colistin against carbapenem-resistant Abc isolates were 2 and 2Antimicrobial Resistance and Stewardship Research Unit, 4 mg/L, respectively. Fifteen isolates (14.2%) were resistant to Department of Microbiology, Faculty of Medicine, Chulalongkorn colistin (MIC range = 4 to 16 mg/L). All of colistin-resistant iso- University lates were A. baumannii. The carbapenem resistance was mostly result due to expression of blaOXA-23-like (88.7%), followed by blaNDM- Emergence of multidrug-resistance in Acinetobacter bauman- like (2.8%) and, blaKPC-like (0.9%). The mcr-1 to mcr-7 genes were not nii and Klebsiella pneumoniae has been increasingly reported detected in all isolates. This study showed the high prevalence of worldwide. The aims of this study were to investigate cepha- colistin resistance in carbapenem-resistant Abc complex. The mcr losporin, carbapenem, colistin susceptibility and characterize gene was not detected in all isolates, suggesting that other mecha- extended-spectrum beta-lactamases (ESBL), carbapenemase nisms must be involved in the resistance. and plasmid-mediated colistin resistance(mcr) resistance genes. Twenty-three A. baumannii and twenty K. pneumoniae isolates from King Chulalongkorn Memorial Hospital were included in P1-GN23 this study. The minimal inhibitory concentrations (MICs) were Characteristics of antibiotics-exposed Pseudomonas determined by agar dilution method for cephalosporins and car- aeruginosa bapenems and broth microdilution method for colistin. The ESBL T.Q. Huynh, M.T. Bui, V.B.T Le, T.N.M.Q. Le, N.H.B Nguyen, genes, carbapenamase genes and mcr genes were detected by T.T.L. Trinh, T.T.H. Nguyen multiplex PCR. The results showed that the prevalence of ceph- School of Biotechnology, International University, Vietnam alosporin resistance in A. baumannii and K. pneumoniae were National University of HCMC, Vietnam 86.95% and 100%, respectively with MIC range 8 to >256 mg/L. The prevalence of carbapenem resistance in MDR A. baumannii Pseudomonas aeruginosa has been reported to have great and K. pneumoniae were 82.60% and 80%, respectively. The prev- ability to develop or acquire resistance to multiple classes of alence of colistin resistance in MDR A. baummannii and K. pneu- antimicrobials. In this work, we studied how antibiotic resistance moniae were 17.40% and 35%, respectively. The blaCTX + blaSHV + and cross-resistance developed when P. aeruginosa ATCC blaTEM were the most common ESBL genes (70%) in K. pneumo-

9027 was exposed to sub-MIC values of 6 common antibiotics niae. The blaOXA-23 were predominant in A. baumannii (78.26%) including gentamycin (Ge), piperacillin/tazobactam (Pt), colistin and blaNDM + blaOXA-48 in K. pneumoniae (65%). The mcr-1 to mcr- (Col), meropenem (Me), ciprofloxacin (Ci), and ceftazidime (Cz). 8 genes were not detected in all of isolates, suggesting that other Revertant strains were collected after 10 days of culturing the mechanisms of resistance play a role in the colistin resistance. resistant strains in antibiotic-free environment. After antibiotic This study showed that blaCTX, blaSH V, blaTEM, blaOXA-23, blaNDM and exposure, P. aeruginosa developed resistance to all exposed blaOXA-48 were associated with multidrug resistance in A. bauman- antibiotics with the MICs increased by 64 (ciprofloxacin exposure, nii and K. pneumoniae isolates. from 0.5 to 32 µg/ml) to 1024 times (ceftazidime exposure, from 4 to 2048 µg/ml). Besides, while Ge-exposed strain was still susceptible to tested antibiotics, other antibiotics-exposed ones P1-GN25 cross resisted to some of them, particularly to the antibiotics Epidemiology on Carbapenem Resistant Enterobacteriaceae of the same family with the exposed ones. Col-exposed strain isolated from Korean children: A retrospective single center showed strong cross-resistance to Me, Cz, Tb and Cm, but study became more susceptible to Im and Pt. After 10 days in antibiotic- YS. Yoon1*, JS. Choi1, HJ. Huh2, NY. Lee2, YJ. Kim1 free environment, Ge-, Col- and Me- exposed strains turned less 1Department of Pediatrics, Sungkyunkwan University School resistance to the exposed antibiotics with MICs decreased by 2 to of Medicine Samsung Medical Center, Republic of Korea, 8 times while Ci-, Cz- and Pt- exposed ones remained. However, 2Department of Laboratory medicine & Genetics, Sungkyunkwan Cz-revertant strain became unexpectedly more resistant to Ci, Im University School of Medicine Samsung Medical Center and Me. In addition, there was noticeable change in morphology during antibiotic exposure with remarkable decrease in cell size Background: The prevalence of carbapenem resistant Enterobac- and alteration in pigment production. Total protease activity of P. teriaceae (CRE) infection is increasing in the world. However, few aeruginosa was also markedly increased through exposure with studies have addressed the epidemiology in children, especially antibiotics. In summary, sub-MICs exposure of P. aeruginosa to in Asia. antibiotics caused significant changes in morphology, virulence Method: This is a single center, retrospective study. From May and antibiotic susceptibility of the pathogen. 2018 to April 2019, patients ≤18 years old with CRE positive specimens were studied. Results: During the study period, 7,177 children were P1-GN24 hospitalized 10,564 times. A total of 106 cultures from 56 children Characterization of cephalosporin, carbapenem, and colistin were identified as CRE (0.78%, 56/7,177 patients). Thirty-four resistance in Acinetobacter baumannii and Klebsiella children (60.7%) were male and median age was 1.7 years (0-17.8 pneumoniae isolates from Thailand years). Among these, 54 (96.4%) patients had chronic underlying A. Klinkajorn*,1, T. Chatsuwan2 diseases and 15 patients (26.8%) had immunocompromised S110 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

condition; hemato-oncologic disease (N=7, 12.5%), organ P1-GN27 transplant (N=6, 10.7%), primary immunodeficiency (N=1, 1.8%) Characterization of carbapenem resistance genes in mul- and inflammatory bowel disease (N=1, 1.8%). The frequency of tidrug-resistant Enterobacteriaceae isolates from Thai pa- isolated CRE is in following order; Enterobacter cloacae complex tients (N=38, 35.8%), Klebsella species (N=26, 24.5%), Proteus species N. Kueakulpattana1*, T. Chatsuwan1,2 (N=21, 19.8%), E.coli (N=13, 12.3%), Morganella morganiis (N=5, 1Antimicrobial Resistance and Stewardship Research Unit, Faculty 4.7%), Citrobacter freundii (N=2, 1.9%), and Serratia marcescens of Medicine, Chulalongkorn University, Bangkok, Thailand, (N=1, 0.9%). CRE were most commonly isolated from urine (N= 2Department of Microbiology, Faculty of Medicine, Chulalongkorn 44, 41.5%), followed by respiratory specimen (N=22, 20.8%) University, Bangkok, Thailand and skin swabs (N=22, 20.8%). CRE positive blood (N=2, 1.9%) and CSF (N=1, 0.9%) culture were also observed. Fourteen Carbapenem resistance in Enterobacteriaceae has been CRE isolates (13.2%) were from other specimens (4 wound, increasingly reported worldwide. The objective of this study was 4 pus, 3 pleural/peritoneal fluid, 3 rectal swab). Eight (7.5%) to characterize carbapenemase-encoding genes in multidrug- Carbapenemase producing Enterobacteriaceae were confirmed resistant Enterobacteriaceae. A total of 113 multidrug-resistant in 3 patients; six KPC-2, one OXA-48, and one OXA-181. In 11 Enterobacteriaceae isolated from Thai patients in King patients, CRE was detected in multiple days and the median Chulalongkorn Memorial Hospital during 2016-2017 were value CRE positive duration was 66 days (3-138 days). The 30day included in this study. The susceptibility of antimicrobial agents mortality rate was 1.8% (1/56). was performed by disk diffusion method. Carbapenemase genes

Conclusions: Carbapenem resistance in pediatric patients is an including blaOXA-48, blaNDM, blaIMP, blaVIM, blaGIM, blaSIM, blaSPM, and important problem that needs urgent attention and proactive blaKPC were detected by PCR and DNA sequencing. Resistance measurements. Effective antibiotic stewardship reinforcement rates of eratapenem, imipenem, meropenem, and doripenem program, comprehensive infection control, and antibiotic were 86.72%, 86.72%, 83.17%, and 83.17%, respectively. resistance surveillance and monitoring are continuously needed. Carbapenemase-producing Enterobacteriaceae isolates were found in 78.76%. The most common carbapenemases were the coproduction of OXA-48+NDM (56.18%), followed by OXA-48 P1-GN26 (26.97%), NDM (15.73%), and IMP (1.12%). Sequencing analysis

Relationship between efflux pump genes and antibiotics in of 29 representative isolates showed that the blaOXA-232+blaNDM-1 multidrug-resistant Acinetobacter baumannii (37.93%) was the most common carbapenemase genes, followed * YJ Kim , HG Jeong, KS Lee, GE Choi by blaOXA-232 (17.24%), blaNDM-1 (17.24%), blaOXA-181 (13.79%), blaOXA-48

Department of Clinical Laboratory Science, College of Health (6.90%), blaIMP-14a (3.45%), and blaOXA-181+blaNDM-5 (3.45%). Of the

Sciences, Catholic University of Pusan, Busan 46252, Korea 12 blaOXA-48-like+blaNDM-like, 11 (91.67%) were blaOXA-232+blaNDM-1.

The results suggest that isolates carrying blaOXA-232+blaNDM-1 may Multidrug-resistant strain of Acinetobacter baumannii(MDRAB) be the clonal spread of the carbapenemase-producing strains. has become a serious problem in nosocomial infection. And Antimicrobial resistance surveillance and rapid diagnosis are MDRAB has relevance to overexpression of the efflux pumps that important to limit the emergence and spread of multidrug- play a major role in drug removal mechanisms. In this study, we resistant Enterobacteriaceae. demonstrate the correlation between gene expression of selected efflux pumps, including adeB, adeJ, macB, abeM, abeS, emrA, emrB, and craA, in clinical isolates of MDRAB and antibiotics by P1-GN28 quantitative reverse transcription-polymerase chain reaction. Clinical manifestation of Ralstonia mannitolilytica infection In the present study, a total of thirty-five MDRAB strains were in pediatric patients isolated and collected from Pusan National University Yangsan Reenar Yoo, Hyejin So, Jina Lee Hospital(PNUYH) from November 4, 2011 to July 11, 2018. To Department of Pediatrics, Asan Medical Center, University of reveal the relationship between efflux pump genes and their Ulsan college of Medicine, Seoul, Republic of Korea. expression, antibiotic category was divided into two groups according to each of MIC values. In all of the studied 35 MDRAB Introduction: Ralstonia mannitolilytica has been occasionally strains, the strains with resistant to imipenem had more gene associated with healthcare associated infection especially in expression of adeB and macB (p < 0.05) than the susceptible immunocompromised patients. Since August of 2018, increased strains, whereas statistically significantly increased expression of detection of R. mannitolilytica has been observed at our institute. the adeJ, emrA and emrB gene was observed in the imipenem- Herein we aimed to analyze the cluster of cases and clinical resistant strains (p < 0.005). In amikacin resistant isolates, adeB, manifestation of R. mannitolilytica in children. adeJ, macB, abeM, abeS, emrA, and emrB gene expression Methods: Pediatric patients with positive culture for R. increased compared with that of the susceptible strains (p < 0.05). mannitolilytica from June 2016 to June 2019 were included in In tigecycline resistant isolates, the increased relative expression the descriptive study. We abstracted demographic data, clinical of adeB, adeJ, macB, emrA and emrB genes was observed (p < findings including diagnosis and outcomes, and antibiotics 0.05). Thus, our study suggested that these selected efflux genes susceptibility results and given from electrical medical records might be new therapeutic targets for MDRAB. retrospectively. Results: During the study period, total 14 cases of R. mannitolilyt- Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S111

ica infections were observed. Median age was 9.1 years (range, P1-GN30 0–20.7 years) and 92.9% patients had underlying disease. Median Characteristics and Risk of Persistency of Carbapenem- hospital stay before the onset of R. mannitolilytica infections was Resistant Enterobacteriaceae 76 days (range, 9–223 days). 92.9% of the patients were diagnosed Soyoon Hwang, Yoon jung Kim, So hyun Bae, Ki Tae Kwon, as pneumonia and 53.8% of them had combined bacteremia; Hyun Ha Chang, Shin-Woo Kim 30-day mortality was 64.3%. Within 14 days before the onset of Department of Internal Medicine, School of Medicine, Kyungpook R. mannitolilytica infection, 85.7%, 78.6%, and 57.1% of patients National University, Daegu, Republic of Korea were managed with carbapenem, mechanical ventilator, and nebulizer therapy, respectively. A cluster of 8 cases was occurred Background: Carbapenmase-resistant Enterobacteriaceae (CRE) from August 2018 to January 2019, and the remaining cases is bacterial strain resistant to carbapenem, which is considered dispersed from June 2016 through December 2017; most of the to be the last antibiotic to drug-resistant gram-negative bacterial strains showed similar antibiotic susceptibility patterns including infection. Globally, CRE infections have increased significantly meropenem resistance. due to aging, increased care in the long-term care facilities, and Conclusion: Although the source of R. mannitolilytica and the increased use of antibiotics. We aimed to investigate the risk mechanisms of multiple resistance were not identified, a cluster of factors of persistency of CRE and time to negative conversion of R. mannitolilytica infections in children with underlying diseases CRE. were significant morbidity and mortality. Clinician should be Methods: A retrospective study was conducted. We reviewed aware about the emerging pathogen in high risk patients. all adults (above 18 years old) admitted to Kyungpook National University Hospital from February 2014 to December 2018 who were identified as CRE carriers by either rectal swabs or clinical P1-GN29 cultures. First report of the key mutations conferring reduced Results: Of the 80 eligible patients, 36 patients (45%) carried susceptibility to ceftriaxone in Neisseria gonorrhoeae Thai carbapenemase-producing carbapenem-resistant Enterobacte- isolates riaceae (CP-CRE). Fourteen were positive for both NDM 5 and N. Kueakulpattana1, 3, N. Teeratakulpisarn2, T. Chatsuwan1* OXA 181 (combined). Two were positive for NDM (1; NDM-1, 1Antimicrobial Resistance and Stewardship Research Unit, 1; NDM-5), 2 were positive for KPC (1; KPC-2, 1; KPC-3), and 2 Department of Microbiology, Faculty of Medicine, Chulalongkorn were positive for OXA-181. Twenty four patients (30%) experi- University, Bangkok, Thailand, 2HIV-NAT, Thai Red Cross AIDS enced decolonization during hospitalization (confirmed CRE Research Centre, Bangkok, Thailand, 3Medical Microbiology, negative culture three times consecutively) and 56 patients (70%) Interdisciplinary Program, Graduate School, Chulalongkorn had remained CRE culture positive during the follow-up period. University, Bangkok, Thailand The factor found to significantly affect the culture negativity was the presence of CPE with Cox proportional hazard model anal- The global development of multidrug resistance of N. gonor- ysis (aOR 3.259, p=0.0004). Kaplan-Meier with log rank test also rhoeae is a serious problem for the gonorrhea treatment. The showed that the CP-CRE is significantly positive for persistency objectives of this study were to investigate the prevalence and the (p=0.0001). Age, length of hospital stay and presence of under- mechanisms of ceftriaxone resistance in N. gonorrhoeae Thai iso- lying diseases were not significant factors in the persistency of lates. Antimicrobial susceptibility testing was performed on a total CRE. Among the 56 patients who remained culture positive, 33 of 137 clinical isolates of N. gonorrhoeae obtained from Anon- patients (58.9%) carried CP-CRE. The figure is a graph of time to ymous clinic at Thai Red Cross AIDS Research Centre and King negative culture. 61.0% remained CRE culture positive at 4 weeks, Chulalongkorn Memorial Hospital, Bangkok, Thailand, during and 36.0% still remained at 8 weeks. The median time to the CRE 2016-2018. Mutations associated with ceftriaxone resistance were culture negativity was 38 days. determined by PCR and DNA sequencing. A high prevalence of Conclusion: CRE negative conversion is less than persistency multidrug resistance (82.84%) was found among the isolates. Ci- during 4 weeks. CRE persisted for a long period (4 weeks; 61%, profloxacin (90.30%), tetracycline (82.09%), penicillin G (73.13%), 8 weeks; 36%). The factor affecting the persistence of CRE is and gentamicin (59.70%) displayed high resistance rates, but presence of CPE genes. reduced susceptibility to ceftriaxone was observed in 2 (1.49%) isolates. Mutations in penA, mtrR promoter, mtrR, and porB genes were associated with reduced susceptibility to ceftriaxone. Both isolates had mosaic PBP2 pattern XXXIV, L421P substitution in PBP1, an adenine deletion in the 13-bp inverted repeat sequence of the mtrR promoter region, a H105Y substitution in the MtrR repressor, G120K and A121N substitutions in PorB porin. To our knowledge, this is the first report to describe the key mutations conferring reduced susceptibility to ceftriaxone in N. gonorrhoeae isolates from Thailand. The isolates reported here may indicate the potential emergence of ceftriaxone-resistant N. gonorrhoeae in Thailand. Figure. Overall Survival (persistency) of CRE S112 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-GN31 Enterobacter cloacae isolates were analysed. An in vitro synergistic effect of α-terpineol-based combina- Results: Of 107 Enterobacter isolates (including 72 E. cloacae, 22 E. tions against multidrug resistant Acinetobacter baumannii aerogenes, 11 E. asburiae and two E. gergoviae) subjected to PFGE clinical isolates analysis, 80 pulsotypes were identified. There was no association C. Kim1, S. Jang2*, S. Lee2, S. Jeong3, Y. Ko2, S. Kang2, G. Park2 between pulsotypes with Enterobacter species or specimen 1Premedical Science, 2Department of Laboratory Medicine, Chosun type. Sequence variations are detected in the ampD (E4K, P62S, University College of Medicine, Gwangju, Korea, 3Department of F63Y, H69N, E131Q, I141V and R143L) and ampR (T106I, E114D, Laboratory Medicine, Yonsei University College of Medicine, Seoul, G149S, A175T, S179C, P208S, I259V, and E274K) gene regions Korea of 13 AmpC-producing E. cloacae isolates, when compared to a wild type E. cloacae strain. However, except for F63Y and I259V, Background: To seek effective candidates for combination none of the sequence variations detected have been previously regimen for eradication of multidrug resistant (MDR) A. associated with AmpC production. baumannii, we evaluated the synergistic activity of α-terpineol- Conclusion: Enterobacter spp. are highly heterogeneous regard- based combinations for antibacterial activity against MDR A. less of species or source of isolation. Other resistant mechanisms baumannii clinical isolates. may be associated with AmpC production in E. cloacae iso- Methods: Multiple-combination bactericidal test (MCBT) was lates. Surveillance and infection control measures are essential to conducted with each combination of α-terpineol with 10 com- limit the spread of these organisms in the hospital. mercially available antimicrobials to screen potential synergistic effects. Time-kill assay were performed for testing antimicrobial synergy on α-terpineol-colistin and α-terpineol-rifampicin com- P1-GN33 binations against 38 clinical isolates of A. baumannii, including 5 Multi-Drug Resistant Gram Negative Infection in Pediatric pan drug-resistant (PDR), 15 extensively drug-resistant (XDR), 14 Ward of a Tertiary Hospital in Indonesia MDR, and 3 susceptible strains. D Puspitasari1*, D Husada1, L Kartina1, PS Basuki1, I Moedjito1, Results: With MCBT, the most effective bactericidal activity was IW Putra1, Kuntaman2 observed in each α-terpineol-based combination with tigecycline, 1Department of Child Health, Faculty of Medicine, Dr.Soetomo rifampicin, doxycycline and ciprofloxacin, respectively. We Hospital/ Universitas Airlangga,Surabaya-Indonesia, used two combination of α-terpineol-colistin and α-terpineol- 2Department of Clinical Microbiology, Faculty of Medicine, rifampicin for time-kill studies. Each α-terpineol-colistin and Dr.Soetomo Hospital/ Universitas Airlangga, Surabaya-Indonesia α-terpineol-rifampicin combination showed same 81.6% (31/38) of synergy rate, 84.2% (32/38) of bactericidal activity, Background: Bloodstream infection with Gram-negative bacteria and no antagonistic effect in 38 clinical isolates of A. baumannii, (GNB) represent a leading cause of serious bacteremia. Antibiotic respectively. Indifference was observed for both combinations options have been compromised by the rapid emergence of multi against 5 PDR A. baumannii strains. drug resistance (MDR) bacteria. Knowing the prevalence of MDR Conclusions: The α-terpineol-based combinations showed high GNB and its antibiotic sensitivity patterns will help clinician synergy rate, and bactericidality against MDR A. baumannii. deciding empiric treatment option available for treatment. These results indicate that each α-terpineol-colistin and Methods: This was a retrospective study of children 1 months α-terpineol-rifampicin combination may confer effective to 18 years hospitalized in pediatric ward of Soetomo Hospital, therapeutic benefits in the treatment of A. baumannii infection. Surabaya, Indonesia during January 2017 until December 2018. Data of antibiotics sensitivity were collected from positive blood culture with GNB. MDR GNB was categorized if the organism P1-GN32 resistant to at least 3 antibiotics. Genetic diversity and ampD/ampR sequence analysis Results: There were 500 culture positive isolates collected from of Malaysian clinical isolates of Enterobacter spp. pediatric ward during the study period, among them 227 (45.4%) F. I. Mohd Khari, R. Karunakaran, S.T. Tay* were due to gram negative bacteria. MDR GNB bacteremia were Department of Medical Microbiology, Faculty of Medicine, found in 186/227 (82%) isolates. The most common MDR GNB University of Malaya, Kuala Lumpur, Malaysia was Klebsiella pneumonia 66/186 (35.5%) isolates, followed by Salmonella species 25/186 (13.4%), Acinetobacter baumanii Background: Enterobacter spp. are nosocomial pathogens 22/186 (11.2%), and Pseudomonas aeruginosa 20/186 (10.8%) frequently associated with cephalosporin resistance due to the isolates. The MDR GNB were sensitive against meropenem 77.6%, production of inducible AmpC β-lactamase (AmpC). Limited fosfomycin 70.2%, amikacin 66.3%, cefoperazone-sulbactam information is available on the genetic diversity of Malaysian 61.1%, chloramphenicol 39.5%, and gentamycin 25.6%. Sensitivity Enterobacter clinical isolates. Some mutations in ampD and were very low toward ampicillin (3.8%), and ceftriaxone (4.8%). ampR gene regions have been associated with overexpression of Conclusion: Multi-drug resistant bacteria were common among AmpC production. GNB bacteremia in pediatric ward Soetomo Hospital, Indonesia. Methods: This study examined the genetic diversity of Meropenem, fosfomycin, amikacin and cefoperazon-sulbactam Enterobacter clinical isolates obtained from blood cultures and can be chosen as empiric treatment if MDR GNB bacteremia is non-sterile specimens using pulsed-field gel electrophoresis suspected. (PFGE). Sequence variation in the ampD/ampR gene regions of Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S113

P1-GN34 Phylogenetic analysis was constructed by MEGA X. Controlling Emergence of Bacterial Resistance Risk by Results: All strains have high-level resistant to CIP (MICs > 16mg/ Appropriate Antibiotic Implementation At Teaching Hospital L), nine were resistant both CIP and TET, and one is multi-drug D. Latupeirissa*, P. Andayani, A. Dharmayanti, IY. Mauleti, resistant to CIP, TET and GEN. The analysis of draft genomes for MN. Oktovina these isolates indicated that their genome sizes were estimated Fatmawati General Hospital, Jakarta, Indonesia between 1.62 and 1.86 Mb. The mean coverage depth varied from 67 to 290 times, and the overall GC content was about 30.5%. The Introduction: The use of antibiotics for threating infectious genetic relationships of resistance determinants (gyaA, tetO, aph diseases is expected to have a positive impact, but irrational and cmeABC families) analyzed with respectively annotated gene use can have a negative impact, including the emergence and similar to 7 reference strains from NCBI. The phylogenetic tree development of antimicrobial resistance bacterial. The quality showed that they exhibited high correlation between resistance indicator on the Antimicrobial Resistance Control Program genotypes. (ARCP), is to monitor and evaluate the use of antibiotics, Conclusion: Our data suggest that the WGS analysis is a powerful qualitatively and quantitatively. tool to identify resistance factors for Campylobacter and can Methods. Retrospective data of antibiotics use at ICU, Fatmawati identify resistance-related genetic elements, including antibiotics General Hospital were obtained from January to March 2019 and not routinely tested in antimicrobial susceptibility testing. were reported the quantity evaluation by using the Defined Daily Dose (DDD) method. Results: The highest average use of antibiotics during January - P1-GN36 March 2019 at ICU of Fatmawati General Hospital was ceftriaxone Anitmicobial resistance of the Salmonella spp. In the Repub- injection which was 55.62 DDD (100 patients-days) rather than lic of Korea, 2009-2018 meropenem injection as one of third-line antibiotics with an H J Jeong, A K Park, J Park, E Shin, S Kim, J-H Chun, K J Hwang, average value of 31.51 DDD (100 patients - days). J Kim Discussion: Evaluation of quantitative antibiotic use with DDD Division of Bacterial Diseases, Center for Laboratory Control analysis method is one indicator of the antibiotic resistance of Infectious Diseases, Korea Centers for Diseases Control and control program in hospitals. The use of meropenem during Prevention, Chungcheongbuk-do, Republic of Korea January - March 2019 has decreased compared to the results from September to December 2018 which has a value of 55.0 DDD Background: Salmonella spp. are one of the most common (100 patients-days). After ARCP implementation, prescribing causes of foodborne diseases in Korea. To summarize serotypes antibiotics among clinician was more selective, indicate rational and antimicrobial resistance characteristics of human infections, use of antibiotics has increased. we analyzed data for 2009–2018 from Korea National Surveillance Conclusion: The use of third-line antibiotics is carried out with Systems (KNSS). the recommendation of ARCP so that monitoring of antibiotic use Methods: We reviewed serotypes and antimicrobial resistance can be more closely monitored. trends for 7,622 Salmonella spp. isolates submitted to KNSS at the KCDC. Antimicrobial susceptibility tests were performed using broth microdilution by Sensititre panel. P1-GN35 Results: A total of 7,622 Salmonella spp. isolates, representing Whole genome characterization of high-level ciprofloxacin- >282 serotype, obtained from human infections, during 2009 to resistant Campylobacter jejuni isolates in the Republic of 2018 were included in this study. The most common serotype Korea was S. Enteritidis, S. Typhimurium, S. I.4.[5],12:i:-, S. Infantis E Shin*, A K park, J Park, S Kim, H J Jeong, J-H chun, K J Hwang, and Bareilly. A total of 7,622 Salmonella spp. were resistant to J Kim at least one antimicrobial agent and 2,439(30.2%) isolates were Division of Bacterial Diseases, Centers for Laboratory control MDR, 327(4.3%) isolates showing resistant to five or more class of Infectious Diseases, Korea Centers for Diseases Control and of antimicrobial agents. The frequency of varied by serotype: S. Prevention, Cheongju-si, Republic of Korea Enteritidis, S. Typhimurium, and S. I.4.[5],12:i:- often exhibited resistance to more agents than other serotypes. There are Background: Campylobacter jejuni is one of the major causative significant increase in resistance of cefotaxime which were pathogens of diarrheal diseases worldwide. In recent years, global most common in S. I.4.[5],12:i:-(11.0%), and S. Kentucky(76%) attention has risen to the increase of emerging antimicrobial exhibited very highly resistance to ciprofloxacin. resistant C. jejuni. It has been known that the number of C. jejuni Conclusion: These data reveal that a higher rate of isolates were isolates displayed high antibiotic resistance such as ciprofloxacin resistant to antimicrobial agents in 2018 than during 2009-2018. in Korea. National surveillance studies are necessary to prevent and control the infection of multi-drug resistant strains. Methods: Based on representative smaI-PFGE patterns and their antimicrobial resistance profile, 15 C. jejuni were subjected to whole-genome sequencing (WGS). The analysis of resistance genes in Campylobacter were performed in the annotated genome and analyzed using RAST server and BLAST program. S114 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-GN37 were examined. Whole genome characterization of ESBL producing Salmo- Results: After exposure to low concentrations of colistin nella I 4,[5],12:i:- between 2009 and 2018 in the Republic of (less than 0.25 or 0.5 mg/L), the rates of colistin-resistant Korea subpopulations were similar (about 10-6) between colistin- J Park, H J Jung, A K Park, E Shin, S Kim, J-H Chun, K J Hwang, susceptible and colistin-heteroresistant isolates. After exposure J Kim to high concentrations of colistin (more than 1 or 2 mg/L), most Division of Bacterial Diseases, Center for Laboratory Control of surviving colonies were resistant subpopulation in colistin- of Infectious Diseases, Korea Centers for Diseases Control and heteroresistant isolates, but colistin-susceptible isolates were Prevention, Chungcheongbuk-do, Republic of Korea killed or no resistant populations were not observed. Amino acid substitutions were identified in PmrCAB and/or LpxACD of Background: Non-typhoidal Salmonella (NTS) is the leading colistin-resistant subpopulations survived at agar with 4 mg/L cause of foodborne illnesses which can cause gastroenteritis in colistin. humans. However, NTS strains that are resistant to cephalosporins Conclusion: When colistin is treated at low concentrations, the have been growing concerns in many countries. Among NTS resistant population is likely to survive in both colistin-susceptible isolates, the rate of S. I 4,[5],12:i:- isolates is a growing trend in and colistin-heteroresistant A. baumannii isolates. Although the past decade. In this study, we described to characterize ESBL colistin-susceptible A. baumannii isolates could be removed with producing S. I 4,[5],12:i:- isolates from diarrheal patients in Korea. the concentrations of more than MIC, colistin-heteroresistant Methods: As a part of the national surveillance system, we col- A. baumannii isolates could not be eradicated and resistant lected clinical samples of S. I 4,[5],12:i:- from humans with diar- populations may result in prospering. rhea. The antimicrobial susceptibilities were determined using the customized Sensititre panel and whole-genome sequencing of cefotaxime (CTX)-resistant isolates were performed for further P1-GN39 characterization. Association between Tigecycline Resistance and Hypermu- Results: A total of 32 CTX-resistant S. I 4,[5],12:i:- isolates were coviscosity in Clinical Klebsiella pneumonaie Sequence Type isolated during study period. The incidence of CTX-resistant S. 23 Isolates I 4,[5],12:i:- has been increased since 2016. The most prevalent Suyeon Park, Haejeong Lee, Kwan Soo Ko ESBL type was CTX-M-55 followed by CTX-M-65, CTX-M-14, Department of Molecular Cell Biology, Sungkyunkwan University

CTX-M-27 and CTX-M-15. The analysis of genetic structure of School of Medicine, Suwon 16419, Republic of Korea surrounding environment of blaCTX-M revealed that 9 of 32 isolates consisted of ISEcp1-blaCTX-M-orf477. This organization is frequently Background: With the application of tigecycline for multidrug- observed in plasmid harboring blaCTX-M worldwide. resistant Klebsiella pneumoniae, tigecycline-resistant (TIG-R) Conclusion: Since the CTX-M-55 producing Salmonella isolates K. pneumoniae isolates have recently reported. In this study, we has been first isolated in 2011 in USA and China, CTX-M-55 investigated the association between tigecycline resistance and producing Salmonella have been identified from a number of hypermucoviscosity (HV) using hypervirulent K. pneumoniae different serotypes from worldwide. In this report, we suggested isolates belonging to ST23. that horizontal transmission of the resistance plasmids Material & Methods: One TIG-R and three TIG-S K. pneumoniae contributed to the dissemination of blaCTX-M -positive Salmonella clinical isolates were examined in this study. While the three isolates. It emphasizes the continuous monitoring to prevent TIG-S isolates were HV K. pneumoniae (hvKP), the TIG-R isolate further spread of resistant clonal strains. was non-hvKP. We obtained in vitro induced tigecycline-resistant (TIG-IR) mutants from the TIG-S isolates. MICs were determined against tigecycline alone or with efflux pump inhibitors. String P1-GN38 test, mucoviscosity test, and capsular polysaccharide (CPS) The effect of exposure to sub-inhibitory concentration of quantification were performed. Expression levels of efflux pump colistin in Acinetobacter baumannii (acrAB and oqxAB) and their regulators (ramA and ramR) were Yoon-Kyoung Hong, Kwon Soo Ko examined using qRT-PCR. The ramA and ramR genes were Department of Molecular Cell Biology, Sungkyunkwan University sequenced and compared. School of Medicine, Suwon 16419, Korea Results: The TIG-IR mutants exhibited reduced HV and decreased formation of CPS, which were shown in non-hv TIG-R Background: The aim of this study was to determine the effect of clinical isolates. The tigecycline MICs had no change when sub-inhibitory concentrations of colistin in colistin-susceptible treated with efflux pump inhibitors. In addition, no differences and -heteroresistant Acinetobacter baumannii isolates. were shown in the expression of efflux pump genes among Methods: Each three colistin-susceptible and colistin-heterore- the strains. However, the expression level of ramA and ramR sistant A. baumannii isolates were included in this study. The iso- increased both in the TIG-R clinical isolate and TIG-IR mutants lates were exposed to various concentrations of colistin (0, 0.016, than TIG-S clinical isolates. Amino acid alterations in ramR gene 0.032, 0.064, 0.128, 0.25, 0.5, 1, 2, 4, 8, 16, and 32 mg/L) for 18h, were identified in the TIG-R and TIG-IR strains. and the survival rates were measured on Muellar-Hinton agar Conclusion: In this study, we revealed that tigecycline resistance plates with or without colistin (4mg/L). Amino acid alterations in may be associated with reduced mucoviscosity in K. pneumoniae PmrCAB and LpxACD in surviving colonies at agar with colistin strains of ST23, which is representative hypervirulent clone. The Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S115

reduced HV may be involved with the overexpression of ramR, a P1-GN41 negative regulator of ramA. Undetected colistin heteroresistance in Klebsiella pneumoniae clinical isolates Jungyu Seo, Kwan Soo Ko* P1-GN40 Department of Molecular Cell Biology, Sungkyunkwan University Trends in Extended-Spectrum β-lactamases (ESBLs) on School of Medicine, Suwon, Korea diarrheagenic Salmonella spp. isolates in Gwang-ju, South Korea: 2014-2018 Background: Klebsiella pneumoniae is emerging as an important Kwang Gon Kim*, Jin Jung, Min Ji Kim, Duck woong Park, nosocomial pathogen due to its rapidly increasing multidrug Ji Hyun Shin, Mi hee Seo, Jae Keun Chung, Hye Young Kee resistance. In K. pneumoniae, colistin resistance, including Health and Environment Research Institute of Gwang-ju, South heteroresistance, has been increasingly reported. Colistin Korea heteroresistance may increase treatment failure. Materials and Methods: In experiment of persister cell formation Background: Salmonella spp. is one of the major etiologic assay, survived populations at high colistin concentration (10 agents for diarrheal disease in young children. Third-generation mg/L) showed the phenotype of colistin resistance, indicating cephalosporins are general therapeutic option for severe cases of that they were not persister cells. Thus, we examined if they these enteric pathogens. However, the emergence of organisms were heteroresistant to colistin using two colistin-susceptible, carrying ESBLs known to confer antimicrobial drug resistance clinical K. pneumoniae isolates (SMC-1205-138 and K16-025). We by hydrolyzing most β-lactams has become of great concern. performed heteroresistance assays such as Etest, disk diffusion In Korea, members of the CTX-M-14 and CTX-M-15 have been test, and population analysis profiling (PAP). Time-killing assay continuously reported in Enterobacteriaceae since the first finding were performed by 1 mg/L colistin. The alterations of the genes of CTX-M clusters in 2001. This study is aim to characterize associated with colistin resistance were identified. ESBLs in diarrheagenic Salmonella spp. mainly from infants and Results: Colistin-resistant subpopulation could not be detected children in the south-west region of Korea over a 5 year period. by methods of Etest and disk diffusion test, but the presence of Methods: Overall, 652 non-duplicate pathogenic Salmonella spp. heteroresistance was identified by PAP in two clinical isolates of isolates, which collected from feces samples of diarrheal patients K. pneumoniae. In vitro time-killing assay, both isolates showed in Gwang-ju, South Korea during 2014-2018, were subjected rapid reduced survival until 4 h after exposure to 1 mg/L colistin to antimicrobial susceptibility testing and PCR for detection of and regrowth after 4 h. In both isolates, an alteration in PhoQ cefotaxime and/or cefoxitine resistant isolates and ESBL genes. (Glu302Lys) was observed in the subpopulation survived in PAPs. Results: On observing the antimicrobial susceptibility testing of Conclusion: This study suggests that there may be undetected the 652 isolates, 53 isolates (8.1%) were resistant to cefotaxime colistin heteroresistance in K. pneumoniae, indicating limitation and/or cefoxitine. The antibiotic susceptibility patterns of in some methods to identify colistin heteroresistance. isolated Salmonella spp. showed relatively high resistance to ampicillin (51.4%) and tetracycline (45.7%), while no Salmonella spp. showed resistance to imipenem, cefotetan, amikacin. Of P1-GN42 53 cefotaxime (cefoxitine) resistant Salmonella spp. isolates, 50 Characteristics of NDM-5 carbapenemase-producing isolates were confirmed to be ESBL-producers, namely TEM, Escherichia coli isolates from a hospital of Korea CTX-M-1, CTX-M-15, CTX-M-55 and CTX-M-14 in 10, 9,19,6 and So Yeon Kim1, Jungyu Seo1, Yeon-Sook Kim2, Kwan Soo Ko1 6 isolates, respectively. Additionally, CMY and DHA were also 1Department of Molecular Cell Biology, Sungkyunkwan University detected in 1 and 5 isolates. Interestingly, Salmonella Virchow School of Medicine, Suwon, Korea, 2Division of Infectious Diseases, showed high cefotaxime resistant rate (44.4%, 4/9 isolates) Chungnam National University Hospital, Daejeon, Korea compared to other Salmonella spp. (8.1%). Also, each Salmonella serovar possessed same type of ESBLs (S. Enteritidis and S. Background: The emergence and spread of New Delhi Virchow; CTX-M-15, S. Infantis; CTX-M-14, S. Agona; DHA, S. I metallo-β-lactamase (NDM) producing carbapenem-resistant 4,[5],12:i:-; CTX-M-55, S. Typhimurium; CTX-M-1). In sum, the Enterobacteriaceae (CRE) presents an urgent threat to human incidence of ESBL production in the collected diarrheagenic health. In this study, we determined the complete sequence of

Salmonella spp. isolates was 8.1 % (53 out of 652 isolates) with a blaNDM-5-harboring IncX3 plasmid of E. coli isolates causing an increasing resistant rate by every year (from 5.3% in 2014 to 11.8% outbreak in a hospital of Korea. in 2018). Materials and methods: Antimicrobial susceptibility testing, Conclusion: The ESBL variants of TEM, CTX-M-1 and CTX-M-15 genotyping (MLST and PFGE), and experiment on the conjugal were prevalent in pathogenic Salmonella isolates. Though the transfer of plasmid were performed for eight CRE isolates. Whole incidence of ESBL production in the collected diarrheagenic plasmid sequencing was done using a PacBio RSII (Pacific Salmonella isolates was relatively low, the result show that ESBLs Biosciences, California Inc., USA) for two isolates. Comparative have spread to communities regarding the relatively short-term, genomic analyses were performed to several other blaNDM-5- low dose of antibiotics administration for patient with diarrheal carrying IncX3 plasmids. disease. Therefore, continuing surveillance and effective infection Results: The eight CR E. coli isolates obtained from patients control measures are need to minimize the spread of ESBLs. during November 2017 to December 2017 were positive with

blaNDM-5 and the gene was found to be carried on IncX3 self- S116 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

transmissible plasmids with identical sizes (~46 kb). Seven School of Medicine, Suwon 16419, South Korea, 2Department of eight isolates showed a very similar PFGE pattern, and of Internal Medicine, School of Medicine, Kyungpook National belonged to the same clone, ST 361, except one isolate (ST12). University, Daegu, Korea These plasmids were readily transferrable to recipient E. coli by conjugation, conferred resistance to multiple antibiotics. Objectives: Recently, the spreading of metallo-beta lactamase Comparative analysis of two plasmids of CNUH-11 (ST361) and (MBL)-producing Acinetobacter species has been reported

CNUH-14 (ST12), revealed completely identity to blaNDM-5-bearing worldwide. In this study, we identified VIM-2-producing IncX3-type plasmids; pCREC-591_4, pNDM5_Z0117EC0033, and non-baumanii Acinetobacter spp. in Korea, and performed pP855-NDM5, which was isolated in Korean patients and a pig comparative genomic analysis of them. originating from China, respectively. Methods: Among 602 Acinetobacter spp. isolates from a hospital Conclusion: Clonal dissemination of ST361 and endemic spread in Korea, we identified 94 Acinetobacter nosocmialis isolates of IncX3-type plasmid contributed to the wide dissemination (15.6%). The minimum inhibitory concentrations (MICs) were of NDM-5 producers in South Korea. In addition, we observed determined by broth microdilution method, and OXA and MBL horizontal transfer of the plasmid between different clones. genes were investigated for 15 carbapenem-resistant isolates (16.0%) by specific PCR assays. Multilocus sequence typing (MLST) was performed for genotyping of nine VIM-2-producing P1-GN43 A. nosocomialis isolates. Whole genome sequencing was carried Analysis of Distribution and Structure of Colistin Resistance out for two VIM-2-producing isolates using PacBio platform. Involved Genes across Klebsiella pneumoniae Isolates Results: Nine A. nosocomialis isolates were identified to produce Sunju Kim, Kwan Soo Ko VIM-2. They showed the same genotype, ST854 in MLST. Whole

Department of Molecular Cell Biology, Sungkyunkwan University genome sequence analysis showed that blaVIM-2 is harbored in School of Medicine, Suwon 16419, Republic of Korea plasmid and the plasmids of two isolates were identical. The

blaVIM-2 was detected inside class 1 integrons, including aada1, Background: Antimicrobial resistant (AMR) is an important emrE and aac(6’)-Ib. global concern. With increasing AMR in Gram-negative Conclusion: We identified clonal spreading of VIM-2-producing pathogens including Klebsiella pneumoniae, colistin, one of the A. nosocomialis isolates. last resort antibiotics, are re-recruited despite its nephrotoxicity and neurotoxicity. Mutations of two component regulatory systems such as PmrAB and PhoPQ have been known to be P1-GN45 involved in the modification of lipid A, resulting in colistin Genomic Analysis of Plasmid IncF Mediating Co-resistance nonsusceptibility. Recently, CrrAB has been revealed to regulate in Escherichia coli Isolated from Human and Animal PmrAB expression by CrrC, and they are responsible for colistin YJ Kim*, SH Kim, and SM Bae† resistance along with KexD, an RND type efflux pump, in K. Division of Antimicrobial Resistance, Center for Infectious Diseases pneumoniae. Research, NIH, Korea Centers for Disease Control & Prevention, Materials & Methods: Distribution of crrABC and kexD are Republic of Korea classified with publically available whole genome sequences in combination with PCR screening of clinical isolates, and the Background: Plasmid IncF is a major shuttle of diverse antimi- genotypes of the K. pneumoniae isolates are classified based on crobial resistance genes (ARGs) in Enterobacteriaceae. In this multilocus sequence typing (MLST). The data were analysed study, we investigated complete genomes of plasmid IncF-carry- with phylogenetic and statistical methods including minimum ing-Escherichia coli originated from human and animal to analyze spanning tree (MST) analysis based on MLST profiles. resistome profiles and genetic relatedness of them. Results: MST based on the public database and clinical isolates Methods: Total of 290 genomes were analyzed, comprising 276 demonstrated that the isolates without crrB only exist among genomes downloaded from Plasmid Database and 14 newly ST11 and those without crrAB only exists among ST23. Genome sequenced genomes of clinical isolates from Korea. They were structures around crrABC-kexD and single nucleotide variants in subject to resistance gene mapping, and then eventually 88 the region showed correlations with their STs and crrABC-kexD genomes (69 of human; 19 of animals) carrying more than 5 ARGs profile. were selected for the further analysis of phylogeny and resistome Conclusion: The results indicate that distribution of crrABC-kexD profile. is in relation with genotype in K. pneumoniae. ST-dependent Results: Total of 50 different ARGs were observed. More than 50% unique profiles are an available explanation how ST11 and 23 of plasmid carried ARGs mediating resistance to aminoglycoside could successfully settle. (other countries vs Korea; 92.9% vs 100.0%), streptomycin (58.6% vs 71.4%), beta-lactam (71.4% vs 83.3%), co-trimoxazole (95.7% vs 100.0%), macrolide (75.7% vs 88.8%), and tetracycline (80.0% P1-GN44 vs 88.8%). Resistance gene network analysis revealed majority of Emergence of MBL-harboring Plasmid in Acinetobacter ARGs were co-localized within Tn 3 family and class 1 integron. Specises in South Korea Noteworthy, resistance determinants against frequently used In-Young Na1, Ki Tae Kwon2, Kwan Soo Ko1* antibiotics in animals but not in human were detected at high late 1Department of Molecular Cell Biology, Sungkyunkwan University (i.e. streptomycin, 71.0%; co-trimoxazole, 100.0%; tetracycline, Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S117

92.8%) in human-origin isolates within transposon and/or 1Department of Internal Medicine, Chonnam National University integron. The k-mer based phylogenomic analysis indicated Medical School, Hwansun, South Korea that the predominant lineage was created by clonal expansion of human-origin E. coli ST131 and suggested its possible Background This study aimed to identify clinical or transmission across human and animals. microbiological factors related to persistence or recurrence of Conclusions: Our findings support that plasmid IncF is the major Stenotrophomonas maltophilia bacteremia in adult patients. source of co-resistance to frequently adopted agents of both Methods S. maltophilia bacteremia patients identified in two human and animals in E. coli. tertiary hospitals between 2005 to 2018 were investigated. Biofilm formation was assessed using 96-well polystyrene plate with 0.5% crystal violet staining in 91 blood isolates. Persistent bacteremia P1-GN46 was defined as the consecutive blood culture positive for ≥ 5 days Analysis of molecular mechanisms of colistin resistance among after initiation of appropriate antibiotics therapy. Relapse was K. pneumoniae defined as isolation of S. maltophilia from blood after completion JA Choi*, SM Bae and JW Kim† of antibiotics treatment for the first episode of bacteremia. Division of Antimicrobial Resistance, Center for Infectious Diseases Results Of total 165 patients with S. maltophilia bacteremia, Research, NIH, Korea Centers for Disease Control & Prevention, 21 of persistent and 12 of relapsing cases were identified. The Republic of Korea median duration of bacteremia after appropriate antibiotics introduction in persistent cases were 9 days(IQR 8-17). The Background: Colistin is one of the last-resort antibiotic for presence of nasogastric tube, mechanical ventilator treatment treatment of MDR Gram-negative bacteria. Resistance to colistin and S. maltophilia recovery from non-blood specimens were is mediated by LPS modification by L-Ara4N and pEtN. In more frequently observed in patients with persistent or relapsing addition, the pmrHFIJKLM or pmrCAB operons are regulated bacteremia. Strains recovered from persistent or relapsing by the two-component systems PhoP/Q and/or PmrA/B. In this bacteremia produced significantly more biofilm (0.81±0.25 vs 0.67 study, we are identified several mechanisms for colistin resistance ± 0.27, p=0.021), and significantly more resistant to trimethoprim/ in K. pneumoniae. sulfamethoxazole (12% vs. 2%, p=0.030). MLST showed the strains Methods: A total of 8 colistin resistant(col-R) and 14 colistin were identical within persistent or relapsed bacteremia episodes, susceptible(col-S) clinical isolates of K. pneumoniae were except one relapsed case. collected from Kor-GLASS. Colistin susceptibility test was Conclusion This study provides evidence that the biofilm determined broth microdilution method. To identify the genetic production and resistance to trimethoprim/sulfamethoxazole mechanisms of resistance, mutations on pmrA, pmrB, phoP in S. maltophilia could contribute to persistence or relapse of and phoQ genes, expression levels of pmrC and pmrK genes, bacteremia. and the presence of plasmid mediated mcr genes (mcr-1,2,3,4,5) were investigated. Lipid profiles were determined using MALDI- TOF MS. The ultrastructure of col-R strains was observed using P1-GN48 transmission electron microscopy. Molecular and clinical characteristics of carbapenem- Results: The MIC range of col-R strains were 4-64 μg/ml. Col-R resistant Klebsiella pneumoniae isolates in Korea: A single strains were classified into 4 mutation patterns according to center experience mutations in the pmrA, pmrB, phoP and phoQ genes. None of the JY Kim*, YJ Jeong, SJ Kim, JH Kim, SB Kim, YK Yoon, JW Sohn, mcr genes were detected in the studied strains. The expression MJ Kim level of pmrK in col-R was 3.3-fold higher than that of col-S Korea University Anam Hospital, Seoul, Korea strain, while pmrC was not change. When analyzed by MALDI- TOF MS, all col-R strains exhibited addition of L-Ara4N to lipid A Background: Carbapenem-resistant Klebsiella pneumoniae component of outer membrane. In addition, the outer membrane (CRKP) has recently emerged and spread as the major pathogen of col-R strains was thinner than that of col-S strains and not of carbapenem-resistant Enterobacteriaceae in hospital settings clearly separated from the cytoplasmic membrane. in Korea. This study explored genetic diversity and clinically Conclusions: Our results shows that upregulation of pmrK important trait of CRKP. (pmrHFIJKLM operon) eventually leads to resistance to colistin Methods: CRKP isolates and patients’ data were collected in by addition of L-Ara4N to the lipopolysaccharide and alteration of a hospital in Seoul, Korea from 2017 to 2018. Antimicrobial the outer membrane in K. pneumoniae. susceptibility, modified Hodge test, carbapenemase gene detection, and MLST with eBURST analysis were done. Results: A total of 68 CRKP isolates collected consecutively P1-GN47 included 53 from in-hospital acquisition and 15 from outside Antibiotics susceptibility, Biofilm Production and Clinical healthcare institutions. MLST analysis identified 10 sequence Characteristics of Persistent or Relapsing S. maltophilia types (ST) comprising of 9 clonal complexes: The eBURST/ Bacteremia SLV diagram indicated in-hospital clonal expansion of the two Baigali Chuluunkhuu*, Sehyeon Ji, Sung Un Shin, Yo han Yu, major clones ST307 (n=30) and ST48 (n=18). Of the 68 patients, Soo sung Kim, Tae hoon Oh, Seong Eun Kim, Uh Jin Kim, 25 showed clinical infections with 52% of in-hospital mortality. Seung Ji Kang, Hee-Chang Jang, Kyung-Hwa Park, Sook In Jung Forty-nine (72%) patients revealed clinical severity with ICU S118 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

care, higher APACHE II scores (26.27 ± 10.13), prolonged ICU Table. In vitro activity of zabofloxacin and comparator agents stay (24.29 ± 31.33 days), and device(s) use (n=46, 67.6%). Prior against 155 MDR S. pneumoniae antibiotic receipts included piperacillin/tazobactam (n=38, Susceptibility (No., %) MIC (μg/ml) Antimicrobials 55.9%), carbapenems (n=27, 39.7%), and extended-spectrum S I R MIC50 MIC90 Range Zabofloxacina - - - <0.03 0.25 ≤0.03-2 cephalosporins (n=27, 39.7%). Interestingly, ST48 showed Ciprofloxacin 107 0 48 1 32 0.25->32 significant higher infection rate than ST307 in terms of virulence (69.03) (30.97) (66.7% vs 26.7%, p=0.014). ESBL producers and carbapenemase Gemifloxacin 136 9 (5.81) 10 (6.45) 0.25 1 ≤0.03-4 genes were detected in 26 (38.2%) and 56 (82.4%), respectively. (87.74) Levofloxacin 132 1 (0.65) 22 1 16 0.25->32 KPC-2 (82.4%) was the most common. Antibiogram showed 1.5% (85.16) (14.19) of isolates were resistant to amikacin, 98.5% to aztreonam, 33.8% Moxifloxacin 136 2 (1.29) 17 1 4 ≤0.03-16 (87.74) (10.97) to tigecycline. b Penicillin 120 19 16 2 8 2-16 Conclusions: This study indicates that CRKP has increased in (77.42) (12.26) (10.32) critically ill patients, along with clonal dissemination. Infection Amoxicillin 54 63 38 4 32 0.5->32 control measures as well as antibiotic stewardship should be (34.84) (40.65) (24.52) A/C 51 (32.9) 61 43 4/2 8/4 0.5/0.25- more intensified in ICUs. (39.35) (27.74) >32/16 Ceftriaxone 77 4 (2.58) 23 1 16 0.5->32 (49.68) (17.84) Cefuroxime 1 (0.65) 0 154 8 32 0.5->32 P1-GP01 (99.35) In vitro activity of zabofloxacin against Streptococcus Erythromycin 6 (3.87) 1 (0.65) 148 128 >128 0.25->128 pneumoniae including extensively drug-resistant (XDR) (95.48) Azithromycin 4 (2.58) 0 151 32 >32 0.25->32 isolates from Asian countries (97.42) JY Baek1,2*, C-I Kang2, KS Ko1,3, DR Chung1,2, KR Peck2, J-H Song1 Clarithromycin 5 (3.23) 2 (1.29) 148 32 >32 ≤0.03->32 1Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, (95.48) 2 Clindamycin 25 1 (0.65) 129 >32 >32 ≤0.03->32 Korea; Division of Infectious Diseases, Samsung Medical Center, (16.13) (83.23) Sungkyunkwan University School of Medicine, Seoul, Korea; SXT 7 (4.52) 15 (9.68) 133 16/304 32/608 0.25/4.75- 3Department of Molecular Cell Biology, Sungkyunkwan University (85.81) >32/608 Daptomycin - - - 0.12 0.5 ≤0.03-1 School of Medicine, Suwon, Korea Vancomycin 155 0 0 0.25 0.5 0.12-0.5 (100.0) c Background: Zabofloxacin is a potent fluoroquinolone agent Teicoplanin 155 0 0 <0.03 <0.03 ≤0.03-0.12 (100.0) that is indicated for community- acquired respiratory infections Linezolid 155 0 0 0.5 1 0.25-1 due to Gram-positive pathogens. In this study, we investigated (100.0) comparative in vitro activity of zabofloxacin tested against a aNo CLSI breakpoints are applicable for pneumococci. b highly selected challenge collection of Streptococcus pneumoniae Criteria by the CLSI (2017) for ‘penicillin parenteral non-meningitis (I, 4 μg/ml; R, ≥8 μg/ml) isolates including extensively drug-resistant (XDR) isolates from cCriteria by the BSAC (2015) for teicoplanin (R, >2 μg/ml) various Asian countries. Methods: Of the S. pneumoniae clinical isolates collected from Asian countries from 2012 to 2018 as part of a multicenter P1-GP02 surveillance study of the Asian Network for Surveillance of Occurrence of linezolid resistance in methicillin-resistant Resistant Pathogen, 155 isolates of multidrug-resistant (MDR) Staphylococcus aureus (MRSA) clinical isolates without pneumococci including the 18 well-characterized XDR isolates linezolid exposure were analyzed. In vitro susceptibility testing for 19 antimicrobial Hye Mee Kim1,2*, Doo Ryeon Chung1,2,3, Kyungmin Huh1,2, agents was performed by broth microdilution method. Sun Young Cho1,3, Yu Ri Kang1,2, Cheol-In Kang1, Kyong Ran Peck1 Results: Zabofloxacin was highly active against MDR pneumo- 1Division of Infectious Diseases, Samsung Medical Center, cocci (Table). Among other fluoroquinolone agents, zabofloxacin Sungkyunkwan University School of Medicine, Seoul, South showed the most potent in vitro activity, with at least 4-fold higher Korea, 2Asia Pacific Foundation for Infectious Diseases (APFID), 3 than that found for gemifloxacin (MIC90, 0.25 versus 1μg/ml). The Seoul, South Korea; Center for Infection Prevention and Control, MIC for zabofloxacin (range, 0.25-2 μg/ml) against all 18 XDR iso- Samsung Medical Center, Seoul, South Korea lates (levofloxacin MIC range 8->32 μg/ml) was low. In addition, zabofloxacin is superior to other valid treatment options, like van- Background: Although linezolid-resistant Staphylococcus aureus comycin and linezolid as demonstrated by MIC values. (LRSA) have been reported worldwide associated with long-term Conclusion: The activity of zabofloxacin was excellent against use of linezolid, linezolid resistance in S. aureus was previously all types of MDR pneumococci, showing 4- to 128 fold-greater reported once. Herein we report two LRSA clinical isolates from potency in comparison with other fluoroquinolones. These two patients who were not previously treated with linezolid. results suggest that zabofloxacin could be an effective therapeutic Methods: Methicillin-resistant S. aureus (MRSA) isolates (LR- option to treat infections caused by MDR and XDR pneumococci. MRSA_01 and LR-MRSA_02) showing linezolid resistance were isolated from wound and catheter of two patients who had not been previously given linezolid, respectively. IIn vitro antimicrobial susceptibility test was performed by broth Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S119

microdilution method. The isolates were tested for the known Conclusions: Rifampin-based combination using ciprofloxacin mechanisms of linezolid resistance. Multilocus sequence typing or levofloxacin showed synergistic antibacterial activity against (MLST), staphylococcal cassette chromosome mec (SCCmec) drug-resistant S. aureus clinical strain. These findings support typing and staphylococcal protein A (spa) typing were performed. the combination therapy with rifampin and fluoroquinolone in Results: Two LR-MRSA isolates exhibited low-level resistance treatment of staphylococcal infections. to linezolid (MIC 8 mg/L). In LR-MRSA_01 belonging to ST72- SCCmec type IV and t664, there was no mutation of L22 ribosomal protein although the mutation of rplV encoding L22 was detected P1-GP05 (T180C). In LR-MRSA_02, ST5-SCCmec II and t2460, we found the Molecular Epidemiology of Invasive Streptococcus mutation of L3 ribosomal protein (Asn93Lys and Gly152Asp) by Pneumoniae Serotype 19A in Thailand, 2008-2018 the mutation of rplC (T279A and G455A) encoding L3. P. Chongtrakool1*1, U. Puangprasart1, W. Kamolwit1, Conclusion: This is the first report of linezolid-resistant W. Pongsamart2, C. Tribhuddarat1 MRSA isolated from patients without linezolid exposure. Low- 1Department of Microbiology and 2Department of Pediatrics, level linezolid resistance in two MRSA isolates without an Faculty of Medicine, Siriraj Hospital, Mahidol University, epidemiological link could not be explained by alleged resistance Thailand. mechanisms. A further investigation is necessary to understand linezolid resistance in S. aureus. Objective: Recently, pneumococcal vaccines (PCV) have shown a significant failure in treating invasive pneumococcal disease (IPD) in Thailand. An increase in the prevalence of non-vaccine P1-GP03 serotypes with non-susceptible to penicillin, especially serotype In vitro synergistic effects of rifampicin combined with 19A has been reported after PCV7. Molecular epidemiology fluoroquinolones against drug-resistant Staphylococcus of invasive S. pneumoniae serotype 19A based on Multi Locus aureus Sequence Typing (MLST) is limited. This study aimed to Yu Ri Kang1,2, Doo Ryeon Chung1,2,3 , Kyungmin Huh1,2, characterize S. pneumoniae serotype 19A causing IPD by MLST Sun Young Cho1,3, Cheol-In Kang1, Kyong Ran Peck1 and correlate to antimicrobial resistance. 1Division of Infectious Diseases, Samsung Medical Center, Materials and Methods: MLST and antimicrobial susceptibility Sungkyunkwan University School of Medicine, Seoul, South testing were performed in 62 isolates of invasive S. pneumoniae Korea, 2Asia Pacific Foundation for Infectious Diseases (APFID), serotype 19A, isolated from 2008-2018. (Collaborations of Seoul, South Korea; 3Center for Infection Prevention and Control, “Pneumococcal Laboratory Network” in Thailand) Samsung Medical Center, Seoul, South Korea Results: 62 isolates belonged to 3 clonal complexes (CC) and 20 different sequence types (STs). The most predominant was Backgrounds: Rifampicin has been frequently used to treat ST320 (n=25), ST2930 (n=9), ST230 (n=7), ST63 (n=3), ST95 staphylococcal infections, in particular, healthcare device-related and ST8346 (n=2), and one isolate of ST1701, ST2062, ST4467, infections, due to its excellent anti-staphylococcal activity and ST4901, ST10379, ST10923, ST12360. In this study, we found 7 biofilm-penetrating ability. We investigated the in vitro synergistic isolates with no establishing STs. By using meningitis criteria, effects of rifampin combined with either ciprofloxacin or 93.33% and 51.67% were non-susceptible to penicillin and levofloxacin . cefotaxime/ceftriaxone whereas by non-meningitis criteria, 30% Methods: Staphylococcus aureus isolates (MRSA 15 isolates, VISA and 8.33% were. 71.67% were non-susceptible to meropenem and 4 isolates, and hVISA 11 isolates) blood isolates, which had been erythromycin while all(100%) were susceptible to levofloxacin/ stocked during a previous Korean nationwide bacteremia study, ofloxacin and vancomycin. were used in this study. Time-kill studies were performed with Conclusion: The three most predominant STs appeared to combination of rifampin and either ciprofloxacin or levofloxacin. disseminate in our region throughout the study period. They Antimicrobial concentrations of 0.5x and 1x MIC were used. seemed to be non-susceptible to antimicrobials of use. Prevention Bacterial growth was quantified at 0 and after 4, 8 and 24 h and control of highly antimicrobial-resistant clonal dissemination incubation at 37℃ by dilution method using the spiral plater. should be of concern. Synergy was defined as a 2-log10 decrease in CFU/mL with the combination at 24 h in comparison with the count with the most active single agent. P1-GP06 Results: Of the 30 S. aureus isolates, 5 (16.7%) isolates were The incidence of antibiotic-resistant Staphylococcus aureus resistance to rifampin, while 21 (70%) isolates were resistant colonization/infection in children and adults with Atopic to ciprofloxacin and levofloxacin. Rifampin combined with Dermatitis ciprofloxacin showed synergy against 13 (43.3%) isolates at 1x M. Laowansiri1,4, T. Chatsuwan2,4, A. Thammahong2,4, MIC concentration and against 7 (23.3%) isolates at 0.5x MIC. P. Chanchaithong3 , D. Chiewchengchol2 Rifampin combined with levofloxacin exhibited synergy against 6 1Medical Microbiology, Interdisciplinary Program, Graduate (20%) isolates at 1x MIC and against 7 (23.3%) isolates at 0.5x MIC. School, Chulalongkorn University, Bangkok, Thailand,2 Immu- Especially, rifampin combined with ciprofloxacin or levoflaxcin nology Unit, Department of Microbiology, Faculty of Medicine, showed synergistic effects against three hVISA strains resistant to Chulalongkorn University, 3Department of Veterinary Microbiolo- fluoroquinolones. gy, Faculty of Veterinary Science, Chulalongkorn University, 4An- S120 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

timicrobial Resistance and Stewardship Research Unit, Faculty of 100% resistant for all 64 strain of vancomycin, ampicillin, Medicine, Chulalongkorn University penicillin, gatifloxacin, and ciprofloxacin agents and also showed high resistant of more than 95% of erythromycin, levofloxacin, Atopic dermatitis (AD) is an inflammatory skin disease rifampin agents. vanA genes was detected all of 64 strain but vanB characterized by chronic and recurrent eczematous rash. AD genes was not detected. In MLST analysis, all 10 sequence types occurs in both children and adults, but children are more affected. were appeared and 17(n=34), 192(n=10) ST types were the most An important aggravating factor is caused by Staphylococcus common types. All of 64 strain were found to be highly resistant aureus infection. Therefore, topical or systemic antibiotics are strains with MIC for vancomycin >256ug/ml. In MLST analysis, essential for treatment of AD with S. aureus infection. However, ST17 and 192 are confirmed that are usually found in South Korea. frequent use of antibiotics causes an increase in the incidence Most vancomycin resistant enterococci are multidrug resistant of antibiotic-resistant S. aureus worldwide. The objectives of this microorganisms. Therefore it is necessary to accumulate evidence study were to determine the incidence and the mechanisms of national antimicrobial resistant management by continuous of antibiotic-resistant S. aureus colonization/infection in AD monitoring the distrubution of molecular epidemiological patients at King Chulalongkorn Memorial Hospital during 2018- characteristics such as multilocus sequence typing and changes 2019. A total of 41 S. aureus isolated from 3 different sites of the in susceptibility to antimicrobial agent skin (nasal cavity, lesion, and non-lesion) in AD patients at King Chulalongkorn Memorial Hospital during 2018-2019. Antibiotic susceptibility testing were determined by disk diffusion method. P1-GP09 The resistance genes in antibiotic-resistant strains were detected Antibiotic resistance profile for Group B streptococcus in by PCR. There were 41 AD patients (23 children and 18 adults). Malaysia S. aureus colonization were found in 30%, 47% and 4% of nasal S.A. Shaari1,2, N. Z. Mohamed-Isa2, N. A. Abu-Bakar2, J. Houssaini1,3* cavities, lesions, and non-lesions in children, respectively whilst 1Microbiology & Parasitology department, Faculty of Medicine, only 16%, 22% and 5% were found in adults. The resistance rates University Teknologi MARA, Malaysia, 2Medical Microbiology of fusidic acid, mupirocin, and cefoxitin in children were 8.70%, unit, Faculty of Medicine, University Teknologi MARA, Malaysia, 4.35%, and 0%, respectively. No fusidic acid- and mupirocin- 3Institute for Pathology, Laboratory and Forencsic Medicine resistant S. aureus was found in adults. The mupA gene producer (I-PPerForM), Universiti Teknologi MARA, 47000 Sungai Buloh, was only detected in children with AD whereas mutations in fusA Selangor, Malaysia. and mecA genes were not detected, suggesting that antibiotic treatment should be reconsidered in children treated with Recent studies in Japan and Africa have reported resistant rates of standard antibiotic without clinical improvement. 15% and 33% respectively, against penicillin, the most commonly used antibiotic to treat Group B streptococcus (GBS) infection. This 3-year study aimed to determine susceptibility profile of GBS P1-GP08 in Faculty of Medicine, University Teknologi MARA in Malaysia. Antimicrobial susceptibility and Multilocus Sequence Typing Clinical samples collected from July 2016 to June 2019 were Analysis of Vancomycin Resistant Enterococci Isolated from cultured. Any GBS isolates were identified using morphological Korea in 2017 ~ 2018 and biochemical tests. Susceptibility testing against penicillin, S.J. Joo1*, E.B. Go1, S.M. Jeon2, S.D. Park1, J.I. YOO1, K.J. Hwang1 erythromycin and clindamycin were performed using Kirby– 1Division of Bacterial Diseases, Center for Laboratory Control Bauer method and interpreted using CLSI guidelines of 2017, of Infectious Diseases, Korea Centers for Disease Control and 2018 and 2019. A total of 182 GBS were isolated. Majority of them Prevention, Korea, 2Division of Bacterial Diseases Research, Center (71%) were from genital-related specimen including vaginal and for Infectious Diseases Research, Korea National Institute of Health, rectal swab. The remaining 28% were from non-genital specimen Korea Centers for Disease Control and Prevention, Korea that included blood, tissue, pus and urine. All GBS isolates (100%) were sensitive to penicillin. Their zones of inhibition range from As the use of antimicrobial agents has been increased worldwide, 25mm to 45mm in diameter. Mean diameters for first, second and antimicrobial resistant enterococci have been reported as a major third year of study were 28mm, 29mm and 29mm, respectively. cause of infection in hospitals. Among vancomycin resistant Reduced susceptibility to erythromycin was present in 12% of enterococcus faecium was first reported in France in 1986 and total isolates, 18 isolates of which were resistant while 4 were the frequency of isolation has been increasing worldwide. This intermediate. Reduced susceptibility to clindamycin was found in study confirmed the characteristics by conducting antimicrobial 3%, 4 isolates of which were resistant while 4 were intermediate. susceptibility and multilocus sequence typing in 64 strain of Six isolates or 3% were resistant to both erythromycin and vancomycin resistant Enterococcus faecium , which was identity clindamycin. This study demonstrated absence of penicillin- isolated from Korea in 2017~2018. Antimicrobial susceptibility resistant GBS in our centre and confirmed appropriateness test were conducted in accordance with the CLSI guide line and of penicillin as the antibiotic of choice for our GBS infection. 13 different types of antimicrobial agents were used. vanA and However, it also confirmed presence of resistance to erythromycin vanB, which are vancomycin resistant genes, were detected by and clindamycin, two commonly used alternative antibiotics for PCR. Multilocus sequence type was investigated using seven individuals allergic to penicillin. types of house keeping gene. The antimicrobial susceptibility results of vancomycin resistant Enterococcus faecium showed Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S121

P1-HI01 Results: Of 190 ICU patients with CRE colonization, 43 (22.6%) Burden and Risk Factors of Nosocomial Urinary Tract developed clinical infection by CRE at a median of 9 days (range Infection in Renal Transplant Recipient: A First Study from 8-65) after identification of colonization. These case patients with Nepal CRE infection were matched with 86 control patients with CRE R. Shrestha1*, B.K. Awal2, K. Shrestha2, P.C. Shrestha2 colonization (1:2 ratio). In multivariate analysis, high APACHE 1Bhaktapur Hospital, Nepal, 2Human Organ Transplant Center, II score at ICU admission was significantly associated with CRE Nepal infection following enteric colonization (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.02-1.12; p= 0.007). Patients with Background: Nosocomial urinary tract infection (UTI) remains CRE infection were more likely than controls to have chronic major threat of renal transplant recipients. Its burden and risks liver diseases (11.6% vs. 5.8%), to be debilitated functional status are unmeasured in Nepal. (74.4% vs. 62.8%) and to receive a recent surgery (32.6% vs. 17.4%), Methods: Retrospective study was conducted to assess the but these were not statistically significant. Infectious disease burden and risk of nosocomial UTIs among live related renal consultation (IDC) during CRE colonization was the independent transplant recipients (LRTR) transplanted during 2013 to 2017 at preventive factor for subsequent CRE infection in ICU (OR 0.35; Human Organ Transplant Center. Only physician diagnosed UTIs 95% CI 0.14-0.87; p= 0.023). within a month of renal transplantation requiring hospitalization Conclusions: We suggest that active IDC service in ICU is needed were included. Patients with incomplete information and those to prevent the progression from CRE colonization to clinical expired following transplant surgery were excluded. Statistical test infection with attention to antibiotics stewardship. applied were X2 test, fisher exact test, independent student t test, Man-whitney U test and logistic regression. Results: Nosocomial UTIs was diagnosed in 21.4% of 229 P1-HI05 patients at the mean of 13.48 days after transplant. Escherichia An Outbreak of Ralstonia pickettii Bloodstream Infection coli was major isolates (42.86%) followed by Pseudomonas Associated with Contaminated Chlorohexidine Solution in a aeruginosa (36.73 %) and Klebsiella pneumoniae (20.41%). tertiary hospital in Malaysia Isolates were highly resistance to carbapenem-34.69%. Urosepsis Siti Fazilah S1, Pauline Angelyna P2, Maizatul’ Itri CH1, was diagnosed in 14.29% of case and graft loss due to UTI was Beatrice Susan J2, Molly K2, Sheila Ivy R2, Zaidah M2, Rohaidah H3 observed in one case. Carbapenem was infused in 67.34% and 1Microbiology Unit, Hospital Umum Sarawak, Ministry of Health, polymixin B in 10.2% for treatment. Risk factors associated with Malaysia, 2Infection Control Unit, Hospital Umum Sarawak, infections were prolonged ICU stay (p=0.0024) and re-operation Ministry of Health, Malaysia, 3Bacteriology Unit, Institute for (p=0.05). Gender, diabetes mellitus, acute rejection, delayed graft Medical Research, Kuala Lumpur, Malaysia. function, prior length of dialysis and duration of chronic kidney disease did not show significant association. Background: Ralstonia pickettii grows in moist environment and Conclusion: There was high burden of nosocomial UTIs among is associated with contaminated solutions used in healthcare LRTR resulting into escalating use of carbapenem. Prolonged facilities especially disinfectants such as Chlorhexidine. It ICU stay and re-operation were risk factors associated with these commonly associated with nosocomial infections and also has infections. been reported causing bloodstream infection. The authors noted a sudden increase of Ralstonia picketii isolation from blood culture specimens from a tertiary hospital in Sarawak. P1-HI03 Methods: These blood culture specimens were taken from 7 Impact of infectious disease consultation on the different wards within a month. We had done contact tracing development of clinical infections with carbapenem- and tried to identify the source and to intervene the ongoing resistant Enterobacteriaceae following colonization in infections. The cases were identified as patients with positive intensive care units blood cultures for Ralstonia pickettii during the outbreak period. C Moon*, JS Kang, SJ Mun Various samples from suspected sources were then taken and Department of Medicine, Inje University Busan-Paik Hospital analysed microbiologically. Results: A total of 13 samples taken including environmental Background: Carbapenem-resistant Enterobacteriaceae (CRE) samples and showed 9 samples isolated Ralstonia pickettii from infection is a serious threat to critically ill patients associated with which the samples were taken from chlorohexidine solution high morbidity and mortality. This study aimed to investigate 1:2000 (0.05%) in aqueous, distilled water and utensils which are factors influencing subsequent clinical infection among CRE- used to make the chlorohexidine solutions. All culture specimens colonized patients in intensive care units (ICU). from 21 case patients isolated Ralstonia pickettii and almost Methods: We conducted a matched case-control study in a all patients related with history of fever prior to blood culture university hospital in South Korea between January 2016 and takings procedure. Fourteen clinical isolates were closely related September 2018. Case patients with CRE infection were compared except one clinical isolate. However, strain-relatedness between with control patients with CRE enteric colonization who did not the probable source and clinical isolate were not able to be develop a clinical infection, according to matching criteria based demonstrated as the isolates from probable source were not grow on age, time of primary CRE isolation, and follow-up time after to proceed for Pulsed-field gel electrophoresis (PFGE). colonization. Conclusion: We report a Ralstonia pickettii outbreak occurring S122 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

among patients with probable source was from contaminated a 70 to 90% reduction in viable bacteria counts on environmental chlorhexidine solutions are used for skin disinfection for blood surfaces after using PX-UV for terminal room disinfection. For culture procedure. In conclusion, a prompt investigation and laboratory studies, there was on average 1.5 to 9-log reductions adequate preventive measures by the infection control team, in several different pathogens, and in some cases complete clinicians and hospital administration is important to prevent elimination (provided as percent reductions). These pathogens similar occurrence. include Acinetobacter baumannii (99.99%), Aspergillus niger (94.6%), Bacillus anthracis (100%), Candida auris (99%), Ebola virus (100%), Enterococcus faecium, vanB gene (99.99%), P1-HI06 Klebsiella pneumoniae, KPC (99.3%), Staphylococcus aureus, Methods to Evaluate the Effectiveness of Pulsed Xenon methicillin-resistant (100%), and Mycobacterium tuberculosis Ultraviolet Disinfection Outside the United States (99%). M Stibich, D Passey, N Gorman, A Ahn* Conclusions: Across a variety of settings outside the US, we found Xenex Disinfection Services, Texas, United States DK Medical that PX-UV systems have proven effectiveness in reducing the Solutions, Seoul, South Korea level of pathogens in the healthcare environment and laboratory, including multi-drug resistant pathogens. Best practices should Background: Pulsed Xenon Ultraviolet (PX-UV) systems have be collected from existing non-US users to address operational been widely deployed in the United States (US) with over 450 differences in non-US settings. hospital users. This use has resulted in 40 published papers and conference abstracts on laboratory, healthcare environment, and infection rate effectiveness of PX-UV in US settings. In the non- P1-HI07 US context, effectiveness may vary from the US due to differences Prevalence of multidrug-resistant organisms and risk factors in hospital operations and infrastructure, for example multi- for carriage among patients transferred from long-term care occupancy units. We examined the literature for data on PX-UV facilities: a one-year single center study systems outside US settings to determine where effectiveness HS Jeong*, SH Kang, HJ Cho research should focus. College of Medicine, Konyang University, Daejeon, South Korea Methods: An exhaustive literature review of studies conducted outside the US using PX-UV for disinfection of pathogens was Patient transport between acute care hospitals and long-term care conducted. This literature review included peer-reviewed facilities (LTCFs) plays an important role in microbial migration, research, conference posters and abstracts. The inclusion especially in Korea where the number of LTCFs with respect criteria included studies using a PX-UV device, conducted in the to population is seven times greater than the average in OECD healthcare environment or laboratory setting, and published from countries. However, limited studies have addressed this concern. 2000 to 2019. In this study, a retrospective chart review was conducted at an Results: We found six environmental studies and three laboratory acute care hospital with 800 beds to investigate the prevalence studies (N = 9). For environmental studies, there was on average and risk factors associated with the carriage of multidrug-resistant

Table 1. (P1-HI06) Included Studies Citation Country Type of Study Main Findings Hosein I, et al. Evaluation of a pulsed xenon ultraviolet light device for 78% reduction in CFU after manual cleaning; 91% isolation room disinfection in a United Kingdom hospital. American United Kingdom Environment reduction in CFU after manual cleaning + PX-UV journal of infection control. 2016 Sep 1;44(9):e157-61. Beal A, et al. First UK trial of Xenex PX-UV, an automated ultraviolet room Reduced environmental bioburden from an average of 35 decontamination device in a clinical haematology and bone marrow United Kingdom Environment CFU to 2 CF U per contact plate; VRE detected in 32% of transplantation unit. Journal of Hospital Infection. 2016 Jun 1;93(2):164-8. manual cleaning and 20% of PX-UV samples Dippenaar R, Smith J. Impact of pulsed xenon ultraviolet disinfection on 90% reduction in total surface bioburden was noted surface contamination in a hospital facility’s expressed human milk feed South Africa Environment from the control period (544 CFU) compared to the preparation area. BMC infectious diseases. 2018 Dec;18(1):91. corresponding PX-UVD period (50 CFU) Casini B, et al. Evaluation of an ultraviolet C (UVC) light-emitting device Reduced CFU on high-touch surfaces after PX-UV for for disinfection of high touch surfaces in hospital critical areas. HIS Italy Environment operating theaters with low turnover and high turnover Conference 2018 operating theaters (94-100%, p<0.0001) Rodríguez-Garrido V, et al. Evaluation of the XenexGerm-Zapping A significant decrease in the number of total MDRO RobotsTM device (XenexGZR) in the control of environmental Spain Environment isolates was observed with the use of PX-UV contamination in an Intensive Care Unit (ICU). HIS Conference 2018 Villacís JE, et al. Efficacy of pulsed-xenon ultraviolet light for disinfection of 75% reduction in MDRO environmental contamination high-touch surfaces in an Ecuadorian hospital. BMC infectious diseases. Ecuador Environment compared to manual cleaning alone; In-vitro testing 2019 Dec;19(1):575. saw a 8-log reduction in MDRO Litvinov VI, et al. Study of mycobactericidal activity of a pulse ultraviolet 99% reduction in Mycobacterium after 8 minutes of PX- radiation of a continuous spectrum. Tuberculosis and Lung Disease. 2018 Russia Laboratory UV at 2-meters distance May 17; 96 (4): 39-46. Stibich M, Stachowiak J. The microbiological impact of pulsed xenon ultraviolet disinfection on resistant bacteria, bacterial spore and fungi Total elimination of Ebola and Anthrax, >6-log reduction Spain Laboratory and viruses. Southern African Journal of Infectious Diseases. 2016 Jan of MRSA, CRE, MDR-A. baumanii 1;31(1):12-5. Maslo C, et al. The efficacy of pulsed-xenon ultraviolet light technology on 99% reduction in C. auris after 15-minute cycle of PX-UV South Africa Laboratory Candida auris. BMC Infectious Diseases. 2019 Dec;19(1):540. at 2-meter distance Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S123

organisms (MDROs) in patients transferred from LTCFs between dilution (IUD) of hospital, 0.5 x IUD and 1.5 x IUD. The bacterial March 2018 and February 2019. Rectal swabs were cultured cell suspensions were inoculated and dried before the carrier was for vancomycin-resistant enterococci (VRE) or carbapenem- immersed in test disinfectants for manufacturer recommended resistant Enterobacteriaceae (CRE) at the time of admission. The contact time. Then the carrier was transferred to neutralizer anti-microbial susceptibilities of microorganisms isolated from solution which was cultured on nutrient agar using spread plate obtained body fluids within 48 hours of admission were analyzed. technique. The number of viable colonies and Microbicidal effect Logistic regression was performed to determine risk factors for the of the disinfectants were calculated. carriage of MDROs. Four hundred and twenty-six patients from Results: Disinfectant 1 was not effective in manufacturer 86 LTCFs were enrolled. Among them, 41.5% (n = 177) patients recommended concentrations on glass, stainless steel and rexine carried one or more MDROs. The prevalence of MDROs was 7.7% surfaces. Microbicidal effect of disinfectant 2 was significantly for methicillin-resistant Staphylococcus aureus (n = 33), 20.7% for higher when compared to disinfectant 1. Both disinfectants extended-spectrum β-lactamase-producing Enterobacteriaceae showed poor activity on rexine surfaces. (n = 88), 2.6% for multidrug-resistant Pseudomonas aeruginosa (n Conclusion: Disinfectant 1 is not effective in manufacturer = 11), 4.0% for multidrug-resistant Acinetobacter baumannii (n = recommended concentration. Effectiveness of high level 17) and 16.7% for VRE (n = 71). Any infectious condition [OR 3.03; disinfectants on rexine is unreliable. (95% CI 1.67-5.50), p < 0.001], previous carriage of MDROs within one year [OR 2.48; (95% CI 1.27-4.84), p = 0.008], or previous use of antibiotics for longer than two weeks [OR 2.37; (95% CI 1.06- P1-HI09 5.28), p = 0.035] were independently associated with carriage Risk factors for Carbapenemase-Producing Enterobacteria- of MDROs (Figure). Our study identifies predictors of MDRO ceae(CPE) Acquisition Among Contacts of Newly Diagnosed carriage, allowing for more efficient management of high-risk CPE Patients During Hospital stay at the Multi-person room. patients. YJ Lee1*, OM Kweon1, KW Cha1, IA Yu1, ES Park1, JY Choi1, 2 1Division of Infection Control, 2Division of Infectious Disease, Severance Hospital, Seoul, Republic of Korea

Background: It is important to identify and monitor contacts of newly diagnosed Carbapenemase-producing Enterobacteriaceae (CPE) patients in order to control the extensive spread of CPE. In this regard, this study analyzed the risk factors for CPE acquisition among contacts of the index patients and ultimately suggested a preventable way to minimize chances of exposure to CPE Method: The case-control study was conducted. All patients, who stayed with the index patients at multi-person rooms for over 24 hours, were included and the data from September 2015 to June 2019 was reviewed. The case group consisted of 57 contacts, who P1-HI08 screened positive for CPE. Also, in their results, the types of both Effectiveness of commonly used disinfectants on bacteria organism and Carbapenemase gene were identical with those of responsible for hospital acquired infections in Sri Jayewar- each index patient. 171 contacts were in the control group, who denepura General Hospital, Sri Lanka screened negative for CPE. They were randomly selected three K Jayatilleke*, Y Weerasinghe, C Boteju, P Gunasekara, times as many as the case group. R Widanagamage, C Karunarathna Result: In the multiple logistic regression analysis, the significant Sri Jayewardenepura General Hospital, Sri Lanka, General Sir risk factors were the attending doctor (aOR 2.80; 95% CI 1.21-6.49, John Kotelawala Defense University, Sri Lanka P=0.016), ICU stay (aOR 2.01; 95% CI 1.02-3.97, P=0.043), and the contact period with the index patient ≥ 7 days (aOR 3.47; 95% CI Background: Hospital-acquired infections (HAI) lead to high 1.79-6.71, P<0.001). morbidity and mortality throughout the world. Contaminated Conclusion: During the hospital stay at the same multi-person instruments and environmental surfaces lead to HAI. Disinfec- room where the assigned nurses are identical, the attending tants play a crucial role in preventing HAI. This study focuses on doctor, ICU stay, and the contact period with the index patient ≥ 7 high level disinfectants named as disinfectant 1 and 2 used in Sri days might have an impact on the acquisition of CPE. Therefore, Jayewardenepura General Hospital (SJGH). Disinfectant 1 had the standard precaution and environmental cleaning measures peracetic acid and hydrogen peroxide and disinfectant 2 had must be strictly maintained to prevent the spread of CPE. Didecyl dimethyl ammonium Chloride. However, characteristics of the index patient such as the range of Method: Quantitative carrier test was performed according to the daily activities could be also potential risk factors. Thus, further European Standard EN 14561:2006. Disinfectants were tested at study is needed to explain such limitation three different concentrations on glass, stainless steel and rexine surfaces against most common three bacteria responsible for causing HAI in SJGH (Escherichia coli, Acinetobacter species and Staphylococcus aureus). Test concentrations used were In use S124 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-HI10 infection; however, related statistics of this age group hardly exists. Augmentation of in vitro Bactericidal Effect of Low Tempera- This study aims to estimate their handwashing behavior in school ture Atmospheric Pressure Plasma with TiO2 and the impact of handwashing education. So Youn Shin1* , Myoung Hee Cha1 Methods: The handwashing education targeted 3rd grader and 1Department of Infectious Diseases, International St. Mary’s the number of participants was 179 from 3 schools (9 classes) Hospital, Catholic Kwandong University College of Medicine, in Daegu. The program was composed of two times of 1.5 hours Incheon, Korea class in April and May during spring semester of 2019, and it included two times of individual survey on handwashing, open- Background: Non thermal atmospheric pressure plasma is a ended class discussion, handouts, learning demonstration novel decontamination method. Applying an electric field to and activities using Glitter Bug and Clean Trace Luminometer. a working gas generates plasma species which cause oxidative Behavior changes were analyzed using paired t-test and chi- stress and damage bacterial cells. This study was carried out to square test. evaluate the bactericidal effect of low temperature atmospheric Results: The mean knowledge and attitude score on handwashing pressure plasma on 5 different pathogens responsible for hospital were 4.36 and 4.59 out of 5, and improved up to 4.73 (p=0.0001) acquired infections. In addition, a photocatalytic agent (TiO2) and 4.74 (p=0.018), respectively. The mean washing time was which is known to be strengthening the radical reaction of the 20.1sec and increased by 3.4sec (p=0.002). The proportion of using plasma was added to increase the bactericidal effect. soap was raised by 19.2% up to 68.0% (p=0.0001). An enhanced Methods: E. coli , S. aureus, E. faecalis, A. baumannii, and P.aeru- drying method resulted in 3.4% of significant increase (58.8% of ginosa were selected to be tested in this study. This experiment proper drying). The most improved students’ behavior was how to was carried out in a chamber designed by the authors. The close a tap: only 32.0% of students closed a tap properly before the plasma was continuously generated by a non-thermal dielectric program. After education on the other hand, 58.4% of participants barrier discharge (DBD) plasma generator (3kV). Suspensions answered that they properly close a tap (p=0.0001). of 0.5 McFarland standard (1.5 x108CFU/mL) were prepared for Conclusion: The handwashing education is likely to help students each organisms. The suspensions were serially diluted until 1:106 improve their knowledge, attitude and practice of handwashing (approximately 102 CFU/ml) and inoculated on agar plates. The in school. plate s were exposed to the plasma in combination with TiO2 for 2 minutes. Results: The results showed that the 2 minutes exposure to TiO2 P1-HI12 coupled plasma chamber showed augmented in vitro bactericidal Prediction of Bacteremia based on 12-year medical data effects compared to plasma chamber only: E.coli (6.18 log CFU/ using machine learning approach cm2 reduction vs 7.18 log CFU/cm2 reduction) and (S.aureus 4.18 Kyoung Hwa Lee1, Jae June Dong2, Su Jin Jeong1, log CFU/cm2 reduction vs 6.18 log CFU/cm2 reduction). The TiO2 Myeong-Hun Chae3, Byeong Soo Lee3, Hong Jae Kim4, coupled plasma chamber was tested for E. faecalis, A. baumannii, Sung Hun Ko4, Young Goo Song1* P.aeruginosa and showed 7.18, 7.18 6.18 log CFU/cm2 reduction 1Division of Infectious Diseases, Department of Internal Medicine, respectively. Yonsei University College of Medicine, Seoul, Republic of Korea, Conclusion: TiO2-based plasma sterilization systems can 2Department of Family Medicine, Yonsei University College of successfully kill pathogens responsible for hospital acquired Medicine, Seoul, Republic of Korea, 3Selvas Artificial Intelligence infections in a very short period of time. This novel technology Incorporate, Seoul, Republic of Korea, 4Department of Medical could significantly contribute to the infection control. Information, Gangnam Severance Hospital, Seoul, Republic of Korea.

P1-HI11 Backgrounds: Analysis using artificial intelligence techniques The Impact of Handwashing Education Program on Knowl- have recently been attracting attention, and they are mainly used edge, Attitude and Practice of Elementary School Student in for diagnosis using medical image or predicting the prognosis Daegu of chronic diseases such as malignancies. The application of the Jin A Kim1, Kyoungmi Kim1, Jiseon Seong1, Yunjung Kim1, machine learning approach to the acute infectious disease is not Hyuna Jang1, Younjoo Kim1, Shin-Woo Kim1,2 yet usable. The aim of this study is to make a model of predicting 1Daegu Center for Infectious Diseases Control and Prevention, bacteremia when the blood culture is applied to the patients of Republic of Korea, 2Department of Internal Medicine, School of acute infectious diseases. Medicine, Kyungpook National University, Daegu, Republic of Methods: From January 2007 to December 2018, all blood culture Korea episodes were extracted from the electrical medical record of patients over eighteen years old at Sinchon and Gangnam Background: According to the yearly report of national infectious Severance Hospital, a university-affiliated tertiary-care center disease (NID) surveillance, 65.2% of the most frequent NID in in Seoul. Only significant true bacteremia were included except Daegu consists of communicable diseases, such as chicken pox, contamination of normal flora and fungal infection. Patients with mumps, and scarlet fever, which are common among children the result of same bacterial strain within 72 hours were excluded. especially in 1-3 year of elementary school. Handwashing with The gender, age, vital sign, and the results of laboratory test within soap is known as cost-effective behavior to prevent disease 24 hours from onset time of blood culture were used as analytical Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S125

variables. For data training, the multi-layer perceptron (MLP), perfringen, C. neoformans, T. rubrum, C. difficile, Multidrug- stacking ensemble and xgboost method were used, and then resistant M. tuberculosis (MDR-TB), M. tuberculosis H37Rv, validation was performed. M. avium (Nontuberculous mycobacteria; NTM), was also Results: A total of 38,752 bacteraemia episodes were identified investigated. Moreover, we continued to investigate a few more from 622,771 patients. In MLP, with 128 hidden layer nodes, the cationic disinfectant formulations for possible destruction effects area under the receiver operating characteristic curve (AUC) of of extracellular bacterial DNA, i.e. resistance plasmids carrying the prediction performance was 0.752 (95% CI; 0.750-0.751) and blaTEM-1, blaNDM-1, blaCTX-M, and mcr-1 genes, respectively. Effects in MLP with 64-128-64 hidden layer nodes, it was 0.742 (95% CI; between our products and the high level disinfectant product 0.732-0.751). In stacking ensemble method, the AUC was 0.751 imported from EU were compared. The results indicated that, the (95% CI; 0.748-0.753). The xgboost, another ensemble model was novel cationic formulation in the concentration of 0.1% exhibited used for analysis, the AUC was non inferior compared with other the antimicrobial activity against antibiotic-resistant pathogens machine learning method (AUC; 0.751 [95%CI 0.745-0.757]). in 1 minute of exposure time and 5 minutes for P. mirabilis. Conclusion: Prediction of bacteremia using artificial intelligence Interestingly, formulations can eliminate the presence of bacterial showed high AUC, and the possibility of applying a machine DNAs in the mixing reactions, while the EU product did not have learning approach to prediction of prognosis in acute infectious this effect. We produced the novel cationic disinfectant formulas diseases. Based on several important vital signs and the results of for killing of antibiotic-resistant pathogens along with their blood tests, the real-time monitoring will be helpful in improving resistance genes that may be released upon killing action. clinical prognosis in real clinical practice.

Table 1. Results and performance of the bacteremia predictions P1-HI14 using various machine-learning techniques. Effect of Developed Enzymatic Cleaning Detergent on in Model Algorithms AUC (95% CI) Sensitivity Specificity vitro Biofilm Removal Efficiency 1,2* 1,3 3 1 A MLP (128) 0.752 (0.750 - 0.751) 0.663 0.706 C. Saenjum , T. Uirungroj , P. Uirungroj , S. Sirilun B MLP (64-128-64) 0.742 (0.732 - 0.751) 0.647 0.703 1Department of Pharmaceutical Sciences, Faculty of Pharmacy, C MLP(128), Stacking(n=10) 0.751 (0.748 - 0.753) 0.677 0.687 Chiang Mai University, Chiang Mai, Thailand,2 Cluster of D MLP(128), Stacking(n=15) 0.751 (0.749 - 0.753) 0.672 0.698 Excellence on Biodiversity Based Economy and Society (B.BES- E XGBoost(Gbtree) 0.751 (0.745 - 0.757) 0.636 0.732 CMU), Chiang Mai University, Chiang Mai, Thailand, Abbreviations: AUC, area under the receiver operating characteristic curve; CI, 3 confidence interval; MLP, multi-layer perceptron. PoseHealthCare Co., Ltd., 1 Soi Ramintra 107, Ramintra Rd., Kannayao, Bangkok, Thailand

P1-HI13 Biofilms are of great importance in cross-contamination, infection High Level Disinfectant STEREX®S: From Bench Lab to control, and healthcare-associated infections. Biofilm formation Commercialized Product on reusable medical device surface is a risk for healthcare- C. Saenjum1,2*, M. Deeudom3, P. Tharavichitkul3, T. Ouirungroj1,4, associated infection. This study aimed to investigate the in vitro C. Tribuddharat5, P. Uirungroj4 biofilm removal of developed enzymatic cleaning detergent. 1Department of Pharmaceutical Sciences, Faculty of Pharmacy, Three formulations of developed enzymatic cleaning detergent Chiang Mai University, Chiang Mai, Thailand,2 Cluster namely Tergezyme®, Posezyme-LF®, and Posezyme-ND® were of Excellence on Biodiversity based Economic and Society selected to investigate for in vitro biofilm removal efficiency. (B.BES-CMU), Chiang Mai University, Chiang Mai, Thailand, Representative biofilm forming bacterial strains and associated 3Department of Microbioloigy, Faculty of Medicine, Chiang Mai infections including Staphylococcus aureus, Pseudomonas University, Chiang Mai, Thailand,4 PoseHealthCare Co., Ltd., 1 aeruginosa, and Escherichia coli were cultured and form biofilm Soi Ramintra 107, Ramintra Rd., Kannayao, Bangkok, Thailand, on 1.5 cm diameter of cover slit in a 24-well-plate system. After 1, 5Department of Microbiology, Faculty of Medicine Siriraj Hospital, 5, and 10 minutes of exposure to enzymatic cleaning detergents, Mahidol University, Bangkok, Thailand the removal of the biofilm was quantified by crystal violet staining, while the efficiency of biofilm removal were evaluated by The prevalence of antibiotic resistance among bacteria has scanning electron microscope (SEM). The resulted demonstrated been increasing worldwide. In our previous study, a novel that all of enzymatic cleaning detergents significantly reduced cationic disinfectant formulation against antibiotic resistant both of biofilm formation and biofilm forming bacterial strains microbial pathogens namely STEREX® S, was developed after 5 minutes of exposure time. Additionally, SEM monograph and used for antimicrobial activity, and showed no toxicity revealed that undetectable biofilm and biofilm forming bacterial in mice.This study was carried out to develop novel cationic strains on cover slit after 5 minutes of exposure time. It can formulation against antibiotic-resistance microbes using for conclude here that, all of selected enzymatic cleaning detergents cross-transmission and cross-contamination prevention and significantly reduced both of biofilm and all representative control. The antimicrobial activity against antibiotic-resistant biofilm forming bacterial species after 5 minutes of exposure pathogens including Methicillin-resistance S. aureus ATCC time. 25923, vancomycin-resistance enterococci, A. baumannii, P. aeruginosa ATCC 27853, ESBL-producing E. coli, K. pneumoniae, P. mirabilis, Salmonella enteritidis, B. subtilis, S. maltophilia, C. S126 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-HI15 transplantation (FMT) appears to be an attractive option for Investigation of a uveitis outbreak associated with the use of decolonization among CPE carriers. an anti-adhesion agent during surgery in a Korean tertiary Methods: FMT was considered on CPE carriers ≥ 18 years with care center risk factors of prolonged carriage of CPE such as carbapenem KW Cha1, OM Kwon1, JY Ahn2*, JY Lee3, HY Bae4, YA Lee5, use, positive CPE in clinical specimen, concurrent Clostridioides EJ Kwon5, ES Park2, JY Choi1 difficile infection, long duration of hospitalization after initial 1Department of Infection Control, Severance Hospital, Seoul, Korea, CPE acquisition. A frozen stool from unrelated healthy donor 2Department of Internal Medicine, Yonsei University College of who were already pre-screened (MicroBiotix FMT Delivery Medicine, Seoul, Korea, 3Department of Urology, Yonsei University Microbiota Preparation) was used for each FMT. One-day College of Medicine, Seoul, Korea, 4Department of Ophthalmology, FMT procedures were performed through colonoscopy or Yonsei University College of Medicine, Seoul, Korea, 5Department esophagogastroduodenoscopy. Successful decolonization was of Operation Room, Severance Hospital, Seoul, Korea determined by three consecutive negative rectal swabs repeated with a 3-7d interval within 3 months after FMT. Background: Five patients developed bilateral anterior uveitis Results: FMT was performed to decolonize CPE in the gut of 16 within 1-2 days after urologic surgery for 40 days since November patients between January 2019 and July 2019. Median duration 2018. We conducted an outbreak investigation to clarify the of CPE colonization before FMT was 2.5 months (range, 2-10 possible cause. months). Decolonization success rates at the 1, 2, 3-month time Methods: We defined a suspected case as diagnosed as bilateral point were 50.0% (8/16), 56.3% (9/16), 62.5% (10/16), respectively. uveitis by ophthalmologists due to the onset of ocular congestion And median time to successful decolonization from FMT within three days of surgery. We hypothesized the patients were procedure was 21 days (range, 9-67 days). exposed to a substance during operation, causing systemic Conclusions: Despite the limitation of the number of included inflammation. Medical records were reviewed to find cases patients, this study indicates a potential benefit of FMT as and controls matched by the operating room or admission decolonization therapy in patients with risk factors of prolonged department. carriage of CPE. Results: We identified 15 cases and 25 controls between Novem- ber and December 2018, and 2 cases and 307 controls during January 2019. The case-control study revealed that the case group P1-HI17 had a significantly higher rate of exposure to one anti-adhesion Effects of Benzalkonium Chloride on Microbiota in Healthy agent during surgery produced by a single manufacturer. (13.3% Eyes vs 0.0%, p<0.001, between Nov and Dec 2018, 7.7% vs 0.0%, Chen Shih-Ying1, Kok Li-Ching2, Chang Hwan-You2, p<0.001 in Jan 2019) No new cases have occurred since discon- Ko Mei-Lan3, Yang Chih-Man1 tinuing the use of this agent. We reported the cases to the Korea 1National Taiwan University Hospital Hsin-Chu Branch, Ministry of Food and Drug Safety. The Patient Safety Alert was Department of Lab, Hsin-Chu, Taiwan, 2National Tsing Hua issued due to the high probability of causing uveitis by non-infec- University, college of Life Science Hsin-Chu, Taiwan, 3National tive immune reactions of the chitosan component. Taiwan University Hospital Hsin-Chu Branch, Department of Conclusion: Post-operative uveitis was possibly related to the Ophthalmology, Hsin-Chu, Taiwan use of an anti-adhesion agent during surgery in this outbreak. Close monitoring of the patient’s symptoms and detection of the Many microorganisms are present on the surface of human outbreak was essential for identifying the source to prevent the eyes, although their relative abundance and dynamic changes new case. stimulated by many environmental factors such as antimicrobial treatments remain unclear. This study investigates the effects of benzalkonium chloride (BAK), a common preservative used P1-HI16 in eye drops, on microbiota of human eyes. Samples of upper The effect of fecal microbiota transplantation for eyelids and lower conjunctiva of the 15 volunteers were collected the decolonization of carbapenemase-producing using a test rod before and after instillation of BAK-containing Enterobacteriaceae in the gut artificial tears for three days. Eye microbes were isolated on blood Seung Soon Lee1*, Ki Tae Suk2, Dongeun Yong3 agar, eosin methylene blue agar and chocolate agar using a three- 1Division of Infectious Diseases and 2Department of zone line technique. The identification and antibiotics sensitivity gastroenterology and hepatology, Chuncheon Sacred Heart testing obtained using the VITEK2 instrument. A total of 29 Hospital, Hallym University College of Medicine, Chuncheon, isolates belonging to 8 species from the eyelid and 16 isolates South Korea, 3Department of Laboratory Medicine and Research belonging to 5 species from conjunctiva were found. Those Institute of Bacterial Resistance, Yonsei University College of reduced to 21 isolates in 7 species and 5 isolates in 4 species, Medicine, Seoul, South Korea respectively after applying 3-day BAK-containing artificial tears, the P values were not significant (0.15 and 0.09). The most Background: Carbapenemase-producing Enterobacteriaceae common isolated species was Staphylococcus epidermidis, which (CPE) is an urgent antibiotic threat due to the high associated up to 52.4% of total isolates. The similarity of the species isolated mortality, limited therapeutic options, and potential to from the eyelid and the conjunctiva was 42.6 ± 43.2%. The number rapid spread between bacterial species. Fecal microbiota dropped to 12.5% ± 32.5% after applying BAK artificial tears for Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S127

three days. The percentages of drug-resistant strains on eyelid use in the hospital. There is a need to empower nurses and increasing from 48.1 to 68.4%. The result strongly suggests that formally recognise their role in antimicrobial stewardship. BAK exerts a selection force to increase resistance of the microbe to other antibiotics, although the detail mechanism remains to be investigated. P1-HI19 To Test or Not To Test: Cost-Minimization Analysis of Immu- 表五、不同組別眼結膜與眼瞼分離菌株的相似度（％） nization Strategy for Healthcare Workers during Measles conjutava/Eyelid Outbreak in Korea ND0 42.6±43.24 HeeKyoung Choi, Hyeri Seok, Won Suk Choi, Hyun Kyung Cho, ND3 12.5±32.5 Jihye Jung, Min-ji Seo, Sul A Sung, Su Hyun Kim, Yun-Kyung Kim, ND0:使用人工淚液前對照組，ND3: 使用人工淚液三天之對照組 G Byung Min Choi, Dae Won Park Korea University Ansan Hospital, Korea 表七、不同組別分離微生物的抗藥性 0R 1R 2R 3R 4R Background: During measles outbreak, non-selective eyelid 14 9 2 2 0 immunization activities are recommended by WHO in countries conjutiva 5 6 1 ND0 Eyelid (%) 51.9% 33.3% 7.4% 7.4% with mortality reduction goals. However, such activities have not conjutiva(%) 41.7% 50.0% 0.0% 0.0% 8.3% been as strongly endorsed in elimination setting, where baseline eyelid 6 11 1 1 0 vaccination levels are high and outbreaks occur in defined conjutiva 2 2 0 0 0 pockets of under-immunization. Therefore, we performed a cost- (看不懂表七, ND3是哪裡) minimization analysis to compare two management options (serology check versus universal vaccination) for healthcare workers (HCWs) during measles outbreak. P1-HI18 Methods: A decision analytic model was developed from a Factors influencing nursing activities in antibiotic use hospital perspective. We assumed that the measured outcomes, within the inpatient setting of a public acute care hospital: A achieving near-perfect immunity, is equivalent. Assumptions qualitative study include equal immunogenicity in both strategies and the cost of M Tan, H Guo, M Ibrahim, J Tan, J Yeo, L Wong, J Somani, L Lum, vaccination and antibody serology testing. We also assumed that D Lye, A Chow* a positive serological result indicate that a HCW was likely to be Tan Tock Seng Hospital, National University Hospital, Singapore immune to the condition. To test the robustness of the economic model, one-way sensitivity analysis was conducted using vaccine Nurses play a critical role in the care of patients. However, nurses costs, serological testing costs, and prevalence of measles have not been formally recognized as members in antimicrobial immunity among HCWs. stewardship teams. Thus, our study aimed to explore the nursing Results: In the base case, the serology check strategy showed a activities pertaining to antibiotic use and the factors influencing cost advantage over the option of universal vaccination strategy such activities to guide future engagement of local nurses in (40,770 versus 50,000). Within the assigned sensitivity ranges with antimicrobial stewardship. cost of lab and cost of vaccine, serology check strategy was always Five focus group discussions (FGDs) were conducted among the preferred strategy, cost advantage never crossed the threshold junior and senior registered nurses (n = 34) who practised in of 0. Sensitivity analysis on percentage of measles immunity medical, surgical, and intensive care wards in a local tertiary showed that universal vaccination becomes the preferred option hospital for at least 1 year. The discussions were analysed using with a prevalence of measles immunity ≤ 70%. applied thematic analysis, guided by the socio-ecological model. Conclusion: The decision model indicated that serology check 5 themes encompassing intrapersonal, interpersonal, and strategy result in lower overall costs in HCWs with uncertain institutional factors emerged from the FGDs. Participants were immunity during measles outbreak in measles elimination involved in antibiotic administration, providing suggestions setting. on antibiotic use, and providing guidance and education to patients/caregivers on antibiotics. Varying responses towards clinical indications for antibiotics and perceptions of current P1-HI20 antibiotic use in the hospital emerged. Nurses were more Improvement of Kor-GLASS: beyond the early implementa- concerned about antibiotic administration than antibiotic tion stage ordering, although responsibility towards patient safety SY Lee*, JW Kim, KJ Lee, C Park, SM Bae† motivated nurses to query physicians’ orders. Nurses expressed Division of Antimicrobial Resistance, Center for Infectious Diseases confidence in escalating orders or querying physicians regarding Research, NIH, Korea Centers for Disease Control & Prevention, antibiotics administration, but also reported a reliance on Republic of Korea pharmacists for their involvement in antibiotics use. Finally, institutional resources and support systems, including antibiotic Background: In 2016, the Korea Centers for Disease Control administration guidelines, influenced nursing activities in (KCDC) established national AMR surveillance system Kor- antibiotic use within the hospital. GLASS, which is compatible with WHO GLASS platform. In this Nurses are involved in various processes pertaining to antibiotic article, we summarized the development and improvement S128 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

process of Kor-GLASS. BSI were more frequent in period 2 (2.7% vs. 11.1%, p=0.002). Methods: Kor-GLASS began AMR surveillance for general, Quinolone resistance (97.8% vs. 26.8%, p <0.001) and extended- medium-sized and long-term care hospitals in six sites, expanded spectrum β-lactamase producers (45.7% vs. 11.3%, p <0.001) to eight sites in 2017 and coordinated hospitals to be collected in among Enterobacteriaceae significantly reduced in period 2. 2018. In addition, one quality control center was established for Conclusion: Strategic restriction of fluoroquinolone prophylaxis quality improvement since 2017. In 2017, we developed a web- and empirical use of carbapenem resulted in significant reduction based Kor-GLASS database system for the management and of resistant bacterial BSIs, without increase in febrile neutropenia, analysis of data collected from each sectors and external quality BSI, and BSI-related death. Antibiotics stewardship program can assessment schemes was added to the database system in 2018. be tried in neutropenic patients, which may improve the ultimate The AMR data are converted to WHO GLASS data format via Kor- outcome. GLASS database and are annually uploaded into the IT platform of WHO GLASS. Kor-GLASS has been designed with five sectors; KCDC (the National Coordination Centre and the National P1-MM01 Reference Laboratory), hospital sentinel sites, analysis center Molecular Identification of Fungi causing Tissue Mycoses (central laboratory), and quality control center. from Formalin Fixed Paraffin Embedded (FFPE) Tissue Results: A total of, 34,582 strains (12 pathogens) were collected Samples in Hospital Serdang from Year 2013-2018 1,2* 1 1 2 3 from the hospital sentinel sites from May 2016 to December 2018. SM Rahim , NB Affendy , R Ibrahim , F Amran , N Omar , MRSA continued to decrease during the last three-year period, SN Masri1 from 53.5% in 2016 to 47.1% in 2018. The resistance of E. faecium 1Department of Medical and Parasitology, Faculty of Medicine to vancomycin increased from 29.9% in 2016 to 39.4% in 2018. The and Health Sciences, Universiti Putra Malaysia, Malaysia, resistance of in E. coli to cefotaxime increased from 35.4% in 2016 2Bacteriology Unit, Institute for Medical Research, Kuala Lumpur, to 38.6% in 2018. The AMR data of Kor-GLASS has been reported Malaysia, 3 Pathology Department, Hospital Serdang, Malaysia to WHO GLASS three times. Introduction: Isolation and identification of fungal from tissue Conclusions: Kor-GLASS provides the current AMR status in our sample using a conventional methods are time consuming. country. KCDC is implementing several next steps to enhance Histopathological examination (HPE) on the other hand is AMR surveillance by providing better evidence for AMR decision not specific, therefore can only give a presumptive diagnosis. making in Korea. Alternatively, non-cultural method like polymerase chain reaction (PCR) is another option for fungal identification. Aim: To determine the usefulness of PCR in diagnosing tissue P1-HI21 mycoses from FFPE tissue sample. Impact of Prophylactic Fluoroquinolone Restriction and Methods: A total of 87 FFPE tissues with positive fungal stains Carbapenem Saving Strategy on the Epidemiology of were collected from archive samples within 5 years duration. PCR Bloodstream Infection during Chemotherapy for Acute was conducted from the extracted DNA and amplified using the Leukemia universal primer sets ITS3F/ITS4R that targeting the ITS 2 region. Y Yi*, SY Cho, DG Lee, JK Choi, HJ Lee, SH Kim, SH Park, SM Choi, Results: Fungal DNA were amplified from 52 (59.8%) samples JH Choi, JH Yoo in which only 26 (50%) of the identification were consistent Division of Infectious Diseases, Department of Internal Medicine, with clinical and HPE findings. The commonest fungi identified College of Medicine, The Catholic University of Korea, Republic of were Aspergillus spp. (55.8%), Candida spp. (28.9%), and Korea Penicillium spp. (5.8%) with different speciation. Beside this, rare plant fungi such as Phytium insidiosum and Diaphorthe longicolla Backgrounds: Fluoroquinolone prophylaxis has been widely were also detected. used in acute leukemia patients due to high risk of neutropenic Conclusion: This revealed that the PCR can be used for accurate fever during chemotherapy. However, concerns about antibiotic and early identification of fungi. However the result must be resistance exist. We assessed the impact of our institutional strat- carefully interpreted as the 50% rate of discordant result seen in egy of restricting fluoroquinolone prophylaxis and empirical car- this study gives the impression that presence of contamination bapenem use, applied since Oct. 2016. Prophylactic fluoroquino- by the saprophytic fungi should not be ignored. Correlating the lone was used only during remission induction chemotherapy. PCR result with clinical and HPE findings is crucial in acquiring a Methods: We retrospectively reviewed consecutive episodes of definitive diagnosis. intensive chemotherapy for acute leukemia from Apr 2016 to Sept 2016 (Period 1) and Apr 2017 to Sept 2017 (Period 2) at the Catholic Hematology Hospital. P1-MM02 Results: 183 and 199 admissions were identified in period 1 and A Rare Clinical Case Report of Unusually located period 2, respectively. Baseline characteristics including types of Sporotrichosis mimicking Cutaneous Tuberculosis leukemia, chemotherapy, severity and duration of neutropenia successfully treated with Terbinafine reported in Western were not different between two periods. Incidence of febrile Nepal neutropenia (84.0% vs. 89.9% p=0.091), bloodstream infection Sushanta Poudel1, Kaushal Malla1, Nabaraj Bhugai1 , Anil Gautam2 (BSI, 44.8% vs. 54.7%, p=0.052), and BSI-related death (1.1% vs. 1Nepal Army Institute of Health Sciences, 2RECAST, Tribhuvan 1.5%, p= 0.539) were not significantly different. Polymicrobial University Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S129

Introduction: Sporotrichosis also known, as rose gardener’s dis- samples. All the C. albicans were susceptible to fluconazole, ease is a rare chronic cutaneous fungal infection caused by fungus voriconazole and echinocandins. Susceptibility of C. parapsilosis Sporothrix schenkii. The fungus is widely distributed on environ- and C. tropicalis towards echinocandins and azoles were 100% ment, soil and agricultural products. Here we describe a case of and 88% respectively. MIC Amphotericin B ranged from 0.2 - 1μg/ cutaneous Sporotrichosis of 39 years old adult male working as L for all the isolated Candida except for C. kefyr, 2.0μg /L. agricultural farmer from Lekhnath-8, Pokhara, Western Nepal. Conclusion: High prevalence of non-albicans candidemia Methods: Patient was presented with non-healing ulcer on right observed in Hospital Kuala Lumpur, Malaysia. Susceptibility pinna for 2 years along with multiple papulo-nodular lesions of towards antifungal are still high among Albicans and non- different shape and size on right forearm and arm for 6 months. albicans Candida except in C. glabrata and C. krusei, hence usage The case was initially misdiagnosed as the cutaneous tuberculosis of these drugs for empirical therapy is still reliable. Continuous was given anti-tuberculosis treatment. However, there was no monitoring of antifungal susceptibility pattern is warranted as the progress on treatment and it further deteriorated with distortion resistance can emerge. of right ear. Histopathological biopsy and microbiological fungal culture was carried. Result: Pathological finding and fungal culture revealed sporo- P1-MM04 trichosis along with features of tuberculosis such as multinucle- Trehalase inhibitor, validamycin A, inhibits the growth ated giant cells, scattered epithelioid cells and histiocytes and and shows an additive effect with amphotericin B against growth of fungus on fungal culture media. The patient was then Aspergillus flavus treated with terbinafine 250 mg for 6 months and case was evalu- N. Plabutong, D. Chiewchengchol, A. Thammahong* ated at every 2 months. Though the patient was recovered, he lost Antimicrobial Resistance and Stewardship Research Unit, the original structure of right ear due to delay in diagnosis and Department of Microbiology, Faculty of Medicine, Chulalongkorn treatment. University, Bangkok, Thailand, 10330 Conclusion: Nepalese population being more than 70% involved Background: Aspergillus flavus is a fungus can be found in the in agriculture is at greater risk of sporotrichosis infection. Since environment. This fungus is able to cause keratitis, cutaneous there is lacking of the particular features that differentiate the infections, and sinusitis in humans. Although this fungus can sporotrichosis with similar other skin infections it causes the be treated with antifungal agents, these main antifungal agents difficulty and delay in diagnosis. So this case report highlights have a lot of side effects. Therefore, the use of virulence factor or the need of early diagnosis, and proper treatment of the case to metabolic pathway specific to the fungus could be an alternative reduce the chronicity of disease and further complications. way to develop novel antifungal agents. Trehalase enzymes in fungi is an enzyme to digest trehalose molecules into two glucose subunits. It is in the trehalose pathway, which exists in fungi, P1-MM03 bacteria, plants, and insects, but not in humans. These enzymes Invasive candidemia; prevalence and antifungal are important for the fungal virulence to combat heat stress susceptibility pattern in a tertiary hospital in malaysia. Data and to survive inside hosts. In addition, a trehalase inhibitor, analysis from 2015 - 2017 called validamycin A, has been used effectively against a rice N. Umur, K. Pachayappan* fungal pathogen, Rhizoctonia solani. Therefore, in this study, our Hospital Kuala Lumpur, Malaysia. objective is to study the effect of validamycin on the growth of Aspergillus flavus. Background: Fungemia could be fatal. The frequency of Methods: Aspergillus flavus ATCC204304 was utilized initially fungemia mainly by Candida species has increased possibly due to study the growth of Aspergillus flavus on different media, i.e. to improvement in healthcare facilities enable those severely glucose peptone agar and trehalose peptone agar, to measure ill and immunocompromised survive longer. Hence, they are the radial growth in both conditions. To study the effect of high risk to develop invasive fungal infection. This study reports validamycin A on the trehalose level, the growth, and the the prevalence of Candida species isolated from blood stream germination rate of A. flavus, glucose oxidase assay, XTT (sodium infection in Hospital Kuala Lumpur from 2015 to 2017, with 2,3, -bis (2-methoxy-4-nitro-5-sulfophenyl) -5- [(phenylamino) analysis of their antifungal susceptibility pattern. -carbonyl] -2H-tetrazolium) assay, and germination assay were Methods: Yeast isolated from blood culture were collected, performed in biological triplicates. For the additive effect of identification was done by using API 32C or Vitek 2 system validamycin A with amphotericin B, the checkerboard assay was (bioMérieux). Antifungal susceptibility testing performed performed in biological triplicates and the fractional inhibitory using Sensititre YeastOne. Sensitivity towards Fluconazole, concentration index (FICI) was calculated. All data were Voriconazole, Itraconazole, Amphotericin B, flucytosine and performed in biological triplicates and analyzed using GraphPad Echinocandins were tested. Interpretations were based on Prism software version 7 and unpaired Student’s t-test was used breakpoints in Clinical Laboratory Standards Institute (CLSI). For for determining the significant difference. P-value < 0.05 showed antifungal and Candida species without reference breakpoints in that the difference was statistically significant. CLSI, MIC range were observed. Results: Aspergillus flavus ATCC204304 was able to grow on Results: Out of all 152 Candida species, 33.6% C. albicans, 31.6% trehalose peptone media similar to glucose peptone media. C. parapsilosis, 14.5% C. glabrata, 17.8% C. tropicalis, 1.3% C. Spores that were grown on media with 1 mg/mL validamycin krusei, 0.7% for both C. kefyr and C. rugosa were isolated in blood A showed significantly higher trehalose levels than the control S130 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

media without validamycin A. The effect of validamycin A on except for a few silent mutations of HS1 (5 isolates in C. albicans). the growth of A. flavus using XTT assay showed that 1 mg/mL Conclusion: Rare yeast species accounted for about 10% of yeast validamycin A inhibited the growth significantly compared to the bloodstream isolates. Despite the increased use of echinocandin control. To find the mechanism behind the inhibition of A. flavus antifungals, echinocandin resistance among C. albicans and growth, we performed the germination assay and found that the C. tropicalis was still low among bloodstream isolates in South spores in media with 1 mg/mL validamycin A germinated slower Korea. significantly at 10 and 12 hours compared to the control. To further investigate the additive or synergistic effect of validamycin A with an antifungal agent, amphotericin B, the checkerboard P1-MM06 assay was performed and showed that validamycin A and Candida vulturna: Novel and Multidrug Resistant Yeast amphotericin B had an additive effect with the FICI between 0.5-1. Species Associated with Candida auris Conclusion: Validamycin A, which is a trehalase inhibitor, Ratna Mohd Tap*, Stephanie Jane Ginsapu, Nur Amalina was able to inhibit the growth of Aspergillus flavus. One of the Kamaruddin, Nur Asyura Nor Amdan, Mohammad Ridhuan mechanisms behind the effect of validamycin A was to delay the Mohd Ali, Mohd Fuat Abd Razak, Fairuz Amran germination of A. flavus spores. In addition, validamycin A also Bacteriology Unit, Institute for Medical Research (IMR), National possessed the additive effect with amphotericin B, which is a Institutes of Health, 40170 Setia Alam, Selangor, Malaysia. fungicidal antifungal agent. The cytotoxicity of validamycin A to human cells and the effect of validamycin A on A. flavus clinical Background: Candida vulturna is a newly described Candida isolates are in progress to decipher the effect and the application species of the Metschnikowiacae, grouped in the Clavispora of validamycin A in the future. clade. It was first isolated from a blood sample of a patient dying of aspiration pneumonia. This emerging organism was first discovered in Institute for Medical Research. P1-MM05 Objective: In the present study, we describe on the mycology Species distribution and antifungal susceptibility of yeast and molecular characteristics of C. vulturna; and reveal their bloodstream isolates in South Korea antifungal susceptibility patterns. SH Kim*, MH Kim, C Park, JH Byun, JK Choi, SH Wie, JH Choi, Methodology and Results: Nine C. vulturna strains were isolated JH Yoo, DG Lee from blood of immunocompromised patients in Malaysian Division of Infectious Diseases, Department of Internal Medicine, hospitals. Macro- and microscopic characteristics of C. vulturna College of Medicine, The Catholic University of Korea, Seoul, are similar to the species of C. haemulonii complex. From the Republic of Korea BLAST results, all strains were 99.7% to 100.0% similar to 11- 1170 type strain. Molecular phylogenetic analysis revealed that Background: Echinocandin antifungals are the agents of choice the C. vulturna strains are close to the C. haemulonii complex for the treatment of invasive candidiasis. Widespread echinocan- and C. auris. Antifungal susceptibility test was carried out using din usage has been accompanies by reports of emerging drug E-test method and the interpretation of minimum inhibition resistance among clinical Candida isolates. concentration values was determined according to the Clinical Method: In a prospective multicenter study, we analyzed 106 of and Laboratory Standards Institute (CLSI) guidelines. All C. bloodstream isolates identified by yeast from three hospitals. For vulturna strains were highly resistant to amphotericin B with the molecular identification of yeast isolates, we performed an MIC >32 µg/ml. Moreover, 89% of these isolates were resistant internal transcribed spacer (ITS 1 & 4 regions) PCR, sequencing, to fluconazole and voriconazole, with MIC values of >256 µg/ and blast searching. The alignment of their sequences was ml and >32 µg/ml, respectively. About 67% of the isolates were performed by clustal omega method, and phylogenetic analysis moderately resistant to itraconazole. Meanwhile, anidulafungin was performed using the Maximum Likelihood method based and caspofungin showed good inhibition activity against all C. on the Tamura-Nei model of MEGA7. Also, we sequenced and vulturna strains. analyzed hot spot regions (HS1 & HS2) mutation of the β-(1,3)-D- Conclusion: This study highlights the need of correct identification glucan synthase for the correlation of echinocandin susceptibility of new and emerging yeast is vital. The multi-drug resistant such in C. albicans and C. tropicalis isolates. infections. Results: The sequencing analysis of ITS showed that C. albicans, C. parapsilosis, C. glabrata, and C. tropicalis isolates were prevalent in the yeast bloodstream infections. In addition, Clavispora P1-MM07 lusitaniae, Cyberlindnera fabianii, Kodamaea ohmeri, Meyerozy- Non-albicans Candida species: Emergence of neglected ma guilliermondii, Pichia kudriavzevii, Saccharomyces cerevisiae, pathogens and Wickerhamomyces anomalus were identified. The genetic K .Parajuli*, A. Sapkota, S. K. Mishra distance in non-candida yeasts arranged from 0.00 to 0.25, and Tribhuvan University Teaching Hospital, Nepal the phylogenetic analysis exhibited four of major clades diverged from that of major Candida species (C. albicans, C. parapsilo- Background: Candidiasis is a common fungal disease found in sis, and C. tropicalis) except for C. glabrata. In the analysis of humans affecting mucosa, skin, nails and internal organs of the HS regions, there were no mutations (641-FLTLSLRDP-649 & body. Although Candida albicans is the most prevalent species 1357-DWIRRTYL-1364) in C. albicans and C. tropicalis isolates involved in infections, the shift towards Non-albicans Candida Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S131

(NAC) which demonstrate low sensitivity to commonly used resistant to fluconazole(81.8%) followed by ketoconazole (63.6%) antifungal drugs are being increasingly reported. As there are only and itraconazole (40.9%). Also, Non- albicans Candida showed scanty data on antifungal susceptibility of Candida from Nepal, higher resistance to azoles in comparison to C. albicans. this study was aimed for the prompt and accurate identification Conclusion: Increasing resistance to commonly used antifungals of Candida species, and determination of their antifungal among Candida species has increased importance of antifungal susceptibility result for effective therapeutic outcome in our set sensitivity testing .Moreover, as biofilm-associated infections are up. more resistant to commonly used antifungals, detection of biofilm Methods: Candida species isolated among the patients attending is also of utmost importance. This study holds further significance Tribhuvan University Teaching Hospital (TUTH), Kathmandu, in being the first report of biofilm formation in Candida spp. from Nepal over 6 months period were included. Candida species were Nepal. differentiated based on germ tube test and colony morphology on CHROM agar. Their antifungal sensitivity test was performed as recommended by Clinical and Laboratory Standards Institute P1-MM09 (CLSI) M44-A document.Due to limited resources; we were Development of Multiplex Real-Time PCR for the Rapid and unable to seek for Candida auris. Quantitative Detection of Aspergillus Results: Seventy-six Candida isolates from clinical specimens WB Kim1*, C Park1, HS Chun1, JH Byun1, JY Park1, Y Yi1,2, SY Cho1,2, were included in study. C.albicans (64.5%) predominated non- JK Choi1,2, HJ Lee1,2, SH Kim1,2, SH Park1,2, SM Choi1,2, JH Choi1,2, albicans Candida. Majority of non-albicans Candida were JH Yoo1,2, DG Lee1,2* C.tropicalis 21% followed by C.krusei 7.9%, C. glabrata 3.9% 1Vaccine Bio Research Institute, 2Department of Internal Medicine, and C. dublinensis 3.9%. In-vitroantibiotic susceptibility tests College of Medicine, The Catholic University of Korea revealed that Candida species were more sensitive to polyenes as compared to azoles group of antifungals, and resistance was more Backgrounds: Rapid identification of Aspergillus species and in non-albicans Candida as compared to Candida albicans. azole-resistance is important in the diagnosis and treatment of Conclusion: It is suggested to identify Candida isolates up to invasive aspergillosis (IA). However, current morphologic and species level and perform susceptibility testing of Candida sequencing-based methods require several days of process. . species to commonly used antibiotics on a regular basis. Simple Therefore, we developed multiplex real-time PCR which shortens methods like germ tube test and chrome agar can be employed the time required for diagnosis by molecular identification. for speciation of Candida in setting like ours. Methods: We designed multiplex PCR that can detect major Aspergillus section (Fumigati, Nigri, Terrei, and Flavi) and TR34 of the cyp51A. Seventy-two Aspergillus and 47 non-Aspergillus P1-MM08 isolates were tested for qualitative and quantitative assessment. Alternative Candida lifestyles: Biofilm formation and We also measured the successful minimum detectable time after antifungal resistance culture for the molecular identification. A.Sapkota*, S.K. Mishra, K. Parajuli Results: The real-time multiplex PCR method showed 100% of Tribhuvan University Teaching Hospital, Nepal sensitivity and specificity for each probe, and there was no cross reactivity between the Aspergillus sections. As a quantitative Background: Candida species, a normal commensal flora of analysis result, the correlation coefficients (R2) for four probes human body, may be associated with superficial and deep-seated ranges from 0.9965 to 0.9998 by a standard curve, and limit of fungal infections in immunocompromised people. Candida detection was 1.0 to 1.2 X 100 copies (40 fg). Also, three azole- albicans is the predominant etiologic agent of candidiasis; resistant Aspergillus fumigatus were successfully detected at however, Non-albicans Candida species that tend to be less Tm 85.6℃ in the melting curve analysis of TR34. The minimum susceptible to the commonly used antifungal drugs are emerging. fungal colony size and culture time required for successful PCR One of major virulence factors of Candida is biofilm formation, detection was 0.2 cm at 24 h. as cells within the biofilms are protected from host immune Conclusions: This multiplex real-time PCR method can responses and the action of antifungals. Therefore, this study was quantitatively identify four major clinical Aspergillus strains designed with a major objective to determine the prevalence of including azole-resistant A. fumigatus. In addition, this method biofilm formation in Candida spp. works in the early stage of culture with high specificity and Methods: A total of 84 consecutive Candida species were isolated sensitivity. These results could provide the template for the rapid from different clinical specimens over 7 months period at and quantitative diagnosis of IA. Tribhuvan University Teaching Hospital, Kathmandu. Candida species were inoculated in Sabouraud Dextrose Agar, and tests for the determination of their antifungal sensitivity profile and biofilm formation were performed with the use of standard methods. Results: Tissue culture plate method detected biofilm formation in 26.2% (n=22) of the Candida isolates. Majority of biofilm producers were Non-albicans Candida (72.7%). Regarding antifungal susceptibility pattern, biofilm producers were more S132 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-MM10 coverage in Cameroon has continuously fallen below target and Clinical characteristics between Candida tropicalis this coverage is unquestionably related to vaccine wastage since candidemia and Candida parasilopsis candidemia wastage translate to less vaccines available for use. This study was You Seung Chung*, Jin Woong Suh, Sun Bean Kim, to assess and compare the vaccine wastage rate in the Littoral Young Kyung Yoon, Jang Wook Sohn, Min Ja Kim, region between rural and urban districts during the two climatic Jong Hun Kim seasons. Division of Infectious Diseases, Korea University Anam Hospital, Methods: This was a record based analytical study carried out in Seoul, Republic of Korea the Littoral Region of Cameroon using the 2017 immunization data. Data from all the 24 health districts were included in the Background: There is limited information regarding the clinical study. Health districts were classified as ‘urban’ or ‘rural’ based characteristics of candidemia stratified by Candida species in on their remoteness. the hospital setting. This study aimed to evaluate the clinical Results: A total of 1369647 doses of vaccines were used to characteristics of Candida tropicalis candidemia (CTC) compared vaccinate 1270401 children less than 5 years. Vaccine wastage to Candida parasilopsis candidemia (CPC) in adult patients (pts) was highest in the BCG (45.58%), then yellow fever (22. 67%) in the Republic of Korea (ROK). and measles (22.59%). Pneumococcal conjugate vaccine (PCV) Methods: Adult pts≥19 years diagnosed with CTC or CPC at a and Rota vaccine had negative wastage rates. Generally, wastage tertiary care hospital in the ROK from 2006 to 2018 were enrolled. rates start low in January and over the months, whenever Results: There was a total of 165 pts with CTC (89 pts, 53.9%) immunization coverage decreases, wastage rate increases and and CPC (76 pts, 46.1%) during the study period. The median vice versa. Wastage rates for all vaccines were higher in rural age was 71 years in CTC group and 66 years in CPC group. districts than in the urban ones with only PCV and Rota having Between two groups, there were no differences regarding sex, statistically insignificant differences (p-value 0.3513 and 0.96 underlying comorbidities (malignancy, cardiac, liver, kidney, respectively). Also, except for Rota (p-value of 0.239) all wastages lung, and neurological disease) and Charlson Comorbidity Index were statistically significantly higher in the dry season. score, Candida colonization, previous long-term care facility Conclusion: The problem with immunization coverage was not residence. Also, presence of total parenteral nutrition, central from lack of vaccines but from vaccine mismanagement with line placement, ventilator placement, and dialysis requirement most of it occurring in the rural areas and surprisingly during the was similar between the groups. However, there were more pts dry season where climatic conditions are more favourable. with age ≥ 70 years (58.4% vs. 40.8%, P= 0.024), steroid treatment (53.9% vs. 38.2%, P= 0.043), neutropenia (14.6% vs. 5.3%, P= 0.049), septic shock presentation (38.2% vs. 19.7%, P= 0.010), and P1-VA02 in-hospital mortality (36.8% vs. 65.2%, P< 0.001) in the CTC group The public health impact and cost-effectiveness of than in the CPC group. Multivariate analysis showed that age ≥ 70 nonavalent HPV vaccination in South Korea: a dynamic years (Odds ratio [OR] 2.332, 95% confidence interval [CI] 1.199 – transmission model 4.535, P=0.013) and in-hospital mortality (OR 3.022, 95% CI 1.560 J.Kim1*, S.Bae, K.Son, I.Choi, J.Park, J.Park2, A.Pavelyev3, V.Prabhu4 – 5.852, P=0.001) were significantly associated with CTC. 1Ewha Womans University College of Pharmacy, Korea, 2Merck Conclusion: Our findings suggest that CTC may have worse Sharp & Dohme, Korea, 3HCL America, Inc., USA, 4Merck & Co., clinical outcomes compared to CPC, despite of differences in Inc., USA clinical characteristics. Background: Human papillomavirus is the main cause of cervical cancer and anogenital warts, and is also well known risk factor P1-VA01 for vaginal, vulvar and anal cancer. This study aims to assess Assessment Vaccine Wastage in the Littoral Region, the public health impact and cost-effectiveness of a nonavalent Cameroon: Differences Between Rural and Urban Health vaccination program among 12 year old girls in Korea. Districts and Policy Implications Methods: Given that HPV is one of sexually transmitted diseases, R Nkenyi1*, P Gi-Deok2, Y Chon3 L Myung-Ken4, C Tonga5 we adapted a previously developed dynamic transmission model 1School of public Health, Yonsei University, South Korea, to assess the public health impact and cost effectiveness of 9vHPV 2Development and Delivery Unit, International Vaccine Institute, vaccine compared to the current NIP which included bivalent South Korea, 3Development and Delivery Unit, International and quadrivalent vaccine, and screening without vaccination. Vaccine Institute, South Korea, 4Yonsei University School of Public We assumed 70% coverage in 12 year old girls with two dose Health, South Korea, 5Central Technical Unit, EPI program, schedule and a 100 year time horizon considering direct and Cameroon indirect protection through herd immunity. We included various HPV related diseases such as cervical intraepithelial neoplasia; Introduction: Vaccination is what is strongly recommended cervical, anal, vaginal, and vulvar cancers; anogenital warts; by the medical community against childhood diseases. In and recurrent respiratory papillomatosis among both women Cameroon, the Expanded Program on Immunization (EPI) began and men, in the model. Cost and incidence rates were applied in 1976 as a pilot project which went operational nationwide based on the NHI database. Additionally, health utilities of HPV in 1982 and vaccination is seen as a fundamental right of every associated health outcomes and parameters regarding sexual child. Vaccines are given to children free of charge. Immunization activity of Korean population were obtained from the literature. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S133

Results: Vaccinating girls aged 12 with the 9vHPV vaccine would Japanese encephalitis, formerly known as Japanese B encepha- reduce HPV related disease cost by 12.8%, which is mainly litis is a disease caused by the mosquito-borne Japanese enceph- attributed to the decreased incidence of cervical cancer by 41.4% alitis virus (JEV). The (JEV) itself is a virus from the family Flavivi- and genital warts for both women and men by 72.7% and 66.0%, ridae, which is a part of the Japanese encephalitis serocomplex of respectively, compared with screening without vaccination. 9 genetically related viruses, some which are particularly severe Specifically, the ICER of vaccination with 9vHPV vaccine was in horses, and four known to infect humans including West Nile estimated at 7.9 million KRW/QALY gained compared with virus. The mosquitoes Culex tritaeniorhynchus and Culex vishnui 2vHPV vaccine and 22.4 million KRW/QALY gained compared are amongst the most important vectors of this disease . This dis- with 4vHPV vaccine with discount rate being 5%. This means that ease is most prevalent in Southeast Asia, South Asia and East Asia. 4vHPV presented better reduction of vaccine preventable disease Japanese encephalitis viral activity has been widespread in India. compared with 2vHPV, while 9vHPV still had the most reduction The first evidence of presence of the virus dates back to 1952. First of disease among various comparators. The range of the ICER for case was reported in 1955. Outbreaks have been reported from 9vHPV vaccine substantially decreased at a 3% discount rate to different parts of the country. During recent past (1998-2004), 15 2.8 million KRW/QALY and 8.2 million KRW/QALY compared states and Union Territories have reported Japanese encephalitis with 2vHPV and 4vHPV vaccine, respectively. incidence. Annual incidence ranged between 1714 and 6594 and Conclusions: Model based analysis shows that vaccinating 12 deaths between 367 and 1665. year old girls with 9vHPV vaccine can lead to better public health In this study, our group has tried to study the epidemiology of this impact and lower HPV related disease burden compared with particular viral disease and the data was collected and retrieved screening without vaccination and current NIP, including 2vHPV from the public databases as well as the local public hospitals and 4vHPV vaccine. Furthermore, it is cost effective in Korea across the infected regions. compared with the current NIP and no vaccination.

P1-VR02 P1-VA03 Predictive factors of patients with severe fever with Optimization of single radial immunodiffusion assays for the thrombocytopenia syndrome, 2013-2019 national lot release of seasonal influenza vaccines Suhyun Oh1,2*, Sang Taek Heo1,2, Bo Ra Shin2,Ye Jin Kim2, Jung-Min Jung*, So Young Park, Eun-Jeong Kwon, Jinhee Woo, Ok Hwa Jang2, Hyang Ran Lee2, Sujin Jo2, Keun Hwa Lee3, Naery Lee Jeong Rae Yoo1,2† Vaccines Division, National Institute of Food and Drug Safety 1Department of Internal Medicine, Jeju National University College Evaluation, Ministry of Food and Drug Safety, Republic of Korea of Medicine and Graduate School of Medicine, Jeju, Republic of Korea, 2Infection control unit, Jeju National University Hospital, Vaccine, a representative of biological products, are produced Jeju, Republic of Korea, 3Department of Microbiology, Jeju National using organism-origin materials. Since it is difficult to maintain University College of Medicine and Graduate School of Medicine, consistency and safety throughout the manufacturing processes, Jeju, Republic of Korea it is essential to confirm the quality of each lot of products, although their manufacturing process has been authorized. Backgrounds: Severe fever with thrombocytopenia syndrome 271 lots for influenza vaccines have been released into market (SFTS) is a emerging tick-borne disease caused by SFTS virus following quality assurance by the MFDS in 2018. We have (SFTSV). Mortality of SFTS estimated to be 21 % in South Korea, performed independent lot release testing including assays for and this disease is difficult to distinguish from common febrile the content of haemagglutinin antigen by an immunodiffusion diseases. Here, we analyzed clinical characteristics between test to ensure vaccine quality. SFTS positive group (SPG) and negative group (SNG) in primary The single radial immunodiffusion (SRID) assay is the common clinical setting. standard method to measure the content of haemagglutinin(HA) Method: In this prospective observational study, data were antigen. In fact, influenza viruses for vaccines are recommended collected on patients with SFTS test performed at single teaching by WHO each year, because the mutations of influenza virus hospital in Republic of Korea between April 2013 and July 2019. occur frequently. Consequently, reference reagents for SRID assay The association between each demographic, climatic, clinical, are newly developed or designated. However, optimization of the and laboratory variable was assessed. All SFTS patients were SRID assays by using new reagents has not been well established confirmed by detecting the S and M segment gene of SFTSV RNA in MFDS yet. Here, we will demonstrate the efforts to find the using reverse transcription-polymerase chain reaction (RT-PCR), optimal requirements in SRID methods for the lot release of and we were confirmed at our laboratory by S segment gene of seasonal influenza vaccines. SFTSV RNA using RT-PCR about patient’s family member and those with close contact. Results: Of the 200 patients in the study periods, 62 (31%) were P1-VR01 SPG and 138 (69%) were SNG. Mean age was 55.1 ± 20.3 years, Surveillance study of Japanese encephalitis: An emerging and 103 (52%) patients were male. In SPG, the comorbidity score infectious disease in India and history of tick bite were significant higher compared with Ravi Kant* SNG. SPG and SNG were prevalent in summer and autumn, University of Delhi, New Delhi-India respectively (60.7% vs. 45.7%, p < 0.05). SPG was significantly S134 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

associated with mean outdoor temperature, humidity, and P1-VR05 rainfall compared with SNG (22.9 ℃ vs. 18.9 ℃; 78.8% vs. 70.6%; Inactivation of Severe Fever with Thrombocytopenia 12.6 mmL vs. 8.5 mmL, all P < 0.01). Dizziness, poor oral intake, Syndrome Virus By Chemicals nausea, and diarrhea were the common in SPG. In laboratory Woo-Jung Park*, Sunhee Jung, Hee-young Lim, Joo-Yeon Lee findings, white blood cell counts, absolute neutrophil count, and Division of Emerging Infectious Disease & Vector Research, Center C-reactive protein were significantly lower in SPG. Lymphocyte for Infectious Diseases Research, National Institute of Health, Korea fraction, activated partial thromboplastin time, and creatinine CDC, Cheongju-si, South Korea phosphokinase were significantly higher in SPG. Case fatality of the SPG and SNG were 9.8% and 1.0%, respectively In multivariate Severe fever with thrombocytopenia syndrome virus (SFTSV) is analysis, mean outdoor temperature, mean humidity, dizziness, an emerging tick-borne Banyangvirus that causes high-fatality and low CRP were predictive factor in SPG. in human with fever, leukopenia, and thrombocytopenia. Since Conclusion: Early prediction of SFTS diagnosis is important, firstly discovered in China in 2010, it is still endemic in China, because this emerging zoonotic disease was a high fatality Japan, and South Korea. Despite the wide distribution and high in endemic areas. When a physician wants to do SFTS test, fatality of SFTS, there is no licensed vaccine and researches for they would consider according to this predictive variable for vaccine development against this pathogen have been poorly differentiating SFTS in primary care settings. studied as well. Inactivated vaccine strategy against emerging diseases has many advantages with safe, well-defined regulatory framework, and readily applied to target diseases. Here, to P1-VR04 develop inactivated SFTSV vaccine, we examined inactivating Development of a reverse genetics system to rescue potential of two kinds of chemical, formaldehyde and hydrogen recombinant severe fever with thrombocytopenia syndrome peroxide (H2O2), for Korea isolate by determination of viral virus derived from a human isolate titers using focus forming assay. As the results for formaldehyde Seok-Min Yun1,*, Hee-Young Lim1, Jungsang Ryou1, treatment, infectious SFTSV was not detectable in 60 min by 2 1 1 Youngmee Jee , Joo-Yeon Lee , and Young-Eui Kim 0.05% and in 120 min by 0.025%. In the H2O2 treatment, SFTSV 1 2 Division of Emerging Infectious Disease & Vector Research, Center was rapidly inactivated in 5 min by 1% H2O2, while 0.3% was for Infectious Diseases Research, National Institute of Health, Korea not inactivated at 120 mins. These results were confirmed that

Centers for Disease Control and Prevention, Cheongju-si, Republic either formaldehyde at both concentration and H2O2 (1%) are of Korea capable for inactivating SFTS virus. We will further investigate the antibody response of inactivated SFTS virus in animal model. Severe fever with thrombocytopenia syndrome virus (SFTSV) is an emerging tick-borne Banyangvirus which can cause lethal disease in humans. There are no licensed vaccines and therapeutics for P1-VR06 SFTSV, it is required to develop the countermeasures against Effectiveness of Early Administration of Cidofovir in Treating SFTSV infection. In this respect, the reverse genetics system is one Human Adenovirus Pneumonia: A Retrospective Cohort of powerful tools to achieve this goal. Study Herein, we established a T7 RNA polymerase-driven reverse Ko JH1*, Lim JU2, Choi JY3, Oh HS4, Yoo H1, Jhun BW1, Huh K1, genetics system to rescue infectious clones of human-derived Peck KR1 Korean SFTSV strain entirely from cDNA. To establish a 1Samsung Medical Center, Sungkyunkwan University School of reverse genetics system, we cloned cDNAs encoding the three Medicine, 2Seoul St. Mary’s Hospital, The Catholic University of antigenomic segments into transcription vectors in which each Korea, 3St. Vincent’s Hospital, The Catholic University of Korea, segment was transcribed under the control of T7 promoter 4Armed Forces Capital Hospital and hepatitis delta virus ribozyme (HdvRz) sequence. We also constructed two helper plasmids expressing the nucleoprotein Background: Cidofovir has been experimentally used for human (NP) or viral RNA-dependent RNA polymerase (RdRp) under the adenovirus (HAdV) pneumonia, but the effectiveness of cidofovir control of T7 promoter and encephalomyocarditis virus (EMCV) has not been evaluated. internal ribosome entry site (IRES). After co-transfection into Methods: A retrospective cohort study in Korean military BHK/T7-9 cells with three transcription and two helper plasmids hospitals was conducted between January 2012 and December and passaged in Vero E6 or Huh-7 cells, we confirmed that 2018. Potentially severe HAdV pneumonia patients with risk the recombinant SFTSV was efficiently rescued. By virological factors for respiratory failure (RF) were included and divided into methods in vitro, including growth kinetics, plaque morphology, early (within seven days post onset of illness (dpoi)) and delayed and pattern of viral protein synthesis, our results indicated that (after seven dpoi) treatment groups. The primary outcome was the rescued virus exhibited similar biological properties to those 21-day RF probability. of the parental virus. Results: A total of 89 potentially severe HAdV pneumonia This SFTSV reverse genetics system will be useful for identifying patients were enrolled in the cohort including 62 early and 27 the molecular viral determinants of SFTSV infection and delayed treatment patients. All patients were males in their early pathogenesis and facilitate the development of vaccine and 20s. Significantly fewer patients in the early treatment group antiviral approaches. progressed to RF (12.9%), compared to the delayed group (66.7%, P <0.001). Early treatment was associated with a decreased 21- Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S135

day RF probability (P <0.001). Lymphocyte count, monocyte of Medicine, Seoul, Republic of Korea, 3Department of Internal count, hypoxemia, CURB-65 score, and whole lung involvement Medicine, National Health Insurance Corporation Ilsan Hospital, (all P <0.05 in univariate analyses) were included in the Goyang, Korea, 4Division of Infectious Diseases, Department of multivariate analysis along with time interval values of cidofovir Internal Medicine, Hallym University Kangnam Sacred Heart administration. In the multivariate analyses, early cidofovir Hospital, Hallym University College of Medicine, Seoul, Korea, treatment within seven dpoi (HR 0.301, 95% CI 0.111–0.814, P 5Division of Infectious Diseases, Department of Internal Medicine, =0.018) was significantly associated with decreased RF risk. Early Kangbuk Samsung Hospital, Sungkyunkwan University School of treatments within six and eight dpoi were also significant, while Medicine, Seoul, Republic of Korea, 6Division of Infectious Diseases, other clinical factors were not. Department of Internal Medicine, Gachon University College of Conclusions: Early administration of cidofovir was associated Medicine, Incheon, Korea with decreased risk of RF progression. It is suggested that cidofovir be administered within six to eight dpoi to prevent RF in Background: The aim of this study was to compare the clinical potentially severe HAdV pneumonia patients. efﬁcacy of peramivir with that of oseltamivir in hospitalized patients with inﬂuenza. Methods: This retrospective cohort study examined data of P1-VR08 adult patients with laboratory confirmed seasonal influenza The seroprevalence of SFTS virus antibody and prevalence of hospitalized in five teaching hospitals and one secondary hospital SFTS infection in patients presenting fever during the scrub from August 2017 through May 2018. Primary outcome was typhus season defervescence rate within 3 days from the first administration of CH Jeon1*, YM Wi1, D Park2, KH Lee2 peramivir or oseltamivir. Secondary outcome was mortality and 1Division of Infectious Diseases, Samsung Changwon Hospital, duration of hospitalization / ICU stay. Sungkyunkwan University, 2Department of Microbiology and Results: A total of five hundred forty-two patients were enrolled; Immunology, Jeju National University School of Medicine, Jeju, 251 were treated with standard dose (300mg, single dose) South Korea peramivir, 42 were treated with exceeding 300mg of peramivir and 249 with oseltamivir (75mg, twice per day for 5 days). There were Background: Severe fever with thrombocytopenia syndrome more ICU and pneumonia cases and older patients in peramivir (SFTS) has the same susceptible population of scrub typhus. The group, especially in high-dose group. Charlson comorbidity index endemic areas of SFTS overlap with the region of the scrub typhus was similar between three groups. There were no significant in Korea. Therefore we investigated the seroprevalence of SFTS differences in terms of defervescence rate within 3 days between virus antibodies and prevalence of SFTS infections in patients three groups. Mortality and duration of hospital stay and ICU stay presenting with fever in the endemic areas of scrub typhus. were no statistically significantly different. Methods: During the scrub typhus seasons in Korea from Factors associated with 30-day mortality were ICU admission, 2013, 2014, and 2015, we collected serum samples from 205 high Charlson comorbidity index (CCI), pneumonia. patients presenting with fever in Samsung Changwon Hospital. Conclusion: Treatment of influenza in hospitalized adults with To molecular diagnosis of SFTS virus, Reverse Transcriptase- either peramivir or oseltamivir resulted in generally similar Polymerase Chain Reaction (RT-PCR) of partial S segments was clinical outcomes. Treatment with peramivir showed good performed. clinical response in influenza patients with pneumonia or Results: The overall seroprevalence of SFTS virus antibodies admitted in ICU. was 51.7% (n = 106) in patients presenting with fever during the study periods. Nineteen patients (9.3%) with SFTS virus infection were identified. Only 3 SFTS patients showed severe clinical P1-VR10 presentation and the mortality rate was 5.3% (1/19). Identification of antiviral drug resistant UL97 and UL54 Conclusions: The result of this study showed the seroprevalence gene mutations in human cytomegalovirus and UL54 of SFTS virus antibody and prevalence of SFTS infection in gene mutation-only presenting cases after stem cell patients presenting fever during the scrub typhus season are transplantation in Korea considerably high in the endemic areas of scrub typhus. Kyu-Hwa Hur1, Heungsup Sung1, Sang-Ho Choi2, Mi-Na Kim1 1Department of Laboratory Medicine and 2Infectious Diseases, University of Ulsan College of Medicine and Asan Medical Center, P1-VR09 Seoul, Korea Clinical effectiveness of intravenous peramivir versus oseltamivir for the treatment of influenza in hospitalized Background: Human cytomegalovirus (HCMV) infection is a patients major cause of morbidity and mortality in immunocompromised Jin Seo Lee1*, Mi Suk Lee2, Yoon Seon Park3, Jacob Lee4, Eun-Jeong hosts, especially stem cell transplant recipients. Detecting UL97 Joo5, Joong Sik Eom6 and UL54 gene mutations is crucial, as these can confer drug 1Division of Infectious Disease, Department of Medicine, Hallym resistance. We investigated the prevalence of UL97 and UL54 University Kangdong Sacred Heart Hospital, Seoul, Korea, gene mutations in immunocompromised cases. 2Division of Infectious Diseases, Department of Internal Medicine, Methods: Cases with prolonged detection or HCMV reactivation Kyung Hee University Hospital, Kyung Hee University School with a CMV DNA real-time PCR titer above 2.42 log IU/mL S136 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

despite receiving ganciclovir (GCV) and/or foscarnet (FOS) for Conclusion: FEV1/FVC and DLCO were lower than those of a over four weeks were enrolled from November 2012 to May 2019. healthy population at 12months, while no significant change was Results: A total of 104 specimens were obtained from 65 enrolled observed for 36 months. Proportions of GGO and consolidation cases including 40 males and 25 females. The median age in chest CT was reduced for 36 months. was 19 years (3 months-81 years). The evaluated HCMV gene mutations were found in 20% (13/65) of cases, with UL97 in 11% (7/65), UL54 in 6% (4/65) and both in 3% (2/65). Among P1-VR12 UL97 mutations, M460I, M460V, A594V, L595S, C603W, 505-506 Whole genome sequencing analysis of influenza C virus in and 597-600 in-frame codon deletions were observed in one young children. case each. For UL54 mutations, F412L, V787L and L802M were Soo Yeon Lim1,2, Han Sol Lee2, Woo Joo Kim2 observed in one case each, and a mutation switch from V715M to 1Division of Brain Korea 21 Program for Biomedicine Science, L501I was observed in one case. L595F with N408D and C603W Korea University College of Medicine, Seoul, Republic of Korea, with N408D and P522S were observed in one case each. All four 2Division of Infectious Diseases, Department of Internal Medicine, UL54 gene mutation-only presenting cases developed HCMV Korea University College of Medicine, Seoul, Republic of Korea infections after receiving haploidentical peripheral blood stem cell transplantation (HaploPBSCT). Background: Through the Hospital-based Influenza Morbidity Conclusion: Four UL54 gene mutation-only presenting cases and Mortality (HIMM) surveillance system, 973 nasopharyngeal had received FOS for over four weeks after HaploPBSCT; GCV swab specimens from children under 2 years of age were collected could not use in order to avoid hematologic toxicity, such as and tested for influenza viruses using real-time PCR. Among the myelosuppression. The observed UL54 gene mutations are tested specimens, 383 were positive for influenza A and / or B known to confer FOS resistance, except for GCV and cidofovir virus. Influenza C virus was confirmed in five specimens. In this resistant-conferring mutation F412L. study, we used five influenza C virus positive specimens and a cell-cultured influenza C virus. Methods: Viral RNA was isolated using the QIAamp viral RNA P1-VR11 mini kit (Qiagen, Hilden, Germany) following a manufacturer’s The long-term outcomes of pulmonary functions and instructions. All isolated RNA was finally eluted with 60 ul of radiographic change in survivors of 2015 Korean MERS distilled water. Reverse transcription reaction was performed outbreak by Primescript 1 st strand cDNA synthesis kit (Takara, Shiga, Yeonjae Kim1*, Ji-Young Rhee2, Jae-Phil Choi3, Yeon-Sook Kim4, Japan) using uni-5’ primer. The genome-wide amplification of Dong-Gyun Lim1, Jun-Sun Park1, Wan Beom Park5, the influenza C virus was performed using taq polymerase. The Hyoung-Shik Shin1 amplified gene fragments were performed using the Nextera XT 1Center for Infectious Diseases, National Medical Center, Seoul, DNA library Prep kit (Illumina), according to the manufacturer’s Korea 2Department of Internal Medicine, Dankook University protocol. Hospital, Cheonan, Korea 3Department of Internal Medicine, Seoul Results: This study was the first report of influenza C virus using Medical Center, Seoul, Korea, 4Department of Internal Medicine, NGS analysis in South Korea. In this study, Chungnam National University Hospital, Daejeon, Korea, young children with influenza C virus infections had acute 5Department of Internal Medicine, Seoul National University respiratory illnesses, such as fever, rhinorrhea, and cough, but Hospital, Seoul, Korea no pneumonia or severe respiratory illness was observed. Based on NGS analysis, we can expand our understanding various Background: The objective of this study was to investigate the symptoms of influenza C virus. change of pulmonary functions and radiological sequelae in survivors of Middle East Respiratory Syndrome (MERS) for 36 months after disease onset. P1-VR13 Methods: Patients were evaluated in the clinic every three A Simple Method for the Analysis of Flavivirus NS1 by an In months. At each visit, lung function tests, six-minute walking dis- Silico Approach to Global Database tance test, and chest computed tomography (CT) were evaluated. C Park1*, WB Kim1, HS Chun1, JH Byun1, JY Park1, SY Cho1,2, Y Yi1,2, Results: 73 among the 148 MERS-survivors were enrolled, and HJ Lee1,2, JK Choi1,2, SH Kim1,2, SH Park1,2, SM Choi1,2, JH Choi1,2, 51 completed the study after 36 months. General characteristics JH Yoo1,2, DG Lee1,2 and clinical courses during acute illness were not different 1Vaccine Bio Research Institute, 2Department of Internal Medicine, significantly from all MERS-survivors. At 12 months, decreased College of Medicine, The Catholic University of Korea forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) (78.0% of predicted) and diffusion capacity of Backgrounds: The spread of endemic human-pathogenic fla- the lung for carbon monoxide (DLCO) (82.0% of predicted) vivirused is increasing public. A major problem in developing were observed. Total lung capacity (TLC), FVC, FEV1 was 96.5%, diagnostic biomarkers in flaviviruses could be the high level of ge- 96.5% and 99.5% of predicted each. However, there was no netic diversity and antigenic cross-reactivity. Here, we attempted significant change for 36 months. Patients who showed ground- analyze antigen information based on a large quantum of genetic glass opacification (GGO) and consolidation were in chest CT variation in medically important flaviviruses from the global data- decreased from 10.6% and 7.6% to 2.3% and 0.0% each. bases Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S137

Methods: By in silico approach, NS1 genes analyzed in this study and Q313R mutations were observed and one sample also had included a total of 6,823 sequences, from Dengue virus (DENV), S334T in NA sequence. Japanese encephalitis virus (JEV), West Nile virus (WNV), Zika Conclusion: Circulating A(H1N1)pdm09 influenza viruses virus (ZIKV), and Yellow fever virus (YKV). We characterized the during 2015-2016 season belonged to clade 6B in Republic of features of genetic variants including their frequencies, and then Korea. Mutations associated with resistance to NA inhibitors were each immunological epitopes were additionally analyzed by confirmed in this study. filtering MHC binding and B cell epitope of each variants. Results: We extracted and analyzed 316 DENV NS1 sequence types (STs), 59 JEV STs, 75 WNV STs, 30 YFV STs, and 43 ZIKV STs P1-VR15 by phylogenetic analysis. STs were re-classified according to the Antiviral therapy for herpes zoster and the risk of dementia variation of the major epitope by MHC II binding. In the members SB Bae1*, SC Yun2, MC Kim3, W Yoon4, JS Lim5, SO Lee1, SH Choi1, of the same serocomplex, there were a few shared certain core YS Kim1, JH Woo1, SY Kim4, SH Kim1 peptides (N-terminus of JEV and WNV). 78 DENV epitope types 1Department of Infectious Diseases, Asan Medical Center, (EpTs), 29 JEV EpTs, 29 WNV EpTs, 12 YFV EpTs, and 5 ZIKV EpTs University of Ulsan College of Medicine, Seoul, Republic of Korea, were extracted according to their major epitopes. Also, there 2Department of Clinical Epidemiology and Biostatistics, Asan was one or two of predominant EpT (68. 6% - 88. 4%) in most of Medical Center, University of Ulsan College of Medicine, Seoul, flaviviruses. Republic of Korea, 3Division of Infectious Diseases, Department of Conclusions: The re-classification of many STs by the locus of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic major epitopes and frequency analysis showed that there could of Korea, 4Department of Psychiatry, Asan Medical Center, be predominant epitope types in NS1 gene of each flavivirus. University of Ulsan College of Medicine, Seoul, Republic of Korea, These results could provide a simple way for the selection of 5Clinical Research Center, Asan Institute for Life Sciences, Asan candidates for the development of diagnostic and vaccine Medical Center, Seoul, Republic of Korea antigens overcoming immunological cross reactivity. Background: Recent epidemiologic studies suggested the association between herpes zoster (HZ) and subsequent P1-VR14 development of dementia. We investigated the association Molecular genetic characteristics of A(H1N1)pdm09 influenza between HZ and dementia, and whether antiviral therapy in HZ viruses during 2015-2016 season in Republic of Korea patients reduces the risk of dementia. HN Kim1,a, JY Kang1,a, SJ Lee1,a, SH Lee1, SH Ahn1, S Lim1, HS Lee1, Methods: We used the National Health Insurance Service- JY Noh1, WS Choi1, JY Song1, J Lee2, YB Seo2, JS Lee3, SH Wie4, National Sample Cohort in South Korea to identify individuals HW Jeong5, YK Kim6, KH Park7, SW Kim8, HJ Cheong1, WJ Kim1 that were followed from 2002 to 2013. Occurrences of HZ and 1Korea University College of Medicine, 2Hallym University School dementia were identified using the relevant diagnostic codes. of Medicine, 3Inha University College of Medicine, 4The Catholic Dementia was defined as the presence of the relevant diagnostic University of Korea, School of Medicine, 5College of Medicine, codes and history of anti-dementia drug prescription. Propensity Chungbuk National University, 6Yonsei University Wonju College score-matching (1:1) was carried out among HZ patients of Medicine, 7Chonnam National University Medical School, according to antiviral therapy. 8Kyungpook National University School of Medicine, Republic of Results: A total of 229,594 individuals aged ≥ 50 years were Korea analyzed. The incidences of the first-diagnosed HZ and dementia aThese authors contributed equally to this study. were 16.69 and 4.67 per 1000 person-years (PY), respectively. HZ patients had a higher risk of dementia (incidence rate ratio [IRR], Background: Molecular genetic analysis on influenza viruses 1.94; adjusted hazard ratio [HR], 1.12). Of the 34,505 patients with contribute to understand the evolution of influenza viruses and to HZ, 28,873 (84%) had received antiviral treatment. The crude select influenza vaccine strain. However, there is a lack of genetic incidence rates of dementia in the treated and untreated groups analyses of influenza viruses during 2015-2016 season in Republic were 7.79 and 12.27 per 1000 PY, respectively, resulting in an IRR of Korea. of 0.63 and covariate-adjusted HR of 0.79. After propensity score Methods: The genetic variations of hemagglutinin (HA) and matching, the treated group showed a significantly lower risk of neuraminidase (NA) genes of A(H1N1)pdm09 influenza viruses dementia (HR, 0.77) and mortality (HR, 0.58). collected during 2015-2016 were analyzed. Influenza vaccine Conclusion: In this large, population-based cohort study with strain (A/California/7/2009) and another circulating A(H1N1) propensity score matching, HZ was associated with a higher pdm09 influenza viruses were used for comparison. risk of dementia. The use of antiviral agents in HZ patients Results: A total of 183 A(H1N1)pdm09 viruses were analyzed. was associated with significantly lower risks of dementia and All of A(H1N1)pdm09 HA sequences clustered in clade 6B. The mortality. clade 6B was differentiated into two groups by the amino acid substitutions S84N, S162N and I216T in subclade 6B.1 and V152T and V173I in subclade 6B.2. The phylogenetic tree of A(H1N1) pdm09 NA genes showed that the two groups varied in terms of V67I, T381I in group 1 and V13I, I34V in group 2. Among known amino acid substitutions associated with drug resistance, S247N S138 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

Table 1. Baseline characteristics of patients with dementia, herpes zoster, or truncated herpes zoster Total Dementia HZ Truncated HZ Variables P Value P Value P Value (n=229,594) (n=10,482) (n=35,017) (n=34,505) Age, mean (SD), y 61.7 (9.4) 68.9 (7.7) <.001 60.4 (8.1) <0.0001 60.3 (8.1) <.001 50–59 99,751 (43.4) 992 (9.5) 15,987 (45.7) 15,925 (46.2) 60–69 77,860 (33.9) 3961 (37.8) 13,164 (37.6) 12,958 (37.6) ≥70 51,983 (22.6) 5529 (52.7) 5866 (16.8) 5622 (16.3) Male sex 104,025 (45.3) 3322 (31.7) <.001 13,526 (38.6) <.001 13,370 (38.7) <.001 Economic Class I 47,139 (20.5) 2427 (23.2) <.001 5793 (16.5) <.001 5681 (16.5) <.001 II 23,660 (10.3) 1285 (12.3) 4966 (14.2) 4908 (14.2) III 37,233 (16.2) 1464 (14.0) 5688 (16.2) 5629 (16.3) IV 46,728 (20.4) 2040 (19.5) 7436 (21.2) 7317 (21.2) V 65,834 (28.7) 3266 (31.2) 11,134 (31.8) 10,970 (31.8) Hypertension 55,639 (24.2) 3699 (35.3) <.001 9426 (26.9) <.001 9233 (26.8) <.001 Diabetes 28,502 (12.4) 1891 (18.0) <.001 4925 (14.1) <.001 4815 (14.0) <.001 Dyslipidemia 20,519 (8.9) 1243 (11.9) <.001 3995 (11.4) <.001 3912 (11.3) <.001 Chronic lung disease 36,683 (16) 2247 (21.4) <.001 6660 (19.0) <.001 6534 (18.9) <.001 Ischemic heart disease 13,192 (5.7) 922 (8.8) <.001 2333 (6.7) <.001 2281 (6.6) <.001 Stroke 7104 (3.1) 663 (6.3) <.001 1015 (2.9) .02 984 (2.9) .005 Heart failure 6835 (3) 550 (5.2) <.001 1107 (3.2) .03 1074 (3.1) .11 Atrial fibrillation 1685 (0.7) 129 (1.2) <.001 265 (0.8) .59 257 (0.7) .80 Valvular heart disease 990 (0.4) 69 (0.7) <.001 167 (0.5) .16 164 (0.5) .18 Chronic renal disease 2148 (0.9) 108 (1.0) .30 392 (1.1) <.001 390 (1.1) <.001 Carotid stenosis 62 (0.0) 7 (0.1) .01 5 (0.0) .12 5 (0.0) .12 Peripheral vascular disease 5746 (2.5) 468 (4.5) <.001 1049 (3.0) <.001 1024 (3.0) <.001 Chronic liver disease 1832 (0.8) 70 (0.7) 0.13 262 (0.7) .26 255 (0.7) .18 Rheumatic disease 10,628 (4.6) 721 (6.9) <.001 2057 (5.9) <.001 2022 (5.9) <.001 Inflammatory bowel disease 929 (0.4) 60 (0.6) .005 185 (0.5) <.001 181 (0.5) <.001 Malignancya 7212 (3.1) 350 (3.3) .23 1084 (3.1) .60 1062 (3.1) .46 Solid organ transplantation 43 (0.0) 0 (0.0) .15 11 (0.0) .06 11 (0.0) .05 HIV infection 19 (0.0) 1 (0.0) .88 7 (0.0) .009 7 (0.0) .007 Depression 1846 (0.8) 143 (1.4) <.001 364 (1.0) <.001 349 (1.0) <.001 Data are No. (%) of persons, unless indicated otherwise.Abbreviations: SD, standard deviation; HIV, human immunodeficiency virus; HZ, herpes zoster. a Including hematologic malignancy and solid tumor.

Table 2. Risk of dementia after herpes zoster Table 3. Risk of dementia and death after zoster in patients ac- IRR (95% CI) P Value Adjusted HRa (95% CI) P Value cording to antiviral therapy All 1.94 (1.83–2.06) <.001 1.12 (1.05–1.19) <.001 Hazard Ratio 95%CI P Value 50–59 2.11 (1.75–2.55) <.001 1.09 (0.90–1.31) 0.39 Dementia 60–69 1.92 (1.75–2.11) <.001 1.07 (0.97–1.17) 0.17 Unadjusted analysis* 0.64 0.56–0.72 <.001 ≥70 2.08 (1.91–2.26) <.001 1.16 (1.07–1.27) <.001 Multivariate analysis† 0.79 0.69–0.90 <.001 Abbreviations: IRR, incidence rate ratio; CI, confidence interval; HR, hazard ratio. Propensity-score matching analysis 0.77 0.65–0.92 .003 a Adjusted for age, sex, economic class, hypertension, diabetes, dyslipidemia, Age, years chronic lung disease, ischemic heart disease, stroke, heart failure, atrial fibrillation, 50–59 0.49 0.12–1.94 .31 valvular heart disease, chronic renal disease, carotid artery stenosis, peripheral 60–69 0.61 0.40–0.94 .02 vascular disease, chronic liver disease, rheumatic disease, inflammatory bowel disease, malignancy including hematologic malignancy and solid tumor, solid organ ≥70 0.82 0.67–1.00 .049 transplant, HIV infection, and depression. Death Unadjusted analysisa 0.44 0.41–0.47 <.001 Multivariate analysisb 0.55 0.51–0.60 <.001 Propensity-score matching analysis 0.58 0.53–0.64 <.001 Abbreviations: CI, confidence interval. a Unadjusted analysis was performed in the total cohort population with zoster. b The results of the multivariate analysis are presented as adjusted hazard ratios. The following variables were included in the multivariate analysis for adjustment: age, sex, economic class, hypertension, diabetes, dyslipidemia, chronic lung disease, ischemic heart disease, stroke, heart failure, atrial fibrillation, valvular heart disease, chronic renal disease, carotid artery stenosis, peripheral vascular disease, chronic liver disease, rheumatic disease, inflammatory bowel disease, malignancy including hematologic malignancy and solid tumor, solid organ transplant, HIV infection, and depression. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S139

we confirmed 4 cases of influenza A and C virus co-infection. Especially, infection with ICV was found not only in children but also in adults. ICV infections were more common in children (11.43%) than in adults (4.87%). The common symptoms of cases with ICV infection were fever, cough. Interestingly, sputum was more frequent in cases with co-infection than influenza virus alone (influenza A, 46.48%; influenza C, 28.59%; influenza A and C, 100%). In conclusion, ICV was significantly circulated during winter and confirmed in all age in Korea.

P1-VR17 Mortality risk factors associated with influenza infection among hospitalized elderly patients admitted to the intensive care unit HJ Lee, SB Kim, JH Kim, YK Yoon, JW Sohn, MJ Kim Division of Infectious Diseases, Korea University Anam Hospital Figure 1. Flow chart of population selection and propensity score-matched analysis Background: Influenza is one of the leading causes of mortality in the elderly. The purpose of this study was to identify mortality risk factors associated with influenza infection among hospitalized elderly patients admitted to the intensive care unit (ICU). Method: From January 1, 2013 to February 28, 2019, patients ≥ 65 years admitted to the ICU were screened and were included in the study if influenza virus infection (influenza A or B) was confirmed. Clinical data of in-hospital mortality, underlying medical conditions, APACHE2 score, ventilator placement, and presence of septic shock was collected. Results: A total of 137 patients were enrolled. Males were 47.4%. The median age was 77 years. In-hospital mortality was 23.4%. Figure 2. Cumulative incidence of dementia after zoster stratified by antiviral Comparison analysis was performed between two groups of treatment. The Kaplan-Meier curve represents the cumulative incidence of dementia in the zoster group with or without antiviral therapy (P Value=0.003 by the log-rank survival and death. There were more older patients (median age test). The first year of the survival curve was zoomed in 81 years vs. 76 years, P=0.030), APACHE2 score ≥ 30 (34.4% vs. 16.2%, P=0.026), ventilator placement (62.5% vs. 27.6%, P < 0.001), and presence of septic shock (65.5% vs. 23.8%, P < 0.001) in the P1-VR16 death group than in the survival group. However, there were Influenza C Virus detection in patients with Influenza-like no significant differences in terms of sex, underlying medical Illness during the 2018-2019 influenza season conditions including immunocompromised status and chronic Han Sol Lee, Ji Yun Noh, Joon Young Song, Hee Jin Cheong, medical diseases, long-term care residency before hospital Woo Joo Kim admission, previous influenza and pneumococcal vaccination, Korea University Guro Hospital, Korea and types of influenza infection (A and B) between the two groups. The multivariate logistic analysis revealed that age ≥ 80 Introduction: Influenza C virus (ICV) generally causes mild years (odds ratio (OR) 4.999 [95% confidence interval (CI) 1.850 upper respiratory illness in children. Therefore, ICV detection has - 13.512], P = 0.002) and presence of septic shock (OR 5.250 [95% been largely neglected, compared to influenza A and B viruses. CI 1.798 - 15.332], P = 0.002) were significantly associated with Recently several studies have indicated that ICV causes severe mortality. acute respiratory illness and pneumonia in children. We studied Conclusion: Our results indicate that old age ≥ 80 years and the to detect ICV and evaluate their clinical significance among presence of septic shock may be critical predictors of mortality patients with influenza-like illness (ILI). among hospitalized elderly patients admitted to the ICU. Method: During the influenza season of 2018-2019, 226 patients with ILI were enrolled through Hospital-based Influenza Morbidity and Mortality (HIMM) surveillance system. Influenza viruses including influenza A, B and C viruses, were detected by the qPCR methods. We analyzed the clinical manifestations of patients with ICV infection. Results and conclusion: Among 226 study subjects, 76 cases (33.63%) of influenza A virus, 1 case (0.44%) of influenza B virus, and 11 cases (4.87%) of influenza C virus were detected. Also, S140 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P1-VR18 P1-VR19 The distribution of Dengue virus genotype in Quang The molecular epidemiology of Rotavirus and Norovirus Nam province in Vietnam during the epidemic dengue detected in fecal samples taken from children with acute hemorrhagic fever in 2018 diarrhea L.N.D.Nguyen1a, D.Q.Phan2a, T.Nguyen2, P.T.T.Pham 1, S.T.Pham 1, T.A.Nguyen2, P.H.Le2, H.Ushijima3, S.H.Le4, N.H.T.Tran4, S.H.T.Nguyen1, D.T.Pham1, N.T.Dang2, H.T.Pham3, S.T.Pham4a, D.K. Tran4, V.H.Pham4,5* V.H.Pham1,5* 1University of Sydney, 2Children Hospital No1, 3Aino Health Science 1Phanchautrinh University, 2The polyclinic hospital of Quangnam, Center, Aino University, Tokyo, Japan; 4NK-Biotek Co., 5Phan Chau 3Phamngocthach University, 4Sydney University, 5NK-Biotek Co., Trinh University, *Corresponding author aFirst author, *Corresponding author Background: In Vietnam, there were few studies reported the Background: In 2018, Quang Nam province had occurred the molecular epidemiology of Rotavirus and Norovirus causing epidemic of dengue hemorrhagic fever without any report about acute diarrhea. However, the surveillance of the circulating the distribution of Dengue virus genotype. The reason for that Norovirus and Rotavirus detected from fecal samples taken from is the lack of facilities to detect and confirm of the genotype of acute diarrheal patients especially children should be often Dengue virus from the patients’ s blood taken during disease. carried out. Aims of the study: Using the multiplex real-time PCR to detect Aims of the study: Detection of the genotype of Norovirus and the genotype of Dengue virus in the blood taken from the Rotavirus detected in fecal samples taken from children with patients with clinical and hematological signs suspected Dengue acute diarrhea and analyze the diversity of the detected genotype. hemorrhagic fever during the epidemic period then analysis the Materials and Methods: The fecal samples were taken from distribution of the genotype of Dengue virus. children hospitalized due to acute diarrhea. For RT-PCR to detect Materials and methods: The study was done at The Polyclinic Norovirus and Rotavirus, the stool samples were diluted to 10% in Hospital of Quangnam. The patients with clinical and hematolog- distilled water then done the viral RNA extraction using QIAamp® ical signs suspected dengue fever of dengue hemorrhagic fever Viral RNA Mini Kit. The extracted RNA from the samples were were included into the study. The tested samples were the plasma denatured with 1/10 volume of 50% DMSO at 95oC for 5min collected from patients right after the diagnosis. The real-time then were carried out the cDNA synthesis using the Transcriptor RT-PCR specific for Dengue virus genotype were carried out ac- Universal cDNA of Roche. The multiplex PCR using 4 primers cording to the published article PLoS Negl Trop Dis. 2013 Jul; 7(7): G1SKF, G1SKR (GI specific), and CO2F and G2SKR (GII specific) e2311. Besides the real-time RT-PCR, the NS1 detection were also for detection of Norovirus. The primers sBeg9 and VP7-1’ were done with the commercial kit that were available at the hospital used for PCR detection of Rotavirus group A, and 4 primers Results and discussions: From 12/2018 to 2/2019, 488 patients ADG9-1F, ADG9-1R (group B specific) and NG8S1, NG8S2 (group were included into the study and among them 300 were C specific) were used for multiplex PCR detection of Rotavirus confirmed diagnosis as Dengue hemorrhagic fever with following Group B and C. The PCR mix were prepared from the QIAGEN criteria: (i) high and persistence fever; (ii) Normal of the number Multiplex PCR kit. The PCR products were then direct sequenced and formula of the blood leukocyte; (iii) Gastro-intestinal using the PCR primers, and the collected sequences were blast hemorrhage or skin petechia or purpura; (iv) The platelet count searched to detect the genotype and carried-out the phylogenetic <100,000 or the hematocrit > 42%; or (v) Real-time RT-PCR had analysis using Mega7 software to analyze the diversity of the detected Dengue virus in the blood sample. There were 273 detected genotypes patients (91%) positive with Dengue virus and the distribution Results and discussions: 38 among 45 PCR products of Rotavirus of Dengue virus genotype were: 12.82% (35/273) D1, 17.95% Group A and 61 among 78 PCR products of Norovirus G.II were (49/273) D2, 0.37% (1/273) D3, 68.50 (187/283) D4, and 0.37% sequenced successfully. Among the Rotavirus, the blast search (1/273) D2+D4. This result said that the predominant Dengue results revealed 9 (23.68%) G2P[4], 20 (52.63%) G3P[8], 2 (5.26%) virus genotype is D4, and the epidemic of Dengue hemorrhagic G4P[8], and 7 (18.42%) G8P[8]. The phylogenetic analysis also fever are caused by many not only by one genotype. Compare said that all the detected genotype of Rotavirus was closely related real-time RT-PCR with NS1, the detected results revealed that the to the reference genotype detected in the gene bank. Among the real-time RT-PCR with the sensitivity 91% is more sensitive than Norovirus, the blast search results revealed 60 (98.4%) GII.4 and NS1 with the sensitivity 83.88%. only 1 (1.6%) GII.17. The phylogenetic analysis said that the GII.4 Conclusion: This is the first study to analysis the distribution were divided into 3 small group, and the phylogenetic analysis of Dengue virus genotype during the epidemic of dengue with time said that most of the Norovirus are presented recently, hemorrhagic fever in Quang Nam, one of the provinces in the differ from strains detected in 2010. middle of Viet Nam. This kind of surveillance should be done Conclusions: The study of the molecular epidemiology of longitudinally for several year since the results can help to Rotavirus and Norovirus should be carried out regularly to predict the big epidemic of this kind of disease with change of the evaluate the efficacy of the Rotavirus vaccine as well as to detect predominant genotype. the changing of pathogenic genotype of Norovirus. This study was done for that purpose and the reported data could contribute to the medical data relating to the health burden in Viet Nam. Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S141

Poster Presentations The outcomes were hospital LOS, mortality, and AKI. AKI was defined by the Acute Kidney Injury Network (AKIN) classification which consists of (1) increase in serum creatinine by ≥0.3 mg/ September 28, 2019 dL (≥26.5 μmol/L) within 48 hours; or (2) increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days. P2-AG01 Results : Computational prediction method of antibiotics resistance by PK/PD algorithms using bioinformatics software Hyunjo Kim* School of pharmacy, Yonsei university, Campus town, Songdo techno park, Incheon city, South Korea

Infection disease is a major cause of morbidity and mortality in the developing world. Antibiotics resistance, which is predicted to rise in many countries worldwide, threatens infection treatment and control. The machine learning can help to identify patients at higher risk of treatment failure in infection diseases Closer monitoring of these patients may decrease treatment failure rates and prevent emergence outbreak of antibiotic resistance. To identify features associated with treatment failure and to predict which patients are at highest risk of antibiotics resistance this study was designed. The most predictive model was forward stepwise selection, although most models performed at or above targeted value. We employed a range of powerful machine learning tools to predict antibiotic resistance from whole genome Figure 1. Flow chart of included patients sequencing data for model strain. We used the presence or absence of genes, population structure and isolation year of Conclusion: There were no significant differences in patient isolates as predictors, and could attain average precision and groups according to their AKI morbidity or hospital death (Table recall without prior knowledge about the causal mechanisms. 1). Patients’ age, BMI, serum VCM concentration, dose of VCM, These results demonstrate the potential application of machine serum creatinine, and/or CrCl were significantly associated learning methods as a diagnostic tool in healthcare settings. with hospital LOS, mortality, and AKI (Table 2-4). ICU patients were more likely to get AKI than general ward patients (Table 3). Patients with lower CrCl (<115 mL/min) had lower mortality P2-AG02 rates than those with higher CrCl and patients who has higher Factors on Hospital Length of Stay, Mortality, and Acute serum VCM concentration (>=16 mcg/mL) had lower mortality Kidney Injury in Patients with Therapeutic Drug Monitoring of rates than their counterpart (Figure 2-(a), (b)). This is because Vancomycin patients’ excellent CrCl (generally more than 100 mg/dL) result J. Y. Kim*, S. Y. Shin the overestimation of their VCM clearance, leading to higher VCM Catholic Kwandong University International St. Mary’s Hospital, dose which is a possible risk for AKI. South Korea In conclusion, this study classifies the patients by two groups according to their CrCl, first serum VCM concentration, and total Background: Vancomycin (VCM), a glycopeptide antibiotic, has duration of VCM treatment to identify cut off points for hospital low therapeutic index and is often monitored for its adverse drug mortality. However, one should be careful in interpreting these reactions including nephrotoxicity, ototoxicity, or neutropenia. results because this study has several limitations; (1) it is derived In this study, the association of risk factors on hospital length of from homogeneous Korean population, (2) it excludes chronic stay (LOS), mortality, or acute kidney injury (AKI) in patients who kidney disease patients and effects of nephrotoxic drugs such were undergoing therapeutic drug monitoring (TDM) of VCM as aminoglycosides, piperacillin-tazobactam, contrast media, was explored. or anticancer drugs such as cisplatin or cyclophosphamide. Methods: Records of 68 patients who met inclusion criteria Therefore, further study with heterogeneous patient population were retrospectively reviewed in secondary hospital between with larger sample size, encompassing possible confounding 2018.10.1~2019.5.31. Patients included had their own calculated factors such as nephrotoxic agents or inherent effect of kidney pharmacokinetic (PK) and pharmacodynamics (PD) parameters disease would be warranted. such as volume of distribution, half-life, first serum VCM concentration, and creatinine clearance (CrCl). Data reviewed was height, weight, sex, body mass index (BMI), serum creatinine, admitting diagnosis, ECOG score, type of admission, total hospital LOS, and concomitant usage of antibiotics or nephrotoxic agents.

Table 1. Baseline characteristics AKI (n=9) Non-AKI (n=59) p Non-survival (n=10) Survival (n=58) p Age, year (mean ± SD) 64 (21) 70.6 (16.5) .303 67.5 (18.4) 69.5 (17.6) .738 Hospital LOS (mean ± SD) 55.3 (42.0) 46.3 (27.1) .416 55.4 (23.2) 45.3 (29.9) .316 Female (no. [%]) 2 (22) 24 (40.7) .469 1 (10) 25 (43) .076 BMI, kg/m2 (mean ± SD) 21.9 (2.7) 21.2 (2.6) .493 21.3 (3.1) 21.3 (2.5) 1.000 First serum concentration of VCM, mcg/mL (mean ± SD) 16.5 (15.6) 13.1 (7.6) .563 13.3 (9.9) 13.4 (8.7) .985 CrCl*, mL/min (mean ± SD) 89.9 (37.7) 99.2 (46.1) .589 115.0 (35.7) 96.1 (46.2) .223 Estimate GFR, mL/min/1.73 m² ¶ (mean ± SD) 124.4 (62.3) 155.6 (65.9) .210 181.5 (74.0) 146.5 (63.1) .118 Serum creatinine, mg/dL (mean ± SD) 0.9 (0.5) 0.6 (0.2) .204 0.6 (0.5) 9.61 (0.2) .914 VCM dose, mg/kg/day (mean ± SD) 29.4 (10.2) 31.8 (11.8) .583 30.6 (9.6) 31.6 (11.8) .795 Target VCM trough concentration >=15 mcg/mL, (no. [%]) 5 (6) 33 (56) 1.000 5 (50) 34 (59) .733 *Calculated from the Cockrosft-Gault equation; ¶Calculated from the original Modification of Diet in Renal Disease (MDRD) equation.

Table 2. Risks of hospital LOS B SE β t p lower 95% CI upper 95% CI (Constant) 124.91 42.99 2.91 .005 38.93 210.89 First serum concentration of VCM, mcg/mL 2.02 .42 .61 4.84 .000 1.18 2.85 Serum creatinine, mg/dL -12.40 12.22 -.12 -1.01 .315 -36.83 12.05 Age, year -.60 .19 -.37 -3.09 .003 -.99 -.21 VCM dose, mg/kg/day -.44 .32 -.17 -1.40 .167 -1.07 .19 BMI (kg/m2) -2.60 1.51 -.23 -1.71 .092 -5.62 .44 Total VCM dose, g* .48 .15 .32 3.17 .002 .18 .78 Adj. R2 =0.371, F= 7.5724 (p<.001) *Total vancomycin dose in gram (g) administered during the hospital stay.

Table 3. Risks of AKI Model 1* Model 2¶ Unadjusted HR (95% CI) p Adjusted HR (95% CI) p Adjusted HR (95% CI) p Admission type General ward Reference Reference Reference Intensive care unit 4.37 (0.81, 23.53) .086 4.70 (0.76, 29.03) .096 4.49 (0.69, 28.92) .114 Height, cm 1.06 (0.98, 1.15) .166 1.03 (0.893, 1.16) .697 Weight, kg 1.05 (0.98, 1.12) .189 1.01 (0.889, 1.15) .865 BMI, kg/m2 1.11 (0.81, 1.53) .504 1.07 (0.74, 1.54) .719 Serum creatinine, mg/dL 15.34 (1.17, 201.08) .038 13.26 (0.69, 256.15) .087 13.04 (0.56, 302.53) .109 *Nagelkerke R2 =0.230, (-2) log-likelihood ratio (LR) = 40.490 ; ¶Nagelkerke R2 =0.244, (-2) LR = 39.934.

2-(a) 2- (b) Figure 2. Kaplan-Meier curve of the hospital mortality according to (a) creatinine clearance and (b) first serum VCM concentration.

Table 4. Risks of hospital mortality by multiple cox regression analysis Unadjusted HR (95% CI) p Adjusted HR (95% CI) p First serum VCM concentration (mcg/mL) 0.94 (0.87, 1.02) .140 0.962 (0.89, 1.04) .345 Total VCM days 0.95 (0.89, 1.02) .184 0.955 (0.89, 1.03) .955 Creatinine clearance (mL/min) 1.01 (0.99, 1.02) .151 1.005 (0.99, 1.02) .368 (-2)LR = 61.232 χ2 = 4.622, df*=3 *df = degrees of freedom. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S143

P2-AG03 P2-AG04 A report of meropenem sparing antibiotic Comparison of Mood Disorders as adverse events after Using Amar W Adisasmito* Imipenem/cilastin versus Meropenem: A Propensity Score Paediatric Infectious Disease Working Group, Department of Analysis Paediatrics, Antimicrobial Resistance Controlling Program Woonji Lee¹, Jung Ho Kim¹, Hye Seong¹,Jun Hyoung Kim¹, Committee, Harapan Kita Women and Children Hospital, Jakarta, Jin Young Ahn¹, Su Jin Jeong¹, Nam Su Ku¹, Joon-sup Yeom¹, Indonesia Jun Yong Choi¹ ¹Department of Internal medicine, Yonsei University College of Background: Meropenem resistance in Gram-negative bacteria Medicine, Seoul, Republic of Korea is increasing lately. Over diagnosis by doctors on results culture of colonization is considered as bacterial infection. Aim of this study Background: Several clinical trials showed that meropenem is to show implementation of meropenem sparing antibiotic will could be at least as effective as imipenem/ciclastin(imipenem), slow the emergence of resistance. and imipenem had more potential for causing seizures when Methods: This retrospective observational study was used to used at high doses. However, psychiatric adverse events such as assess rational use of meropenem. The study was reviewing mood disorders has not yet been well reported. In this study, we medical records of 530 patients who received meropenem during compared adverse events including mood disorders after using January to December 2018. The indicator for meropenem usage is imipenem versus meropenem by a propensity score analysis. calculated as DDD-Defined Daily Dosage. Methods: 837 inpatients who used imipenem or meropenem Results: We report meropenem DDD on first/second semester were included in single-center retrospective study. Age, dose 2018, on Paediatric, Maternity, Pediatric-Maternity ICU, and of carbapenems, site of infection, Sequential Organ Failure Neonatal-ICU wards. Decreasing meropenem prescription was Assessment(SOFA) score, baseline serum creatinine level, and followed by decreasing bacterial resistance. Glasgow Coma Scale(GCS) were used for propensity score 1:1 matching. Results: By propensity score matching, baseline characteristics of 234 patients were not significantly different. 30day mortality was not significantly different between two groups (p = 0.081) which was 44.4% in the imipenem and 33.3% in the meropenem group. The Kaplan-Meier analysis also showed no significantly difference of survival between two groups (p = 0.214). Analyzing adverse events, there was no significantly different seizure event between two group using the Kaplan-Meiers analysis (p = 0.578), and both of groups had 1.7% of seizure events. The imipenem group had more mood disorders compared to meropenem group (6.8% vs. 0.9%, p = 0.035). The Kaplan-Meier Graph 1. Meropenem DDD (n=350) analysis confirmed the significant difference in cumulative incidence of mood disorders between the two groups (p = Table 1. Multiple Drug Resistant Organism Trend (n=350) 0.017). By fitting Cox’s proportional hazards model, imipenem Bacteria %MDRO %MDRO use (p = 0.035), duration of carbapenem usage (p = 0.033) were st nd 1 semester, 2018 2 semester, 2018 significant predictors of cumulative incidence of mood disorders, MDRPseudomonas aeruginosa 33 27,5 and imipenem usage increased the risk of mood disorders (HR, MDRAcinetobacter baumanii 84 67 ESBLKlebsiella pneumoniae 60 56 10.949; 95% CI, 1.182-101.391). Among patients who had mood ESBLEscherichia coli 59 53 disorders, there was one psychosis (0.1%) which is the most ESBLEnterobacter cloacae 33 0 severe presentation of psychiatric adverse events. CRKlebsiella pneumoniae 26 16 Conclusion: Using imipenem/cilastin was the risk factor of CREscherichia coli 10 6 mood disorders as an adverse event compared to meropenem. CREnterobacter cloacae 33 6 Psychiatric adverse events of imipenem/cilastin such as mood CRAcinetobacter baumanii 78 55 disorders as well as psychosis should be further studied. MDR = Multiple Drug Resistance, ESBL = Extended Spectrum Beta Lactamase, CR = Carbapenem Resistance

Conclusion: It is necessary to improve prescribing habit to reduce unnecessary meropenem usage, and enhance rational antibiotic use. Meropenem appropriate usage led to decreasing bacterial resistance. S144 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

and genome sequencing. Results: Altogether 71 lytic phages were isolated against carbapenem resistant K. pneumoniae, A.baumannii, P. baeruginosa and colistin resistant Salmonella spp. Selected phages were found to be tailed phages. Individual phages and cocktails showed vary in host range. Among phages, cocktails of K. pneumonia phages showed interesting result which lysed 3 carbapenem resistant A. baumannii but individual phage did not lyze the same strain. To the best of our knowledge, this is the first study demonstrating synergy among phages during lytic infection to the bacteria other than its primary host genus. This promising effect has raised the possibility to expand the phage host range for phage therapy. However, more detailed studies at molecular level are needed to understand this synergy mechanism. Conclusion: We could able to isolate virulent bacteriophage against carbapenem resistant bacteria. The phage cocktail has raised the possibility to expand the host range crossing the genera which would be use for phage therapy.

P2-AG06 Increased concentration of divalent cations in extracellular environment reduces antibiotic activity of tigecycline Jo JW, Kim SJ, Ko KS Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea

Background: Concentrations of extracellular and intracellular divalent cations, especially magnesium (Mg2+), may be critical for biological actions of tigecycline, because the binding of tigecycline to 30S ribosomal subunits are mediated by the Mg2+ of the complexes. In this study, the effect of increased divalent cations (i.e. magnesium and calcium) in extracellular environment on antibiotic activity of tigecycline was investigated. Methods: We included each two strains of four Gram-negative bacterial isolates, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii. Minimal P2-AG05 inhibitory concentrations (MICs) of tigecycline against the eight Enhanced phage host range by the synergistic effect of phage strains were measured using cation-adjusted Mueller-Hinton cocktails broth (MHB II) with or without Mg2+ and Ca2+. Then, bacterial G.R. Dhungana*, M. Regmi, E. Upadhyay, I. Gnyawali, H. Upreti, survival rates were evaluated upon their exposure to 2X or 4X MIC P. paudel, A. Parajuli, R. Malla of tigecycline for 24 hours. Central Department of Biotechnology, Tribhuvan University, Results: The results showed that the MICs of tigecycline increased Kathmandu, Nepal 2- or 4-fold in all strains when the divalent cations were added in medium. In addition, bacterial survival rates were also increased Background: Increasing antibiotic resistance and declining significantly. development of new effective antibiotics is leading towards Conclusion: High concentration of divalent cations, Mg2+ and a post-antibiotic era. Among many options, phage therapy is Ca2+, may hinder the antibiotic activity of tigecycline. considered as one of the most affordable, efficient and promising alternative. This study aimed to screen, isolate and determine host spectrum of bacteriophage against clinical multidrug resistant P2-AG07 (MDR) bacteria using single as well as phage cocktails to explore A Survey on Physician Perception, Attitude and Current their synergistic effect against the MDR bacteria. Practices towards Antibiotic Allergy Testing Methods: The clinical isolates were identified by amplification SY Tan*, WB Lee of 16srRNA gene and amplification of resistance gene blaKPC Changi General Hospital, Singapore and blaNDM. Lytic phages were isolated and characterized morphologically by TEM, Protein profiling by SDS-PAGE, Introduction: The prevalence of antibiotic allergy is reported multiple host range, temperature and pH stability, phage life cycle to be about 10-30% of hospitalized patients. These allergies Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S145

limit antibiotic choices and are associated with inappropriate can make one or both antibiotics increasing the efficacy. antimicrobial prescribing, microbiological resistance, higher Results and discussions: There were 241 strains of E. coli and antimicrobial costs, and suboptimal patient outcomes. The allergy K. pneumoniae resistance to carbapenem were collected during histories are often dated and inaccurate. In our instituition, a 2017 and 2018 were included in the chess-board antibiotic 1000-bed tertiary hospital, in-house Antibiotic Allergy Testing combination ertapenem with imipenem and ertapenem with (AAT) is not available. Hence, the Antimicrobial Stewardship meropenem. The results detected that the combination of (ASP) Team carried out a survey among doctors in our institution, ertapenem with imipenem had made the synergistic efficacy so as to assess the potential of incorporating AAT into the ASP of 88.8%, and the combination of ertapenem with meropenem program. has made the synergistic efficacy of 88.8%. The detailed analysis Methods: A paper survey was distributed by hand to medical also revealed that the double carbapenem were also help the staff from various departments. The questions aimed to poll the imipenem or meropenem resistance became sensible and the perceived knowledge, current practices, as well as the perceived ratio was high or low was depended on the concentration of value of AAT in our institution. ertapenem. For example, with the concentration of ertapenem Results: There were 72 respondents to the survey, and they 8mg/L, 47.1% of imipenem resistance strains became sensible, consisted of senior and junior clinicians from various disciplines. with ertapenem 4mg/l the ratio is 35.2%, with ertapenem 2mg/ In general, most respondents agree that de-labelling a patient’s l then the ratio is 33%, and with ertapenem 1mg/l then the ratio antibiotic allergy would improve on the selection of appropriate go down to 24.4%; for meropenem, with the concentration antibiotics, reduce unnecessary use of broad spectrum antibiotics of ertapenem 8mg/l, 4mg/l, 2mg/l and 1mg/l, the ratio of and reduce cost of antimicrobial therapy. A large proportion also meropenem resistance became sensible were 62.6%, 60.3%, agreed that it would lead to safer administration of antibiotics as 54.9% and 55.9% respectively. well. Conclusion: The result of the study had proven that double Out of 72 respondents, 45 (62.5%) respondents had no prior carbapenem had the in-vitro efficacy against the CRE. This experience with AAT, while 42 (58.3%) respondents had finding has also mobilized the clinical lab to establish the attempted de-label a patient’s antibiotic allergy in the past. antibiotic combination testing, especially the double carbapenem All respondents were keen to refer patients to the AAT team trial in-vitro to support the clinical to have more tool for fighting should it be established in-house. these special antibiotic resistant pathogen. Conclusion: AAT is perceived to be a useful tool to improve antibiotic utilization by physicians in our institution. The survey results support the move to establish the AAT service. P2-AR01 Collateral Damage of Using Colistin for Short-term Treatment of Infections in Pigs on Emergence of Colistin- P2-AG08 resistant Enterobacteriaceae in Pigs In-vitro efficacy of the double carbapenem against the P. Poolperm, T. Tangkoskul, C. Seenama, N. Maknakhon, carbapenem resistant Enterobacteriaceae clinically isolated V. Thamlikitkul* from patients hospitalized at Nguyen Tri Phuong hospital in Faculty of Veterinary Medicine, Kasetsart University and Faculty of Viet Nam Medicine Siriraj Hospital, Mahidol University, Thailand S.T.Pham 1,a, B.T.Pham2,3, N.B.L.Luu3, H.T.Pham4, V.H.Pham3,5* 1Sydney University, 2University of Medicine and Pharmacy Background: Colistin has been widely used in food animals in HCMC, 3NK-Biotek Co., 4Phamngocthach University, in Thailand. Previous study on using colistin for prevention of 5Phanchautrinh University, aFirst author, *Corresponding author infections in pigs revealed that such colistin usage was associated with emergence of colistin-resistant Enterobacteriaceae in pigs. Background: Carbapenem resistance Enterobacteriaceae (CRE) Therefore, colistin has been no longer permitted for prevention is creating a big challenge not only because of the increasing of infections in food animals since 2017. However, colistin is of the detecting ratio but also until now none of the medical still permitted for short-term treatment of infections in food doctor has found the most effective antibiotic treatment for these animals. This study determined occurrence of colistin-resistant bacterial pathogens. Enterobacteriaceae in pigs that received colistin for short-term Aim of the study: Study the in-vitro efficacy of the double carbap- treatment of infections. enem against the carbapenem resistant Enterobacteriaceae clin- Methods: Study was conducted in 2 swine farms with more than ically isolated from patients hospitalized at Nguyen Tri Phuong 500 swine breeders in Thailand. These farms had not used colistin hospital in Viet Nam for prevention of infections in pigs for longer than a year. Rectal Materials and methods: The objectives of the study are the swabs were collected from the same 66 pigs at birth, and day 7, carbapenem resistance strains of E. coli and K. pneumoniae 14, 21, 28 and 60 after birth. Colistin was used to treat sick pigs by that were isolated from patients with infection and hospitalized instilling colistin solution into mouth of a particular sick pig twice Nguyen Tri Phuong hospital in Hochiminh City. The method of a day for up to 3 days. If the study pigs were sick and received study is using the chess-board method to find-out the in-vitro colistin treatment, rectal swabs were additionally collected efficacy of the combination of ertapenem with imipenem or with from pigs during colistin treatment period. Rectal swabs were meropenem against those bacterial pathogens. The synergistic determined for colistin-resistant Enterobacteriaceae. efficacy was determined when the combination of two antibiotic Results: No colistin-resistant Enterobacteriaceae was detected S146 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

in rectal swabs of pigs at birth. Some pigs in both farms had P2-AR03 diarrhea and received colistin for treatment during day 2 and Molecular characterization of extended-spectrum day 27. Colistin-resistant Enterobacteriaceae was detected in β-lactamase producing-Salmonella enterica serovar Virchow 13% to 50% of sick and health pigs when some of them were sick isolated from food-producing animals in South Korea during and received colistin. No sick pigs were observed during day 28 2010-2017 and 60, and colistin was not used during such period. Colistin- SH Na*, HY Kang, DC Moon, BH Hyun, SS Yoon, and SK Lim resistant Enterobacteriaceae was detected in 3% to 10% of healthy Bacterial Disease Research Division, Animal and Plant Quarantine pigs on day 28 and 0% to 3% of healthy pigs on day 60. MCR-1 was Agency, Republic of Korea detected in 50% of colistin-resistant Enterobacteriaceae isolates. Conclusions: Short term treatment of sick pig with colistin was Background: The emergence and dissemination of Salmonella also associated with emergence of colistin-resistant Enterobac- spp. resistant to extended-spectrum cephalosporins is a public teriaceae in pigs. However, colistin-resistant Enterobacteriaceae health concern. The aims of this study were to investigate was much decreased or disappeared after pigs were not sick and antimicrobial resistance and characterize the third-generation did not receive colistin. cephalosporin resistant Salmonella isolated from food-producing animals. Methods: Salmonella isolates from food-producing animals were P2-AR02 collected from all provinces in Korea during 2010 and 2017 were Comparative Assessment of Antimicrobial Resistance and investigated by serotyping, antimicrobial susceptibility testing, Virulence in Staphylococcus pseudintermedius Isolates from and molecular methods. Dogs with Otitis Externa and Healthy Dogs Results: High rate of the third-generation chphaolsporin- Gi Yong Lee1, Haeng Ho Lee1, Hong Sik Eom1, Sun Young Hwang2, resistance (63.8 %) was observed in Salmonella enterica serovar Soo-Jin Yang1* Virchow. A total of 169 ceftiofur-resistant S. Virchow strains were 1School of Bioresources and Bioscience, Chung-Ang Univ, Anseong, isolated from food-producing animals mainly from chicken 2 Korea, Haemaru Referral Animal Hospital, Sungnam, Korea (96.4 %). The blaCTX-M-15 and blaCMY-2 genes were identified by sequencing in 147 and 23 S. Virchow isolates, respectively. The Introduction: The recent emergence of S. pseudintermedius in 169 ceftiofur-resistant S. Virchow represented seven pulsotypes dogs with otitis externa and skin and soft tissue infections has with two predominant type II (58.6 %) and III (26.0 %). These become a significant issue in public health owing to the high two pulsotypes were detected in 96 farms. Most (81.0 %) of levels of antimicrobial resistance along with various virulence conjugative plasmid of blaCTX-M-15 belonged to ST-IncHI2 with factors. Although S. pseudintermedius is mainly associated with ISEcp1 and orf477 of the bla gene environments. In addition, all canine skin infections, sporadic human cases have recently conjugative plasmids of blaCMY-2 were belonged to ST12/CC12- been reported, indicating that this pathogen has a zoonotic IncI1 plasmids with ISEcp1. potential. In the current study, genotypic and phenotypic factors Conclusion: This study suggests that the specific blaCTX-M-15 associated with antimicrobial resistance and virulence in S. and blaCMY-2-carrying S. Virchow clones and plasmids were pseudintermedius were evaluated. predominant through the nationwide in food-producing animals. Methods: A total of 41 S. pseudintermedius strains isolated from Our results suggest that it needed the restriction of cephalosporin dogs with otitis externa (n = 26) and healthy dogs (n = 15) were use and strict surveillance in poultry production industry. used for comparative analyses of (i) genotypes (multilocus sequence typing, agr, and spa types), (ii) methicillin resistance and SCCmec types, (iii) multidrug resistance (MDR), (iv) biofilm P2-AR04 formation, and (v) susceptibility to human cathelicidin (LL-37). Prevalence of plasmid-mediated quinolone resistance Results: A high degree of genetic diversity was observed in both determinants in Escherichia coli isolated from food – groups of S. pseudintermedius strains, regardless of methicillin producing animals in South Korea resistance. Almost all methicillin-resistant strains (>95%) HJ Song1, DC Moon1, SC Park2, SS Yoon1, SK Lim1 harbored SCCmecV and displayed MDR. Although there was 1Bacterial Disease Research Division, Animal and Plant no difference in biofilm formation, S. pseudintermedius strains Quarantine Agency, Republic of Korea, 2College of Veterinary derived from otitis externa exhibited enhanced resistance to LL- Medicine, Kyungpook National University, Republic of Korea 37 compared with strains from healthy dogs. Conclusions: The high degree of MDR phenotype and wide- Background: Fluoroquinolones are broad-spectrum spread SCCmecV among methicillin-resistant S. pseudintermedi- antimicrobials and an important class of drugs in both human us (MRSP) strains suggest that continuous surveillance of antimi- and animal health. Resistance to fluoroquinolone in bacteria can crobial resistance among staphylococci in companion animal is be due to chromosomal and plasmid-mediated mechanisms. necessary. Furthermore, major virulence mechanisms associated The aim of this study was to investigate antimicrobial resistance with antimicrobial peptide resistance in MRSP should be ad- and plasmid–mediated genes in Escherichia coli isolated from dressed in future research. food-animals. Methods: A total of 480 faecal samples of healthy food–animals were collected from 58 farms from 2017 to 2019. E. coli was isolated using a selective agar and confirmed by Maldi-Tof. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S147

Antimicrobial susceptibility testing was performed by broth Pham Thi Ngoc Quyen, Nguyen Ba Thang dilution method. Plasmid-mediated quinolone resistance Ho Chi Minh City University Medical Center, Vietnam (PMQR) genes were detected by PCR. Results: Overall, antimicrobial resistance rates of indicator E. Introduction: Reversible splenial lesions of the corpus callosum coli from pigs and chickens were significantly higher than those have been found in various conditions including seizures, from cattle. PMQR genes of E. coli isolates were detected at 2.7%, antiepileptic drug toxicity or withdrawal, viral encephalitis, 27.0% and 15.4% in cattle, pigs and chicken, respectively. The hypoglycemia, Wernicke’s encephalopathy, multiple sclerosis, most common PMQR gene was qnrS (87.0%), followed by qnrB AIDS dementia, lymphoma, certain vaccinations and infections. (7.2%) and aac (6’)-lb-cr (5.8%). The co-carriage of two PMQR Mild encephalopathy with reversible splenial lesion (MERS) genes in one strain was found in 7 (1.5%) isolates. No qnrA, qnrC, is a clinicoradiological diagnosis reported mainly in children. qnrD and qnrV genes were detected. Antimicrobial resistance of We present a case of MERS in an aldult patient with Salmonella PMQR-positive E. coli isolates was higher in ceftiofur, gentamicin infection. and streptomycin than those from PMQR-negative isolates Case presentation: A 33-year-old man with persistent fever in (p<0.05). one month presented with one week of diarrhea and altered Conclusion: The existence of PMQR genes conferring susceptibil- mentation. Physical examination showed a temperature of ity to fluoroquinolones in food-producing animals suggested that 39oC, slurred speech, drowsiness, recent memory disturbance a significant reservoir of antimicrobial resistance genes relevant with intermittent hallucinations and otherwise normal vital to human medicine. signs. Abdominal CT examination showed slight symmetrical thickening of the wall of the terminal ileum, cecum, ascending colon. Brain MRI showed well- defined irregular lesion of the P2-CC01 splenium was seen on DWI/ADC with restricted diffusion Severe disseminated septicemic melioidosis involving the and no enhancement on T1 with Gadolinium. Blood cultures lungs, myocardium, and central nervous system in a patient grew Salmonella paratyphi associated with normal results with hemoglobin H-thalassemia disease: A case study in cerebrospinal fluid examination. Patient responsed with Walaiporn Wangchinda*, Pornpan Koomanachai Levofloxacin treatment. Repeat brain imaging one week following Division of Infectious Diseases and Tropical Medicine, Department revealed resolution of splenial lesion of the corpus callosum with of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol complete neurologic recovery. University, Bangkok, Thailand Discussion: MERS is a rare clinicoradiological syndrome and pathogenesis of MERS is not entirely established. No specific Background: Melioidosis is an infectious disease that is endemic treatment is recommended for MERS besides indicated treatment in Southeast Asia and Northern Australia. It has a wide spectrum for the underlying infectious disorder. Clinicians should be of clinical presentations, and it often mimics other diseases. aware of this disorder and include it in their differential of Patients with thalassemia disease have a higher risk of contracting encephalopathy, especially in tropical regions with various melioidosis. infectious diseases. Methods: Case report and review of pertinent international literature. Results: We report a 54-year-old Thai man with hemoglobin P2-CC03 H-thalassemia disease presented with prolonged fever Case Report: Superimposed Native Valve Endocarditis without organ-specific symptoms. He was transferred to our Caused by Vancomycin-resistant Enterococcus Faecium center for further evaluation. The diagnosis in this patient was While Treating Endocarditis by Streptococcus Anginosus severe disseminated septicemic melioidosis with pulmonary Seok Oh1, Hyung Yoon Kim1, 3, Yochun Jung2, Seong Eun Kim1, 4 involvement that was complicated by myocarditis and meningitis. 1Department of Internal Medicine, 3Division of Cardiovascular This case demonstrates an uncommon presentation and Diseases, 4Division of Infectious Diseases, Chonnam National uncommon complications of melioidosis that can be difficult to University Hospital, Gwangju, Korea, 2Department of Thoracic and diagnosis. The patient responded to treatment with meropenem Cardiovascular Surgery, Chonnam National University Hospital, followed by trimethoprim-sulfamethoxazole. The optimal Gwangju, Korea. antibiotic duration for melioidosis myocarditis and meningitis has not been defined. Longer duration of intravenous and Case Summary: A 56-year-old male with chief complaint of oral antibiotic therapy may be required in patients with these dyspnea had visited emergency room of tertiary hospital. There complications. were hypertension, atrial fibrillation and unstable angina in Conclusion: Melioidosis should be a differential diagnosis in his past history. Elevated N-terminal pro-hormone B-type patients with prolonged fever, especially patients that live in natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) endemic areas and that have risk factors for this condition. was detected. His chest radiogram revealed cardiomegaly and both lung increased haziness. Severe mitral regurgitation with chordal rupture was seen in transthoracic echocardiogram. P2-CC02 He was admitted for medical treatment and planned mitral Mild encephalopathy with reversible splenial lesion in valvular replacement. On hospital day 7, he developed fever salmonella infection: a case report and transesophageal echocardiogram was performed in S148 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

suspicion of infective endocarditis. Multiple oscillating materials nal pain. One month ago, the patient had dull aching left upper were seen attached to mitral valve. Infective endocarditis was quadrant pain worsening while taking deep breath. He denied diagnosed and multiple periodontal abscess was also diagnosed pain in other area. The pain was persistent all day without relief by as a result of consultation to dentist for evaluation of portal of any medications. He had no history of cough. He had no fever, no entry. Ampicillin-sulbactam combination with gentamicin was diarrhea, no vomiting. He lost 2 kg of his weight in this period. He administered empirically for viridans streptococci. On hospital went to private clinic and was prescribed oral trimethoprim-sul- day 12, Streptococcus anginosus was isolated from blood culture famethoxazole (80/400) twice a day for 7 days without improve- specimen which was drawn on day 7. From the hospital day 7 to ment. 35, ampicillin-sulbactam was continued. Despite of resolution of Past medical history: The patient had no underlying disease. He fever and negative conversion of follow up blood culture, there denied history of major trauma or major surgery. He denied use was still remained elevated inflammatory marker. Blood culture of alcohol and tobacco. He had no history of tuberculosis contact. was performed on hospital day 33 for the possibility of other Medications: none nosocomial infections. The blood culture isolates were confirmed Allergies: none vancomycin-resistance Enterococcus faecium (VRE) and same Epidemiological history: Patient is a farmer. He lives in northeast organism was also detected from vegetation which was removed of Thailand, Southeast Asia. There was no history of traveling by mitral valvular replacement on hospital day 35. Ampicillin- outside the area. sulbactam was discontinued and linezolid was started from Physical examination: He appeared well and was afebrile during hospital day 35, and the patient was well treated and discharged admission (maximum temperature 37°C). Other vital signs were on hospital day 64 after 4 weeks of linezolid treatment (Figure 1). in normal limits. The abdominal examination demonstrated mild This case suggests that superimposed drug resistant bacterial tenderness at left upper abdomen without sign of splenomegaly, endocarditis can occur while antibiotics are used in patients with his liver span was 9 cm without tenderness, shifting dullness was infective endocarditis. negative. Other physical examinations were unremarkable. Studies: His Hemoglobin was 11.3 g/dl (normal range 12.7- 16.9 g/dl). His white blood count was normal (8430/mcl). He had mild elevation of absolute eosinophil count (792, 9.4%). His renal function and liver function test were all in normal range. His fasting blood sugar was 92 mg/dl and HbA1C was 6.1%. Chest x-ray showed no definite infiltration. Hemocultures were obtained but showed no significant growth. Abdominal computed tomography was performed which demonstrated prominent size of spleen with multiple small hypodensity nodules, 0.5-1.6 cm in size and there was fluid collection 1.4x6.1 cm at lateral part of spleen suspected abscess forming. Liver showed normal size without space taking lesion. Diagnostic procedures and results: The fluid collection at lateral part of spleen were collected with ultrasound-guided aspiration. Figure 1. As there grew Streptococcus anginosus in the blood culture specimen on There were no bacteria found in pus gram stain, however pus the hospital day 7 and echocardiogram showed prominent findings of vegetation culture identified Burkholderia psuedomallei which was sensitive on the mitral valve, empirical antibiotics were administered. However, there were to antibiotics ceftazidime and co-trimoxazole. still high level of inflammatory markers. So the follow-up blood cultures were done from the hospital day 33 to 35, showing vancomycin-resistant Enterococcus faecium. Treatment and follow up: Patient was given 2-week course of In mitral valve replacement on the hospital day 35, the same microorganism was intravenous 2 gram every 8 hours of ceftazidime. He remained detected from the specimen of vegetation. New antibiotic therapy with linezolid was afebrile and his abdominal pain gradually improved until administered from the hospital day 35 and he was discharged on hospital day 64. completely resolved. Twenty-week of oral co-trimoxazole is Discussion Points: 1. Which portal of entry did vancomycin- planned for maintenance therapy. The Follow up imaging was resistant Enterococcus faecium, the second pathogen most planned at 6 weeks of treatment. probably use in this case? Discussion: Melioidosis is an infectious disease caused by 2. Is it possible for developing superimposed endocarditis despite Burkholderia psuedomallei. It mainly occurs in southeast Asia of intravenous antibiotic use? and northern Australia. Important risk factors in developing this infection include thalassemia and uncontrolled diabetes mellitus. The typical clinical manifestations are bacteremia, visceral P2-CC04 abscess, and community acquired pneumonia. There were only Unusual cause of abdominal pain: Isolated splenic melioidosis few case reports of isolated melioidotic splenic abscess and most T. Chaemsupaphan, P. Koomanachai cases have uncontrolled diabetes. We present an uncommon case Division of Infectious diseases and Tropical medicine, Department of isolated splenic melioidosis in a patient who does not have any of Medicine, Siriraj Hospital, Mahidol University, Thailand medical history. Most melioidotic cases are very well responded to intravenous ceftazidime. History of present illness: Sixty-year-old man without comor- Final diagnosis: Isolated melioidotic splenic abscess bidities presented with persistent left upper quadrant abdomi- Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S149

P2-CC05 and urine bag was removed, and antibiotics were shifted to Purple Urine Bag Syndrome: A Case Report meropenem in line with the sensitivity pattern of culture results. KO Rengel*, N Gomez After the 3rd day of antibiotic therapy, repeat blood and urine Department of Internal Medicine, Jose B. Lingad Memorial culture turned negative. The patient had improved neurological Regional Hospital, Philippines and clinical symptoms and was subsequently discharged after 2 weeks of antibiotic treatment. Background: Purple Urine Bag Syndrome (PUBS) is a purple Conclusion: The case presented a patient with the identified risk discoloration of the urine over a period of hours or days following factors in developing PUBS such as female gender, high urinary urinary catheterization. It is a rare condition with unknown bacterial load, renal failure and diabetes, as described in previous prevalence in the Philippines. The main risk factors identified studies. This phenomenon proved useful in recognition of an are female gender, increased dietary tryptophan, alkaline urine, underlying urinary tract infection among catheterized patients. constipation, chronic catheterization, high urinary bacterial load, Awareness of this syndrome should be done due to the high renal failure, and the use of a polyvinylchloride (PVC) plastic morbidity and mortality if left untreated. Immediate removal catheter. of urine catheter and prompt administration of appropriate Case Summary: A 61 year old woman diagnosed with end- antibiotics are necessary to manage this case. stage diabetic nephropathy for a year. She presented with 1-week history of altered sensorium accompanied by fever, jaundice, malaise, anorexia, insomnia, vomiting, and abdominal pain. P2-CC06 She was noted to be disoriented, febrile, jaundice with icteric Uncommon Viral Meningoencephalitis with sclerae and edematous. She was initially treated as a case of Common Clinical Syndrome: Human Herpesvirus 6 Ascending Cholangitis, Acute Liver Injury and Uremia secondary Meningoencephalitis to diabetic nephropathy. Urine catheter and urine bag was M. Kehaloon, P. Koomanachai* also inserted upon admission of the patient to monitor urine Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand output. On the 7th hospital day, the urine bag was noted to be purple in color (Figure 1). Urine culture revealed ESBL positive A 72-year-old man with type 2 DM& HT presented with subacute E. coli with 50,000 colonies/ml of urine. Blood cultures were fever with generalized vesicles on erythematous base for 3 also positive for the same pathogen. She then treated as a case of weeks & developed confusion for 1 day. Physical examination: Septic encephalopathy secondary to urosepsis. Urinary catheter he was confused& stiffness of neck was positive. The clinical diagnosis was meningoencephalitis. Magnetic resonance imaging(MRI) showed old cortical infarction without definite mass or leptomeningeal enhancement. The lumbar puncture was performed. Cerebrospinal fluid (CSF) analysis showed clear fluid with open pressure of 6.9 mmHg, WBC 191 cell/ mm3 with lymphocyte of 99%, RBC 85 cell/mm3, protein 100 mg/dl & glucose 77 mg/dl. The patient was diagnosed of TB meningoencephalitis for a provisional diagnosis with herpes zoster encephalitis for the differential diagnosis thus the empirical treatment were HRZE and acyclovir. CSF viral polymerase chain reaction(PCR) was performed with positive result for HHV- 6 viral DNA so anti-HIV was investigated due to the reports of HHV-6 meningoencephalitis were mostly related to HIV/AIDs patients. Anti-HIV was reactive with CD4 of 515. Ganciclovir was prescribed instead of HRZE & acyclovir. The patient was rapidly clinical improved within a week & completely recovered on D-12 of ganciclovir without neurological complication. Antiretroviral drugs were prescribed as soon as possible. Discussion: Few cases were reported of HHV-6 meningoencephalitis in HIV patients. The association of HHV-6 CNS infections with HIV patients is unclear. 5 cases of HHV-6 encephalitis have been reported. 4 cases died while one case that received ganciclovir & foscarnet for 6 weeks was improved. HHV-6 which related to the CNS infection can occur in immunocompromised host including AIDS patients. In summary, we reported one more patient of uncommon viral infection, HHV-6 with common clinical presentation of meningoencephalitis whom was undiagnosed of HIV/AIDs beforehand.

Image 1. Image of the purple urinary bag S150 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P2-CC07 literature worldwide. Cases have been reported from France, Endophthalmitis caused by Kocuria kristinae: a case report Denmark, Ireland, United States, Spain, Australia and Argentina. M Alles, D Wariyapola, K Salvin, K Jayatilleke* We report the case of a septic, immunosuppressed 54-year old Sri Jayewardenepura G. Hospital, Sri Lanka female who became bacteremic with Pandoraea and reviewed other reported cases. We assessed the risk factors and profiles Introduction: Kocuria kristinae is a Gram positive bacterium, of previous cases and compared them to our patient. We also ubiquitous in nature and a commensal of the skin and mucous reviewed treatment and outcomes. Our patient responded to membranes of humans. It can also cause opportunistic infection treatment and was successfully discharged from the hospital. We according to limited available data. Here we present the first describe, to our knowledge, the first reported case ofPandoraea reported case of K. kristinae endophthalmitis in Sri Lanka. bacteremia in the Philippines and in Asia. Case report: Previously healthy farmer aged 67 presented As 20 of the cases reviewed were from CF patients and 1 was with Branch Retinal Vein Occlusion causing macular oedema from a patient with sarcoidosis, it would be prudent to conduct of the right eye, for which 2 doses of intravitreal bevacizumab further investigation for intrinsic lung diseases among non-CF were administered 3 months apart in the local District General patients isolated with Pandoraea. In most areas in the Philippines hospital. A few days after the 2nd dose, he developed acute visual where molecular methods for identification and speciation are blurring in his right eye and was diagnosed with endophthalmitis. not available, knowledge of Pandoraea will allow for a thorough A trans pars plana vitrectomy was performed and a specimen review of specimens from patients who manifest a chronic and of vitreous humor was directly plated on blood and chocolate multi-drug resistant pattern of infection. agar plates for bacterial culture. Circular, low convex, non hemolytic, white colonies which were 2 mm in diameter grew on both plates following overnight aerobic incubation. These were P2-CC09 catalase positive and coagulase negative. A Gram stain revealed Pyogenic Sacroiliitis Caused by Salmonella enterica Gram positive round cocci in tetrads. The isolate was resistant to Serotype Derby furazolidone and bacitracin but had a zone of inhibition around KL Moon*, KW Hong, OH Cho, SI Hong, BH Ryu, IG Bae vancomycin. It was identified via VITEK 2 as Kocuria kristinae. Department of Internal Medicine, Gyeongsang National University Following surgery intravitreal vancomycin and ceftazidime was College of Medicine, South Korea administered. Discussion: In a study involving 8 cases of Kocuria endophthal- Background: Nontyphoidal Salmonella infection usually oc- mitis, 5 were due to open globe injury. The rest were following curred in patients with the underlying immunosuppressive con- cataract surgery, microbial keratitis and an endogenous cause. dition. We report a case of acute sacroiliitis with bacteremia by Iatrogenic vitreal infection is likely to have occurred in our patient Salmonella enterica serotype Derby in young man without under- following intravitreal bevacizumab. While Gram stain and bio- lying conditions. chemical features could misidentify the organism as coagualase Case: A previously healthy 21-year old man was admitted with negative Staphylococcus or Micrococcus species, studies show that complaints of fever, altered mentality, and left hip pain. The the VITEK 2 system gives correct identification. Though guide- patient had a temperature of 38.9 ºC, a blood pressure of 105/65 lines do not exist for antibiotic susceptibility testing for Kocuria mmHg, and a pulse rate of 120/minute. Laboratory finding species, high rates of efficacy have been shown with vancomycin. included WBC 8570/mm3 (seg. Neutrophil 87.2%), platelet 116,000/mm3. Erythrocyte sedimentation rate (ESR) was 42 mm/h with a C-reactive protein (CRP) measuring 162.5 mg/L. P2-CC08 AST=80 U/L, ALT=44 U/L were elevated. Creatinine was 4.34mg/ Pandoraea Bacteremia in a 54-year old Female in the dL. Ceftriaxone was empirically administered. After admission, Philippines: A Case Report and Review of the Literature he had suffered from left hip pain for several days with inability K Valmoria, E Salvaña to walk and bear weight on the left hip. The magnetic resonance Manila Doctors Hospital, Philippines imaging of hip showed acute sacroiliitis on left pelvis area. Salmonella enterica serotype Derby was identified on the blood Pandoraea. is a gram-negative bacillus that is considered an culture. On the 5th day of hospitalization, the fever was subsided. emerging nosocomial pathogen today. It is aerobic, catalase- Antimicrobial therapy was changed to oral ciprofloxacin on the positive, non-lactose fermenting and motile with a polar flagella 9th day of admission. He was discharged after 10 days in good able to grow in Burkholderia cepacia Selective Agar (BCSA) condition. Antibiotic therapy continued for a total of 7 weeks at media. The genus was created in 2000 to accommodate organisms outpatient setting. that have previously been tentatively assigned as Burkholderia or Conclusion: We report the first case of acute sacroiliitis by Ralstonia. It is difficult to identify using conventional biochemical Salmonella enterica serotype Derby. Unlike it is known to mainly methods, and use of molecular methods is recommended. occur in immunocompromised patient, it is also reported in Pandoraea is most often found among patients with cystic fibrosis, healthy adults. who are typically colonized with Pseudomonas aeruginosa. It is usually susceptible to trimethoprim-sulthamoxazole and the carbapenems. As of this writing, there are only 20 case reports published in the Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S151

P2-CC10 debridement. A case of fatal adult diphtheria infection A 36-year-old diabetic backhoe driver presenting after a fall was M Zainal *, N Umur, CL Leong investigated for back pain at a local hospital and transferred with Kuala Lumpur Hospital, Malaysia severe pneumonia and septic shock. A 46-year-old farmer and a 55-year-old priest with community Background: Diphtheria was once a major cause of disease in acquired pneumonia and uncontrolled diabetes, were found to children. It has markedly decreased after introduction of effective have lung abscesses. The latter presented with septic shock. diphtheria vaccine and implementation of routine immunization The fifth patient was a 46-year-old trishaw driver with diabetes in Malaysia. Diphtheria previously a rare disease in adult has now and pyrexia of unknown origin for one month. re-emerged. This is a case report of a fatal diphtheria infection All five patients had blood cultures positive within 24 hours of in an immunocompetent, vaccinated adult in Hospital Kuala incubation with Gram negative bacilli confirmed as Burkholderia Lumpur, Malaysia. pseudomallei. Four were seropositive for melioidosis antibodies. Case report: A case of a fully vaccinated 27 year old male All were started on IV meropenem with oral cotrimoxazole and presented with 4 days history of sore throat, neck swelling and four responded to treatment. fever, without respiratory distress. Total leucocyte was high with Discussion: Melioidosis is known as a great mimicker with neutrophils predominant. Throat examination noted white patch iceberg disease pattern. This series of bacteraemic patients with at the pharynx. Unfortunately, the clinical diagnosis of diphtheria 20% mortality highlights following messages. infection was made after he was hypoxic and required intubation. It is important to consider melioidosis in the differential diagnosis Findings during intubation showed slough membrane extending of community acquired pneumonia, deep-seated abscesses and to the right bronchus. He received diphtheria antitoxin and pyrexia of unknown origin. Blood cultures are vital in detection. erythromycin intravenously after intubation and was isolated Diabetes is a common risk factor. Trauma can be an initial immediately. Despite treatment, he deteriorated rapidly and died presentation misleading the diagnosis. of diphtheria infection with multiorgan failure within 48 hours of admission. Laboratory diagnosis were obtained from throat swab and pharyngeal tissue culture after his demise. The gram P2-CE01 positive rod bacteria grew on tellurite media were identified as Multidrug resistant Streptococcus pneumoniae of non- Corynebacterium diphtheriae using Vitek 2 system (BioMérieux, vaccine type causing invasive pneumococcal disease by close France) and confirmed presence of toxin by PCR and Elek test. contact from baby to healthy young mother Contact tracing were conducted but all investigations were Jeong Rae Yoo1*, Sang Taek Heo1, Suhyun Oh1, and Keun Hwa Lee2 negative. All contacts were given prophylactic antibiotic. Only his ¹Department of Internal Medicine, Jeju National University School fiancée was symptomatic and successfully treated. of Medicine, Jeju, Republic of Korea, 2Department of Microbiology Conclusion: High clinical suspicion and diagnosis of diphtheria and Immunology, Jeju National University School of Medicine, is crucial for early management and implementation of control Jeju, Republic of Korea measures. Public health plays important role to ensure increased uptake of scheduled immunisations and introduction of Background: The incidence of carriage and disease associated periodic adult booster in national vaccination programme as with vaccine-type serotypes declined in vaccinated children, recommended by Centers for Disease Control and Prevention and also in unvaccinated children and adults. Non-vaccine type (CDC) might be necessary. (NVT) Streptococcus pneumoniae disease is increasing in recent years. Here, we report that invasive pneumococcal disease caused by NVT of multidrug resistance (MDR) S. pneumoniae from PCV P2-CC11 13 vaccinated infant to unvaccinated healthy mother. Bacteraemic Melioidosis - A case series at the National Method: We interviewed about family members of patient with S. Hospital of Sri Lanka pneumoniae. We examined nasopharyngeal swab culture about T Ranasinghe*, D Vidanagama, G Patabendige family members at our outpatient room. Colonies were collected National Hospital of Sri Lanka from the plates for identification using an automated system (VITEK II, bioMerieux). All isolates with appropriate properties Introduction: Burkholderia pseudomallei, the etiological agent were serotyped by the sequetyping method. of melioidosis is an intracellular Gram-negative bacterium which Result: The 29-year-old previous healthy woman with fever and can cause fatal outcomes. Sri Lanka is an endemic country but headache for three days visited in our hospital, and had been late presentations and delayed diagnosis of the disease is noted. breastfeeding her baby for eight months. She was diagnosed with We present five bacteraemic cases of melioidosis with different brain abscess and sinusitis by S. pneumoniae. However, although clinical presentations from a six months period. she had never been exposed antibiotics before, its antibiotic Case series: A 28-year-old housewife with newly diagnosed susceptibility test showed an MDR pathogen. The serotype of S. diabetes and trauma to head one month back, presented to a pneumoniae was 15B/C, and same serotype identified from her local hospital with headache, fever, unilateral facial swelling. baby’s nasopharyngeal specimen. Radiological investigations suggested a sub-masseteric abscess Conclusion: We experienced an invasive MDR pneumococcal and extensive invasion of sinuses and temporal fossa. She disease in immunocompetent young adult in the community. We succumbed to infection despite appropriate antibiotics and think that her infectious disease was spread by close contact from S152 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

her baby with S. pneumoniae of NVT colonizer to mother. We more than two-fold changes (p-value<0.05) in all the H. pylori consider immunization and recommendation development for isolates from human and cockroaches with the range of 2.30 to NVT in universal. 11.31 folds, respectively. This suggests that H. pylori isolates from cockroaches has the ability in adhering human stomach cells with the presence and higher expression of non-adhesin gene. P2-CE02 Conclusion: The in-vitro study of the H. pylori isolates from The correlation between Helicobacter pylori strains from human and cockroaches provided better understanding of the Human and Cockroaches in causing Gastroduodenal host-pathogen interaction. The expression of ureA and flaA Infection gene also demonstrated the same role of the non-adhesins in Jamal Hussaini2,3, Noor Masyitah Jumahat1,3, the pathogenesis of H. pylori infection for both human and Nurul Fathiyah Zaipul Anuar1,3, Zaini Mohd Zain3, cockroaches’ isolates. Hence, there was a significant association Navindra Kumari Palanisamy3, Annamalai Chandra Mouli3 between both isolates due to the high similarity in H. pylori 1Institute of Medical Molecular Biotechnology (IMMB), Universiti stains isolated from human and cockroaches. It also indicates the Teknologi MARA, 47000 Sungai Buloh, Selangor, 2Institute for possible role of the cockroaches as H. pylori infection sources. Pathology, Laboratory and Forencsic Medicine (I-PPerForM), Universiti Teknologi MARA, 47000 Sungai Buloh, Selangor, 3Faculty of Medicine, Universiti Teknologi MARA, 47000 Sungai P2-CE03 Buloh, Selangor Clinical score system to predict severe fever with thrombocytopenia syndrome in patients with endemic zoonoses Introduction: Helicobacter pylori (H. pylori) is a Gram negative Dae-Hyuk Heo1*, Yu Min Kang2, Kang Il Jun3, Chang Kyung Kang3, 5, and microaerophilic fastidious human pathogen that often Song Mi Moon1, Pyoeng Gyun Choe3, 5, Wan Beom Park3, 5, associated with gastritis, peptic ulcer and responsible in Ji Hwan Bang4, 5, Eu Suk Kim1, 5, Hong Bin Kim1, 5, Sang-Won Park4, 5, development of gastric carcinoma and mucosa-associated Won Sup Oh2, Nam Joong Kim3, 5, Myoung-don Oh3, 5, lymphoid tissue lymphoma (MALT). Cockroaches are source Kyoung-Ho Song1, 5 of bacterial infections that can transmit disease by easily 1Department of Internal Medicine, Seoul National University contaminating food, eating utensils, kitchen surfaces. The aim Bundang Hospital, Seongnam, Republic of Korea, 2Department of this study is to investigate the correlation between H. pylori of Internal Medicine, Kangwon National University School of strains from human and cockroaches. Medicine & Hospital, Chuncheon, Republic of Korea, 3Department Methods: Hundred H. pylori isolates from patients and of Internal Medicine, Seoul National University Hospital, Seoul, cockroaches were collected. The bacteria isolates were Republic of Korea, 4Department of Internal Medicine, Boramae subjected to polymerase chain reaction (PCR) for genotyping Medical Center, Seoul, Republic of Korea, 5Department of Internal and speciation. In-vitro co-cultured of the H. pylori isolates with Medicine, Seoul National University College of Medicine, Seoul, human stomach epithelial (AGS) cells were done to regulate Republic of Korea the expression of H. pylori virulence gene (ureA and flaA) after interaction with the host cells by using quantitative real-time PCR Background: Severe fever with thrombocytopenia syndrome (qRT-PCR). (SFTS) is an emerging infectious disease with high mortality in Results: The percentage of H. pylori detected in human and East Asia. This study aimed to develop, for primary care providers, cockroach samples were 64.4% and 58.18%, respectively. The a prediction score using initial symptoms and basic laboratory amplifications of the targeted genes also revealed the presence blood tests to differentiate between SFTS and other endemic of similar variation of H. pylori virulence genes in both H. pylori zoonoses in Korea. isolates from human and cockroaches. The cagA gene presence Methods: Patients aged ≥18 years diagnosed with endemic in 80% of the H. pylori isolates with p-value<0.05. Furthermore, zoonoses during a 3-year period (between January 2015 and chi-square test showed that there was a significantly association December 2017) were retrospectively enrolled from 4 tertiary between the genotypes and frequency of the different isolates university hospitals. A prediction score was built based on with p-value<0.05. The expression of ureA and flaA of the H. pylori multivariate logistic regression analyses. strains showed higher expression as compared to control with Results: Of 84 patients,35 with SFTS and 49 with other endemic

Table 1. (P2-CE03) Diagnostic performance of the severe fever with thrombocytopenia syndrome (SFTS) prediction score systema Sensitivity Specificity PPV NPV LR+ LR- Cut-off (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) 1 0.971 0.612 0.642 0.968 2.505 0.047 (0.857–0.999) (0.531–0.632) (0.566–0.659) (0.839–0.998) (1.828–2.710) (0.002–0.268) 2 0.829 0.959 0.935 0.887 20.300 0.179 (0.717–0.875) (0.880–0.992) (0.810–0.988) (0.813–0.918) (5.966–116.491) (0.126–0.321) 3 0.429 1.000 1.000 0.710 NA 0.571 (0.330–0.429) (0.930–1.000) (0.770–1.000) (0.660–0.710) (0.571–0.721) 4 0.200 1.000 1.000 0.636 NA 0.800 (0.116–0.200) (0.940–1.000) (0.579–1.000) (0.598–0.636) (0.800–0.941) CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR-, negative likelihood ratio; NA, not available. aPrediction score system = (1 x neurologic symptoms) + (1 x diarrhea) + (1 x leukopenia) + (1 x normal CRP) Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S153

zoonoses were enrolled. In multivariate logistic regression in February(30.8%), May(34.5%) and June(36.8%)(P<0.001). analysis, independent predictors of SFTS included neurologic Rhinovirus activity was highest in August(23.1%), but not symptoms (odds ratio [OR] 12.915, 95% confidence interval statistically significantly higher than in other months (P=0.313). [95%CI] 2.173–76.747), diarrhea (OR 10.306, 95%CI 1.588–66.895), After adjusting for age, screening year, travel in prior 7 days, and leukopenia (<4000/mm3) (OR 19.400, 95%CI 3.290–114.408), and influenza vaccination in past 12 months, influenza Infection normal C-reactive protein (<0.5mg/dL) (OR 24.739, 95%CI 1.812– was 5-6 times higher in February (aOR 4.85, 95%CI 1.21-19.50, 337.742). We set up a prediction score by assigning one point to P=0.026), May (aOR 4.90, 95%CI 1.29-18.65, P=0.020) and each of these four predictors. A score of ≥2 had 82.9% sensitivity June (aOR 6.39, 95%CI 1.72-23.75, P=0.006) respectively than (95%CI 71.7%–87.5%) and 95.9% specificity (95%CI 88.0%–99.2%) in December. No difference in viral activity between months (Table 1). The area under the curve of the clinical prediction score was observed for rhinovirus, coronavirus, parainfluenza, and was 0.950 (95%CI 0.903–0.997) (Figure 1). adenovirus respectively. Interestingly, coronavirus infection was Conclusion: This study finding suggested a simple and useful 3 times higher in patients who had travelled in the prior 7 days scoring system to predict SFTS in patients with endemic zoonoses. (aOR 3.29, 95%CI 1.19-9.08, P=0.022). We expect this strategic approach to facilitate early differentiation Conclusion: A bimodal circulating pattern (Feb and May-June) of SFTS from other endemic zoonoses, especially by the primary was observed for influenza in tropical Singapore. However, care providers, and to improve the clinical outcomes. seasonality is less clear for rhinovirus and other respiratory viruses.

P2-CE06 Resurgence of Taenia saginata in Republic of Korea?: Five cases of human taeniasis at a university hospital Yu Jeong Lee1, Moon-Ju Kim1, Eun Jeong Won1,2*, Seung Ji Kang3, Sook In Jung3, Soo Hyun Kim2, Jong Hee Shin2 1Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea, 2Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea, 3Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea

Figure 1. Receiver operating characteristic (ROC) curve of the clinical prediction Background: Human taeniasis is a zoonotic parasitic infection score for severe fever with thrombocytopenia syndrome (SFTS) in patients with caused by tapeworm, Taenia species. In Korea, taeniasis was endemic zoonoses prevalent in the past, however, it has been rarely reported in a recent 10 years. Recenlty, we encountered five cases of human taeniasis caused by Taenia saginata in a five month period at a P2-CE04 university hospital in Jeollanam-do, Republic of Korea. Seasonal variations of influenza and other respiratory Methods: All of five patients presented some pieces passed viruses in tropical Singapore out from their stool. Morphological and molecular diagnosis A Chow*, M Lim, AA Hein were performed to several proglottids obtained from each case. Tan Tock Seng Hospital Singapore The mitochondrial cytochrome c oxidase subunit I (cox1) gene and elongation factor-1-alpha (ef1a) genes were targeted in Background: Seasonal patterns of respiratory viruses are well PCR amplification and sequencing. Phylogenetic trees were established in temperate climates, but less well understood in the constructed by the neighborjoining method using the geneious tropics. We sought to assess for the seasonal variations of major computer program. respiratory viruses in tropical Singapore. Results: All patients were suffered from discharged proglottids in Methods: We recruited 717 consecutive patients who presented their stools without any abdominal symptoms and they had food at the emergency department of a 1600-bed acute adult hospital history of raw cow meat or liver. Ova of Taenia species were found for upper respiratory tract infection, June 2016 through Nov in all but one case. The sequences of cox1 gene of 1,760 bp of the 2018. Participants were screened for 15 major respiratory segments were 99.4-99.9% identity with T. saginata and 95.1- viruses using a multiplex PCR respiratory virus pathogen panel 95.8% identity with T. asiatica. Sequencing of the segments for the (Seeplex RV15 ACE Detection) via throat and nasal swabs. We 1,124 bp ef1a gene showed 100% identity with T. saginata, 99.3% compared monthly viral activities, and assessed for independent with T. asiatica and 95.2% with T. solium. The neighbor joining associations between respective viruses and months of the year tree demonstrated that our specimen was phylogenetically using multivariable logistic regression models. compatible to T. saginata, but far from T. asiatica or T. solium, Results: Influenza(20.6%), rhinovirus(14.4%), coronavirus(3.6%), based on reports from various Asian countries and deposited in parainfluenza(3.4%), and adenovirus(3.2%), were the top five the GenBank. All of patients were treated with praziquantel and circulating respiratory viruses. Influenza activity was highest after that ova of Taenia species were no longer found in follow-up S154 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

observation. and/or third generation cephalosporins cause significant mor- Conclusion: It is note that our cases were concentrated at bidity and mortality. Avibactam (AVI) is a β-lactamase (BL) inhib- Gwangju·Jeonnam area and all of them were encountered in itor of Class A, C and some Class D serine BLs. The combinations a short term period. Traditional habit of ingesting raw beef ob- of AVI and ceftazidime (CAZ) and aztreonam (ATM) are being served in this area can be a risk factor for T. saginata infection. It developed to treat infections caused by carbapenem-nonsuscep- indicates the possibility of the presence of cattle with T. saginata tible (NS) Eba. We evaluated the in vitro activity of CAZ-AVI and metacestodes and the connection with human fecal material ATM-AVI against Eba collected in Asia/Pacific through the An- containing infective eggs before. The current cases suggest that T. timicrobial Testing Leadership and Surveillance (ATLAS) global saginata infection which may be hidden especially in Korea can surveillance program. be neglected. Methods: Non-duplicate causative pathogens were collected Key word: human taeniasis, Taenia saginata, Republic of Korea from 44 hospitals in Australia, China/Hong Kong, Japan, Malaysia, Philippines, S. Korea, Taiwan, and Thailand. Susceptibility testing was performed by CLSI broth microdilution at Peking University P2-CE07 Medical College Hospital, Beijing (China isolates) and IHMA, Molecular epidemiological typing and antimicrobial Inc. (all other isolates). AVI was tested at a fixed concentration of resistance of Neisseria gonorrhoeae strains in Thailand 4 mg/L. Extended-spectrum β-lactamase (ESBL) screen-positive Yuchui Narissara, Boonbumrung Khaemaporn* (CAZ or ATM MIC >1 mg/L) and meropenem (MEM)-NS (MIC Faculty of Allied Health Sciences, Chulalongkorn University, >1 mg/L) phenotypes were used as markers of BL production. Thailand Results: The percentages of ESBL screen-positive and MEM- NS Eba increased over the 4 years surveyed (Table). CAZ-AVI Sexually transmitted diseases are major problems in many showed potent in vitro activity against all Eba and ESBL screen- countries around the world. Gonorrhea is one of five common positive isolates (92->99% susceptible). Activity was reduced sexually transmitted diseases caused by “Neisseria gonorrhoeae”. against MEM-NS Eba but restored against the subset of MEM-

Nowadays, the 3rd generation of cephalosporin is used for NS MBL-negative isolates. ATM-AVI tested with MIC90s of 0.12- treatment; there was the trend that 3rd cephalosporin decreased 2 mg/L against all and resistant organisms. 99.5% (211/212) susceptibility. The bacteria were supported by the Thai Bureau of MEM-NS Eba and >99.9 (9045/9048) of all Eba for which of AIDS, TB, and STD. The samples stored from October to data were available were inhibited by ≤8 mg/L of ATM-AVI. December 2016 were used for the experiment. A total of 141 gonococcal isolates were analyzed for antibiotic susceptibility test, sequence typing (ST) for NG-MAST and analyze for the similarity of same ST by Pulsed-field gel electrophoresis (PFGE). The experiments showed that azithromycin, cefixime, and ceftriaxone which this present medicine has a trend decrease susceptibility in ST12563. The result of analysis from database found ST that 39 different types and more than 2 samples have 12 STs different result. ST11371 has the most duplicate of 8 samples. Furthermore, there is data that cannot be identified yet (new sequence type) because of no found in the database which has 78 samples (55.3%). The result of the experiment of the PFGE method by using SpeI restriction enzyme in 6 samples of ST11371, found similarity with average more than 80 percent which supports the results of data analysis by the NG-MAST method and can be easily searched on the website compared to worldwide data. This experiment did not Conclusion: The regional and local prevalence of different found ST1407 which causes the problem gonorrhea multidrug carbapenem-resistance mechanisms must be considered when resistance spread of global but ST12563 that has MIC of cefixime evaluating treatment options. and ceftriaxone are 0.125 and 0.032 µg/ml respectively which is a concern, should monitor of spread multidrug resistance in the future. P2-CE09 In Vitro Activity of Aztreonam-avibactam and Ceftazidime- avibactam against Pseudomonas aeruginosa Collected in P2-CE08 a Global Surveillance Program in the Asia/Pacific Region, Trending Analysis of ESBL Screen-positive and Carbapenem- 2014–2017 nonsusceptible Enterobacteriaceae Collected in Asia/Pacific: M. Hackel1, G. Stone2, M. Dowzicky2, A. Johnson1*, D. Sahm1 ATLAS Global Surveillance, 2014−2017 1International Health Management Associates, Schaumburg, IL, K. Kazmierczak1, G. Stone2, A. Johnson1*, D. Sahm1 USA, 2Pfizer, Cambridge, MA, USA 1IHMA, Inc., Schaumburg IL, USA; 2Pfizer, Groton CT, USA Background: Ceftazidime-avibactam (CAZ-AVI) demonstrates Background: Enterobacteriaceae (Eba) resistant to carbapenems good activity against Enterobacteriaceae (Eba) and Pseudomonas Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S155

aeruginosa (Pae) producing class A, C and some class D Organism Ceftaroline Linezolid Tigecycline Source (n: CPT, LNZ and TGC) β-lactamases (BLs). Aztreonam-avibactam (ATM-AVI) is a MIC90 %S* MIC90 %S MIC90 %S combination under development that shows good activity against SSTI SA (4084, 4455) 1 99.9 2 100 0.25 98.1 MRSA (2453, 2626) 1 99.8 2 100 0.25 98.0 Eba isolates carrying MBLs, including those co-producing serine MSSA (1631, 1829) 0.25 100 2 100 0.25 98.3 BLs. This study evaluated the in vitro activity of ATM-AVI, CAZ- BHS (846, 865) 0.015 100 2 99.9 0.06 100 AVI and comparators against clinical isolates of Pae collected in MIC90 in µg/mL; %S, % susceptible (*dose-dependent for CPT vs SA); MRSA, the Asia/Pacific region from 2014-2017. methicillin-resistant SA; MSSA, methicillin-susceptible SA; PSSP, penicillin- Methods: Non-duplicate isolates were collected in eight countries susceptible SP; PRSP, penicillin-resistant SP in Asia/Pacific (Australia, Hong Kong, Japan, South Korea, ≥99% of SA from RTI and SSTI were susceptible to CPT based on Malaysia, Philippines, Taiwan and Thailand). Susceptibility the CLSI dose-dependent breakpoint of <4 µg/mL. >98% of SP testing was performed and interpreted using CLSI broth from RTI were susceptible to CPT, with 95.4% penicillin-R isolates microdilution guidelines. susceptible. LNZ and TGC maintained good in vitro activity Results: against all G+ isolates, with %S ≥99.9% for LNZ and >93% for TGC.

Organism/ Drug (MIC90 in µg/mL|% Susceptible) Conclusion: CPT, LNZ, and TGC continue to demonstrate potent Year (n) CAZ CAZ-AVI ATM ATM-AVI CST MEM in vitro activity against clinically relevant G+ pathogens associated P. aeruginosa, 64 77.2 8 92.4 32 67.8 32 NA 2 96.8 >8 78.5 (2836) with RTI and SSTI in patients in APAC. 2014 (804) 64 74.3 8 91.7 64 65.1 32 NA 4 89.4 > 8 73.9 2015 (646) 64 77.4 8 91.5 32 65.0 32 NA 2 99.2 > 8 77.9 2016 (671) 64 79.3 8 92.9 64 69.0 16 NA 1 99.9 > 8 79.1 P2-CE11 2017 (715) 64 78.5 8 93.6 32 72.3 16 NA 1 99.9 8 83.6 Epidemiology of Herpes Zoster in Solid Organ Transplant ATM, aztreonam; AVI, avibactam at a fixed concentration of 4 µg/mL; CAZ, Recipients: A Meta-analysis of Observational Studies ceftazidime, CST, colistin; MEM, meropenem; NA, no breakpoint available Da Eun Kwon1, Hye Sun Lee2, Kyoung Hwa Lee1, Sang Hoon Han1, 1 CAZ-AVI showed excellent activity against Pae isolates (MIC90, Young Goo Song 8 µg/mL; 92.4% susceptible). ATM-AVI demonstrated reduced 1Divison of Infectious Disease, Department of Internal Medicine, activity against Pae isolates (MIC90, 32 µg/mL). Activity of CAZ- Yonsei University College of Medicine, Seoul, Republic of Korea, AVI and ATM-AVI remained unchanged between 2014 and 2017. 2Biostatistics Collaboration Unit, Yonsei University College of Of the tested agents, CAZ-AVI and colistin were the most active. Medicine, Seoul, Republic of Korea Conclusion: CAZ-AVI showed potent in vitro activity against Pae collected in the Asia/Pacific region. ATM-AVI activity was limited Background: The latent varicella-zoster virus frequently can lead against Pae. to localized or disseminated herpes zoster (HZ) after solid organ transplantation (SOT). Several observational studies reported various features of HZ among heterogeneous subjects of SOT P2-CE10 recipients. We performed a meta-analysis to clarify clinical In Vitro Activity of Ceftaroline, Linezolid, and Tigecycline epidemiology of HZ in SOT recipients. against Staphylococcus aureus and Streptococcus Methods: We collected the articles using keywords of “herpes pneumoniae by Infection Site in the Asia/Pacific (APAC) zoster” or “human herpesvirus 3” or “varicella zoster” and Region, 2014-17 “transplant” in Pubmed and EMBASE database. Among total 3671 M. Hackel1, G. Stone1, M. Dowzicky2, A. Johnson1, D. Sahm1 papers, 739 overlapping and 1406 irrelevant studies were removed 1International Health Management Associates, Schaumburg, IL, by abstract review. The full text review deleted 1512 studies (301 USA, 2Pfizer, Cambridge, MA, USA in pediatrics, 956 in hematopoietic stem cell transplantation, 23 Background: Gram-positive (G+) bacteria are common causes of of laboratory studies, 217 of case report, and 15 of non-English). infections, and there is an increasing trend of infections caused by Because two studies were not eligible due to insufficient data, we antibiotic-resistant strains. This study presents the in vitro activity finally included total 6560 SOT recipients from 12 observational of ceftaroline (CPT), linezolid (LNZ) and tigecycline (TGC) studies in meta-analysis. We systemically analyzed given data against G+ isolates from respiratory tract infections (RTI) and according to sex and transplant organs with R package. skin-soft tissue infections (SSTI) in APAC. Results: Total pooled proportion (PP) of HZ was 0.092 (95% Methods: Non-duplicate isolates of S. aureus (SA), S. pneumoniae confidence interval [CI], 0.075-0.114) in random effects model (SP), and beta hemolytic streptococci (BHS) were collected in (I2=84%). PP of HZ was significantly difference between transplant 8 countries in APAC. Susceptibility testing was performed and organs of kidney (KT, n=3135), liver (LT, n=2303), heart (HT, interpreted using CLSI broth microdilution guidelines. n=609), and lung (LTx, n=513) (overall p<0.001). HT (0.164, 95% Results: CI 0.134-0.198) and LTx (0.126, 95% CI 0.102-0.155) recipients Organism Ceftaroline Linezolid Tigecycline had significantly higher PP of HZ compared to KT (0.061, 95% Source (n: CPT, LNZ and TGC) MIC90 %S* MIC90 %S MIC90 %S CI 0.046-0.081) and LT (0.083, 95% CI 0.066-0.103) recipients RTI SA (2946, 3290) 2 99.5 2 99.9 0.5 95.1 (all pairwise comparison p-values of < 0.001). HT and LTx MRSA (2004, 2231) 2 99.3 2 100 0.5 93.8 subpopulations had high homogeneity with I2 of 0%. The meta- MSSA (942, 1059) 0.25 100 2 99.9 0.25 97.8 SP (1454, 1656) 0.25 98.1 2 100 0.03 99.5 regression revealed PP of HZ in recipients with graft rejection was PSSP (626, 682) 0.03 100 2 100 0.03 100 significantly higher than in recipients without rejection (p=0.024). PRSP (478, 550) 0.5 95.4 1 100 0.03 100 However, PP of HZ was similar between male and female S156 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

(p=0.450). Meta-regression for publication year (p=0.890) and years. The monthly incidence rate of IE of our institution has linear regression of funnel plot (p=0.514) showed no publication been increased (RR 1.06; 95% CI, 1.02 - 1.10; p = 0.005). Whereas, bias. the mortality rate showed trends toward down (RR 0.93; 95% CI, Conclusion: This meta-analysis revealed PP of HZ was different 0.88 - 0.99; p = 0.020). Causative microorganisms were identified between transplant organs. HT and LTx recipients from fairly in 309 patients (73.7%) and included streptococci (34.6%), homogenous studies had high PP of HZ with ≥ 0.1. The active and staphylococcus aureus (15.8%). The in-hospital mortality program for HZ vaccination should be implemented in high risk rate was 14.6%. A multivariate logistic regression analysis SOT recipients. found aortic valve endocarditis (OR 3.18; p = 0.001), IE caused by staphylococcus aureus (OR 2.32; p = 0.026), a presence of neurologic complications (OR 1.98; p = 0.031), a high SOFA score (OR 1.22; p = 0.023) and a high Charlson’s comorbidity index (OR 1.11; p = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be protective factors against mortality (OR 0.25; p <0.001). The mean AUC value of logistic regression model was 83.0. Conclusion: Although IE has been increasing, mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis.

P2-CE13 Activity of Ceftolozane/Tazobactam Against Clinical P. aeruginosa Isolates Collected in Asia/Pacific – SMART 2016- 2018 S. Lob1, K. Kazmierczak1, L. Chen2, K. Young3, M. Motyl3, D. Sahm1 1IHMA, Inc., Schaumburg, IL, USA, 2Merck Sharp & Dohme, Taipei, Taiwan, 3Merck & Co., Inc., Kenilworth, NJ, USA

Background: Ceftolozane/tazobactam (C/T) is an antipseudomonal cephalosporin combined with a β-lactamase inhibitor. The combination was cleared by FDA and EMA and is approved in the United States and over 60 countries worldwide. Using recent isolates collected in Asia/Pacific countries as part of the global SMART surveillance program, we evaluated the activity of C/T and comparators against P. aeruginosa (PA). P2-CE12 Methods: In 2016-2018, 49 clinical laboratories in 10 Asia/Pacific Trends, microbiological features, clinical characteristics and countries collected up to 250 consecutive, aerobic or facultatively outcomes of infective endocarditis: A 12-year retrospective anaerobic, gram-negative pathogens from blood, intraabdominal, study in South Korea urinary, and lower respiratory infections. MICs were determined JH Kim1, HJ Lee2, JY Ahn1, SJ Jeong1, NS Ku1, SH Lee2, JY Choi1, for 3,973 PA isolates using CLSI broth microdilution and JS Yeom1, YG Song1 interpreted with CLSI 2019 breakpoints. Isolates collected in 2016- 1Department of Internal Medicine, Yonsei University College 2017 that tested with C/T MICs >4 µg/mL were screened by PCR of Medicine, South Korea, 2Department of Thoracic and and sequencing for genes encoding β-lactamases. Cardiovascular Surgery, Yonsei University College of Medicine, Results: The activity of C/T and comparators is shown in the South Korea table. Carbapenemases were detected in 3.8% (97/2529) of PA isolates Background: Infective endocarditis (IE) is a potentially lethal collected in 2016-2017, ranging from 0-0.6% of isolates collected disease that has undergone constant changes in epidemiology in Hong Kong, Australia, New Zealand, and Taiwan to 11.3% and pathogen. Therefore, it is necessary to investigate the overall in Thailand and 39.5% in Vietnam. Among C/T-NS PA isolates trends, microbiological features, clinical characteristics and (n=201), 47.8% of isolates carried carbapenemases (IMP, NDM, outcomes of IE in South Korea. VIM, and GES), 7.5% carried only ESBL, and in 44.8% no acquired Methods: We performed a retrospective cohort study of patients β-lactamases were detected. with the diagnosis of IE admitted to tertiary care center in South Conclusions: Susceptibility to C/T exceeded 92% in all countries Korea. The trends of IE incidence and mortality rate and risk except Thailand and Vietnam, where rates of carbapenemase- factors for in-hospital mortality were analyzed. positive PA were highest. Only amikacin and colistin Results: There were 419 IE patients (275 male vs. 144 female) demonstrated similar or higher activity, while susceptibility to during the study period. The median age of the patients was 56 the β-lactam comparators and ciprofloxacin was typically 10-25 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S157

percentage points lower. C/T provides an important treatment ranging from 1.4% in Thailand (where 98.6% of IMI-NS isolates option for infections caused by PA in the Asia/Pacific region. carried MBL and/or OXA-48-like cpases [MBL/OXA]) to 81.7% in Taiwan (5.0% MBL/OXA-positive, 50% KPC-positive). A total of 53 KPC-positive KP (92.5% IMI/REL-S; including KPC-2 (n=41) and P2-CE14 KPC-17 (n=12)) and 42 BL-positive, cpase-negative KP (83% IMI/ Activity of Imipenem/Relebactam Against REL-S) were detected. Among IMI-NS EC (n=61), 54.1% of isolates Enterobacteriaceae from Asia/Pacific – SMART 2015-2017 were IMI/REL-S, 49.2% were MBL/OXA-positive, and 6 carried S. Lob1, K. Kazmierczak1, L. Chen2, K. Young3, M. Motyl3, D. Sahm1 KPC-2 (all IMI/REL-S). 1IHMA, Inc., Schaumburg, IL, USA, 2Merck Sharp & Dohme, Conclusions: IMI/REL was active against >96% of EC and KP Taipei, Taiwan, 3Merck & Co., Inc., Kenilworth, NJ, USA and >93% of KPC-positive isolates. Susceptibility to IMI/REL among IMI-NS KP varied across the region, with higher activity Background: Relebactam (REL) is an inhibitor of class A and in countries with high proportions of KPC-positive and low C β-lactamases (BL) in development in combination with proportions of MBL and/or OXA-48-like-positive isolates. IMI/ imipenem (IMI). We evaluated the activity of IMI/REL against REL promises to be an important treatment option for IMI-NS isolates collected in Asia/Pacific (AP) as part of the SMART cpase-negative isolates and KPC producers. surveillance program. Methods: In 2015-2017, 45 clinical laboratories in AP collected up to 250 gram-negative pathogens from intraabdominal, urinary, P2-CE15 and lower respiratory infections. Susceptibility was determined Clinical Features of Invasive Nontyphoidal Salmonella for 6863 E. coli (EC) and 4450 K. pneumoniae (KP) using CLSI Disease in Taiwan: A Single Institution Study broth microdilution and CLSI breakpoints (using IMI breakpoints YC Chen*, YJ Chang, CH Chiu for IMI/REL). Isolates with IMI MIC >1 µg/mL were screened by Department of Pediatrics, Chang Gung Memorial Hospital, PCR and sequencing for genes encoding BL. Taoyuan, Taiwan Results: Among all EC, 99.6% of isolates were IMI/REL- susceptible (S) in AP overall, ranging from 98.3% in Vietnam Background: Invasive nontyphoidal Salmonella (iNTS) disease to 100% in 5 countries. Susceptibility and proportion carrying have been reported sporadically. However, there is limited study carbapenemases (cpases) among all KP are shown in the table. to describe the clinical features and epidemiology of iNTS in the Among IMI-nonS (NS) KP (n=245), 39.2% were IMI/REL-S, pediatric population. The study was undertaken to describe the

Table. P2-CE13 % Susceptibleb Country (no. of sites)a n C/T P/T FEP CAZ MEM IMI ATM CIP AMK CST Australia (5) 753 97.3 82.5 87.5 86.1 87.8 80.2 77.7 83.5 97.2 99.3 Hong Kong (3) 94 93.6 68.1 75.5 73.4 73.4 66.0 60.6 70.2 98.9 100.0 South Korea (7) 394 93.9 60.2 70.8 68.5 71.3 68.0 60.7 56.1 94.7 99.8 Malaysia (4) 344 92.4 75.0 83.1 77.6 84.6 78.5 69.5 84.0 95.1 99.7 New Zealand (5) 399 98.3 88.2 87.0 89.98 89.97 83.5 79.2 80.5 97.7 100.0 Philippines (4) 173 94.2 76.3 80.4 77.5 75.1 77.5 65.3 65.9 96.5 99.4 Taiwan (9) 1152 96.1 74.1 82.6 80.2 82.0 79.5 67.5 78.1 99.0 99.7 Thailand (5) 446 79.6 62.8 69.7 67.7 66.6 62.8 56.1 67.7 88.3 99.3 Vietnam (6) 182 56.6 51.1 45.1 50.0 39.6 42.9 39.6 36.8 61.5 100.0 Asia/Pacific (49) 3973 92.2 73.4 79.5 77.9 78.9 74.9 67.4 74.0 94.7 99.6 aOnly countries with ≥2 participating sites are shown individually, Not shown are isolates from Singapore (n=36) bSusceptibility values ≥90% shaded gray C/T, ceftolozane-tazobactam; P/T, piperacillin-tazobactam; FEP, cefepime; CAZ, ceftazidime; MEM, meropenem; IMI, imipenem; ATM, aztreonam; CIP, ciprofloxacin; AMK, amikacin; CST, colistin

Table. P2-CE14 % Susceptible Country (no. of sites) n IMI/RELa IMI ETP CAZ P/T CIP AMK CST % KPC % MBL and/or OXA-48-like Australia (5) 535 98.1 97.6 95.7 89.5 93.3 85.8 99.6 99.4 0.0 1.9 Hong Kong (2) 110 100 100 100 89.1 95.5 74.6 100 97.3 0.0 0.0 Korea, South (7) 482 100 99.2 95.4 68.5 77.6 58.5 95.0 99.2 0.6 0.0 Malaysia (4) 490 96.9 95.3 92.5 67.4 80.0 65.7 98.4 98.0 0.0 2.4 New Zealand (4) 253 100 100 98.8 75.1 85.0 70.8 100 98.4 0.0 0.0 Philippines (3) 365 94.5 91.8 91.0 68.0 81.1 55.3 98.1 98.9 2.2 4.9 Singapore (2) 229 99.6 97.8 99.1 84.7 87.8 72.1 99.1 100 0.0 0.4 Taiwan (9) 1292 99.2 95.4 89.6 71.5 78.7 62.5 95.2 98.1 2.3 0.3 Thailand (5) 468 84.6 84.4 82.3 46.6 59.0 37.2 97.7 90.4 0.0 16.5 Vietnam (4) 226 91.2 83.6 82.7 60.2 69.9 47.4 88.5 98.2 5.3 10.2 Asia/Pacific (45) 4450 96.7 94.5 91.6 70.7 79.4 62.5 96.8 97.7 1.2 3.3 a For comparison purposes, CLSI breakpoints for IMI were used for IMI/REL. IMI/REL, imipenem/relebactam; ETP, ertapenem; CAZ, ceftazidime; P/T, piperacillin-tazobactam; CIP, ciprofloxacin; AMK, amikacin; CST, colistin; MBL, metallo-β- lactamase S158 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

clinical presentation, antimicrobial susceptibility pattern, and P2-CE16 outcome of iNTS in a tertiary care center in northern Taiwan. Kathmandu is still the “enteric fever capital”: A journey from Methods: We retrospectively reviewed the medical records of 52 2009 to 2018 pediatric patients with iNTS from 2016 to 2018. iNTS disease is Shyam Kumar Mishra* defined as a positive NTS isolates recovered from any specimen Medicare National Hospital, Kathmandu, Nepal of a sterile body site. Medical records of patients were reviewed to obtain information on clinical manifestations, comorbidities, Background: The capital city of Nepal “Kathmandu” was coined complications, antimicrobial resistance, treatment, and clinical “enteric fever capital of the world” in previous studies. Therefore, outcome. this study was aimed to assess the prevalence of Salmonella Results: A total of 52 culture-confirmed cases of iNTS were spp. causing bacteremia and to determine change in common diagnosed during the study period. The median age of the cases antibiotics among Salmonella sp. over a period of a decade. is 1.5 years old, and 56% are male. Among these 52 isolates, 51 Method: A retroprospective study was conducted from January were recovered from the blood sample, and the remaining 1 was 2009 to December 2018 at Medicare National Hospital, Nepal from cerebrospinal fluid. Fever (96%) and diarrhea (90%) were on a total of 13,928 blood samples, received in the microbiology the two most common symptoms. Forty-nine (94%) patients were laboratory from patients suspected of bacteremia. The samples hospitalized, and the mean hospitalization duration is 10 days. All were manually processed from 2009 to 2015, while BD BACTEC hospitalized patients received parental antibiotic treatment with blood culture system was employed after 2016 for bacterial a mean duration of 7.7 days (7.7 ± 5.8). There was no mortality culture. Kirby-Bauer disc diffusion method was adopted for or relapse among the patients. The rates of insusceptibility of antibiotic susceptibility testing. NTS isolates to ampicillin, chloramphenicol, trimethoprim/ Result: Out of total 13,928 samples, significant bacterial growth sulfamethoxazole, ceftriaxone, and ciprofloxacin were 40%, 35%, was obtained in 4.8% (n=665) excluding contamination (3.2%). 21%, 12%, and 4%, respectively. The prevalence of Salmonella enterica (serotypes Typhi and Conclusion: iNTS disease occurred relatively more in young Paratyphi A) was 67.3% (448/665) which showed a fluctuating children (< 2 years old) in Taiwan. Local susceptibility patterns trend among the growth positivity each year over a period may serve as a guide for the antimicrobial therapy. Continued of a decade, viz., 65.2% (30/46), 40.9% (9/22), 28.6% (10/35), surveillance is warranted to monitor the emergence of resistant 76.5% (39/51), 65.1% (28/43), 44.1% (26/59), 77.3% (34/44), strains. 53.8% (84/156), 64.3% (83/129) and 87.5% (70/80) in respective years from 2009 to 2018. The non-Salmonella isolates (n=217) Table 1. Baseline characteristic and clinical presentation were basically gram-negative bacteria including Klebsiella Baseline characteristic % (n/total) pneumoniae, Acinetobacter calcoaceticus baumannii complex, Sex (male/total) 56 (29/52) Burkholderia cepacia complex. Similarly, around 16% of the Age (year) (median; range) 1.5 (0.1-4) isolates were methicillin resistant Staphylococcus aureus (MRSA), Underlying diseases 25 (13/52) and one out of four Streptococcus pneumoniae isolates were Clinical feature Fever 96 (50/52) resistant to Ceftriaxone. Resistance to Ciprofloxacin was found to Fever days (mean ± S.D) 5.5 ± 3.0 decrease from 73.8% during 2016-2017 to 64.3% (45/70) in 2018. Diarrhea 90 (47/52) Conclusion: Salmonella enterica still reigns the bacteremia cases Diarrhea days (mean ± S.D) 5.75 ± 3.4 in the capital of Nepal. However, the decrease in resistance to Bloody stool 23 (12/52) fluoroquinolone during the last year is an appealing finding and Vomiting 17 (9/52) this kind of yearly surveillance on bacteremia is essential to help Abdominal pain 12 (6/52) Admission as order diagnosis 19 (10/52) clinicians to manage the cases efficiently based on laboratory Hospitalization days (mean ± S.D) 10.02 ± 7.03 results.

Table 2. S. enterica serogroup classification and antibiotic insusceptibility rate P2-CE17 Sal.enterica serogroup % (n/total) Facility-specific risk factors for colonization of Serogroup B 10 (5/52) carbapenemase-producing Enterobacteriaceae (CPE) in an Serogroup C1 10 (5/52) interconnected healthcare network Serogroup C2 10 (5/52) 1* 1 2 2 1 Serogroup D 51 (27/52) A.H.Aung , P.Y.Hon , B.Ang , D.C.B.Lye , A.Chow , 1 2 Serogroup E 19 (10/52) Department of clinical epidemiology, and Department of Antibiotic insusceptibility infection control, Tan Tock Seng Hospital, Singapore Ampicillin 40 (21/52) Ciprofloxacin (R) 4 (2/52) Background: Risk factors for colonization of carbapenemase- Ciprofloxacin (I) 33 (17/52) producing Enterobacteriaceae (CPE) vary geographically and Ceftriaxone 12 (6/52) Chloramphenicol 21 (9/42) demographically. Our study aimed to identify facility-specific risk Ertapenem 0 (0/52) factors for CPE colonization in a healthcare network comprising Imipenem 0 (0/52) an acute care hospital (ACH) and its intermediate- and long-term Sulfamethoxazole + Trimethoprim 35 (18/52) care facilities (ILTCFs). Methods: During June-July from 2014 to 2016, inpatients of an Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S159

ACH and 6 ILTCFs were screened for CPE colonization. Data were P2-CE19 obtained from clinical records. Stratified analyses using modified Comparison of Clinical and Genotypic characteristics of Poisson regression models were performed to assess for facility- healthcare-associated Uropathogenic Escherichia coli specific independent risk factors. According to Extended-spectrum beta-lactamase production Findings: Of 5357 participants, 56 were colonized with CPE, 39 in Korea (69.6%) were from ACH. After adjusting, the prevalence of CPE Miri Hyun, Ji Yeon Lee, Hyun Ah Kim, Seong-Yeol Ryu colonization tripled in patients with prior usage of penicillins Department of Infectious disease, Keimyung University School of (adjusted prevalence ratio [aPR] 2.90, 95%CI 1.05 – 8.06) and Medicine, Dongsan Medical Center, Daegu, South Korea PPI (aPR 3.19, 95%CI 1.01 – 10.07) in the ACH. Hospital-stay for ≥3 weeks (aPR 2.17, 95%CI 1.09 – 4.33), dementia (aPR 3.24, Objective: Increasing of extended-spectrum beta-lactamase 95%CI 1.43– 7.34) and prior carriage of carbapenem-resistant (ESBL) production in Enterobacteriaceae is an important Enterobacteriaceae (CRE) (aPR 58.15, 95%CI 24.59 – 137.50) were problem worldwide. The purpose of this study was to determine also associated with CPE colonization in the ACH. In ILTCFs, the risk factors of ESBL production in healthcare-associated prior presence of wound (aPR 5.10, 95%CI 1.09 – 23.84), prior uropathogenic E. coli (UPEC) infection. usage of carbapenems (aPR 2.98, 95%CI 1.06 - 8.38), prior VRE Method: We compared clinical and genotypic characteristics of carriage (aPR 17.07, 95%CI 1.52– 191.52), and prior CRE carriage UPEC in healthcare-associated acute pyelonephritis according (aPR 621.25, 95%CI 27.65 - 13958.45) were significantly associated to ESBL production from February 2015 to June 2018. The with CPE colonization. phylogenetic groups and virulence factors were identified using Conclusion: Similarities and differences in risk factors for specific primers by polymerase chain reaction. CPE colonization were observed between healthcare facility Result: A total 96 patients were analyzed, 28 of ESBLs and 68 of types. Prior CRE carriage was the strongest risk factor for CPE non-ESBLs. Male was observed more in ESBL group, without colonization. Pre-emptive isolation and contact precautions significance. Mean age and underlying diseases showed for CRE carriers in ACHs and ILTCFs could prevent CPE no differences between the two groups. Recurrent UTI and transmission. concomitant bacteremia were observed more in ESBL group, without significance. Prior usage of antibiotics within 3 months was more associated with ESBL group (64.7% vs. 32.1%, p=0.004). P2-CE18 In phylogenetic group, B2 was the most common in both groups. Characteristics of Plasmodium vivax malaria in children and Among the virulence genes, papC (77.3% vs. 55.6%, p=0.036) in adolescents in the Republic of Korea during the period 2000 adhesins, and hlyA (54.5% vs. 7.4%, p=0.001), cnf1 (56.5% vs. 8.0%, to 2016 p=0.001) in toxins were more associated with ESBL group. In JE Song1, 6*, SY Park2, YS Park3, Y Park3, YG Kwak1, KS Lee4, multivariate analysis, prior antibiotic use within 3 months (Odds SH Cho5, SE Lee5, HI Shin5, JS Yeom6 ratio [OR] 5.348, 95% confidence interval [95% CI] 1.648-17.359, 1Department of Internal Medicine, Inje University Ilsan Paik p=0.005) and identification of cnf1 (OR 9.115, 95% CI 1.025- Hospital, 2Division of Infectious Diseases, Dongguk University 81.036, p=0.047) were risk factors of ESBL production. Ilsan Hospital, 3Department of Internal Medicine, National Health Conclusion: Rather than host factor and clinical characteristic, Insurance Service Ilsan Hospital, 4Division of Infectious Diseases, virulence factor and prior use of antibiotics were more associated Myongji Hospital, 5Division of Vectors and Parasitic Disease, with ESBL production in healthcare-associated UPEC infection. Korea Center for Disease Control and Prevention, 6Department of Further study will be needed to determine the risk factors of ESBL Internal Medicine, Yonsei University College of Medicine production including antibiotic associated genes.

Background: Reports about Plasmodium vivax (P. vivax) malaria in children and adolescents have been limited to case reports. P2-CE20 Thus, we aim to describe the incidence and characteristics Antimicrobial susceptibility of microorganisms isolated Method: This study is retrospective study conducted in four from patients with intra-abdominal infection in the Republic hospitals located in Goyang, Gyeonggi province, and one hospital of Korea: multicenter study (2016-2018) in Seoul. We reviewed the medical records of patients under 18 YK Yoon1*, MS Lee2, C Moon3, J Hur4, H Lee1, SW Kim5 years and collected information, including the severity of malaria. 1Korea University Anam Hospital, 2Kyung Hee University Hospital, Results: During the 16-year study period, a total of 156 patients 3Busan Paik Hospital, 4Yeungnam university medical center, were included. The distribution of vivax malarial disease from 5Kyungpook National University Hospital School of Medicine 2000 to 2016 showed a peak incidence of 25 (16.0%) cases in 2006. Among them, 21 (13.5%) were classified as severe vivax malaria, Background: The aim of this study was to evaluate the antimi- and 2 (9.5%) required intensive care. Patients with severe vivax crobial susceptibility of pathogens isolated from patients with malaria were older and had more abnormal finding in laboratory intra-abdominal infections (IAIs) in South Korea. tests. Common severe malaria manifestations were jaundice Methods: This multicenter study was performed at 5 university- (78.6%), unlike adult data. affiliated hospitals in South Korea, between 2016 and 2018. All Conclusion: P. vivax malaria in children and adolescents occur patients with microbiologically proven IAIs were retrospective continuously, although small percentage. Further research on the included. Identification and antimicrobial susceptibility testing clinical features and characteristics are needed. was performed, using automated microbiology systems. S160 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

Results: A total of 1583 non-duplicated clinical isolates were then decreased significantly from 2012. Positive rate declined isolated from 1181 patients. Of them, 377 patients (31.9%) were by approximately one half, from 13.7% (range = 15.4-10.1%) in nosocomial infections, and 584 (49.4%) presented complicated prevaccine era (2004-2008) to 6.7% in 2018. IAIs. In-hospital mortality rate was 9.2%. The distribution of the During 2004-2011, the rotavirus season consistently occurred microorganisms were aerobic Gram-negative (65.1%), aerobic between January and May, with the peak occurring during Gram-positive (30.7%), anaerobic (1.5%) and fungal (2.7%) February. After 2011, the seasons became February and April, pathogens. The most common pathogens were Escherichia coli with the peak occurring during March. (26.3%), followed by Klebsiella spp. (22.3%) and Enterococcus Since 2008, we analyzed rotavirus genotyping. Major rotavirus spp. (18.0%). Susceptibility rates of E. coli and K. pneumoniae to genotypes were observed to vary slightly from year to year. In major antibiotics were as follows: amoxicillin/clavulanate (61.3%, the prevaccine period (2008), G1P[8] (46.8%) was the overall 70.2%), cefotaxime (71.5%, 90.1%), ciprofloxacin (53.5%, 57.1%), predominant genotype. Among postvaccine period, G1P[8] (44- piperacillin/tazobactam (82.8%, 74.0%), amikacin (88.0%, 66.6%) 64.3%) dominated during 2009-2010 and was then replaced by and imipenem (90.3%, 95.7%). Enterococcus spp. susceptible G2P[4] (41-49%) at 2011-2012. At 2013, redetected most frequently to vancomycin was 72.2%. Susceptibility rates of Pseudomonas strain was G1P[8]. Looking at the genotypes from 2016-2018 in the aeruginosa and Acinetobacter spp. to imipenem were 66.7% and vaccine era, G2P[4] (71.4%) was the most prevalent in 2016 and 35.3%, respectively. was then replaced by G8P[8] (29.8%) at 2017 and G9P[8] (20.1%) Conclusion: In the era of antimicrobial resistance, continuous during 2018. And some unusual combinations (G2P[8], G4P[2], monitoring is important to determine appropriate empirical G8P[6] and G12P[9]) also were identified. Also non vaccine target antibiotic therapy based on the actual situation of the resistance gene of G8, G9, P[4] types have increased. of pathogens to antibiotics. Conclusion: A review of the rotavirus epidemic over the last 15 years clearly confirms that vaccination has reduced rotavirus infection. Rotavirus epidemic season was also slightly shifted. P2-CE21 However, the prevalent genotypes have changed little by little Trends in Laboratory surveillance of Group A rotavirus and the emergence of new genotypes that are not included in the before and after vaccine introduction in Gwangju, Korea. vaccine has been confirmed. Therefore these emerging strains 2004 to June 2018 should be considered as candidates for new rotavirus vaccines in Min Ji Kim, Sun Hee Kim, Tae-Sun Kim, Duck woong Park, the future. Kwang gon Kim, Jin Jeong, Mihee Seo, Hye jung Park , Ji Hyun Shin, Jae Keun Chung, Hye-young Kee Health and Environment Research Institute of Gwangju P2-CE24 Characteristics of Pseudomonas aeruginosa Colonization on Background: Two live attenuated RV vaccines were licensed and Human Body became commercially available in South Korea. RotaTeq (Merck N.M.H Nguyen, N.B.V Tran, Q.M Truong, L.Q.A Nguyen, & Company, Inc, Whitehouse Station, NJ, USA), launched in T.T.H Nguyen September 2007, is a vaccine that consists of five distinct bovine School of Biotechnology, International University, Vietnam reassortants, and each of the five vaccine strains contains outer National University of HCMC capsid proteins from a serotype of the human RVs (G1, G2, G3, G4, and P[8]). Rotarix (GlaxoSmithK-line, Rixensart, Belgium), P. aeruginosa is both important human pathogen and of human licensed in June 2008, consists of a single attenuated G1P[8] strain normal flora. Surprisingly, understanding on its prevalence and of human RV. Despite the global introduction of vaccinations body distribution has not been well documented. In this work, we for rotavirus over a decade ago, rotavirus infections still result in studied characteristics of P. aeruginosa colonization on human >200,000 deaths annually. To evaluate the long-term impact of body. Samples were collected from 512 healthy volunteers rotavirus vaccination on disease prevalence and seasonality in including 310 females and 202 males with age from 1 to 84 years Gwangju, South Korea, we analyzed laboratory rotavirus test data old. Pseudomonas was then isolated using selective media. from EnterNet-Korea during the prevaccine (2004–2008) and Obtained isolates were identified using conventional PCR with postvaccine (2009–2018) periods. P. aeruginosa specific primers targetingoprL, nfxB and algD. 16S Materials/methods: Stool samples were collected from 41,191 rRNA gene sequencing was applied to check PCR accuracy in patients presenting to approximately ten referral hospitals for identification. 23.83% (122/512) volunteers had P. aeruginosa-like treatment of acute gastroenteritis in Gwangju. Patients included containing samples. However, only 14 were identified to have P. in the study had a clinical diagnosis of acute gastroenteritis aeruginosa (2.73%). Furthermore, among them, 11 (78.57%) were which was defined as more than two episodes of watery diarrhea young adults (age 18-35 years) and 3 (21.43%) were old adults within a 24 hr period. Samples were tested using enzyme-linked (age >55 years). Interestingly, P. aeruginosa colonization seemed immunosorbent assay and standardized G and P typing methods to be more associated with female (12/14 or 85.71%; p=0.003) by KCDC (Korea Centers for Disease Control and Prevention). than male (2/14 or 14.29%; p=0.610). An important finding in our Results: The positive rate of rotavirus was the highest in 2011 study is that we found a correlation between people with sinusitis (18%), but it has been decreasing continuously since then. The and P. aeruginosa respiratory tract colonization (11/14 or 78.57%; change point detection analysis of the time series shows that the p = 0.011). Preferable colonizing site of P. aeruginosa was throat incidence rate (average 14.3%) is constant from 2004 to 2011, and at the ratio of 9/15 (60 %) following by naris and outer ear, both at Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S161

3/15 (20 %). Most of the obtained strains were sensitive to all 10 tested antibiotics including amikacin, gentamycin, tobramycin, piperacillin/tazobactam, imipenem, meropenem, ciprofloxacin, levofloxacin, cefepime and ceftazidime. In summary, colonization of P. aeruginosa was found to be 2.73 % in the community and was associated with female and sinusitis. Commensal P. aeruginosa was still susceptible to multiple antibiotics.

P2-CE25 Analysis on the Causes of Hospital-Acquired Infections in the Intensive Care Unit of Medical City in Iraq WR Lee1, SQ Park1, DW Bang1, EH Chu1, SY Park1, YH Kim1, JK Jung1, H Al-Timimi2, AA Al-Gharawi2, M Mohammedowy2, W Ibraheem Ali2, M Mahir Abdulillah2, AS Jaber Al Allawee2, L Ali Hakeem2 1Soonchunhyang University Hospital, Republic of Korea, 2Medical City, Republic of Iraq

Background: Soonchunhyang University Hospital has carried out a KOICA (Korea International Cooperation Agency) project for establishing critical care center in medical city(MC), Baghdad, Iraq. In 2018, a high prevalence of hospital-acquired infections (HAIs) was found as a result of preliminary investigation of intensive care units(ICUs) from two main hospitals. The aim of this study is to identify the factors causing HAIs in the ICUs and to develop strategies to reduce it. Methods: The case report forms of patients hospitalized at least 48 hours in the ICUs from October 2018 to June 2019 were prospectively collected. Multivariate analysis was performed to assess the independency of associations between HAIs and other factors. Results: In total, 83 patients were studied and of these, 29 (34.9%) had HAIs and the most common HAIs were ventilator-associated pneumonia (28.9%). Among patient with HAIs, 41.2% were died. Patients with sepsis at ICU admission had significantly higher HAIs (OR=3.29, P=.048) than those without sepsis. HAIs was strongly associated with exposures to both ventilators (89.7%, P = .03) and tracheotomy (82.8%, P < .001) but it did not clearly explain its correlation due to missing data of point of time for the exposures. There was no significant difference in patients with HAIs according to APACHE score (20.17 ± 5.87 vs 17.89 ± 7.7, P = .173). S162 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

27.7±6.3; p=0.782), outcome of pregnancy (term:72(70.6%) vs. 104(64.2%); p=0.283, preterm:28(27.5%) vs. 58(35.8%); p=0.159, stillbirth:2(2.0%) vs. 6(3.7%); p=0.715), infantile birth weight (3211.2g±504.0 vs. 3087.0±546.1), socioeconomic status (96(94.1%) vs. 160(98.8%); p=0.058), and antennal care (87(85.3%) vs 121(76.1%); p=0.072) between ACT group and non-ACT group. In the multivariate logistic regression, there was no significant difference in birth weight of infants born to women who received ACT and those who did not (odds ratio, 1.208; 95% confidence interval, 0.490-2.976; p=0.682). Conclusion: The sepsis presence at ICU admission was Conclusion: The results from the available data have shown significantly associated with HAIs. Thus, it requires particular that treatment of malaria with or without ACT does not affect the attention to patients with sepsis at ICU admission to prevent HAIs newborn weight. in the ICU. In the future study, data on the time of intervention will be collected to analyze the association between exposure to invasive devices and incidence of HAIs. P2-CE27 Effects of Vancomycin withβ -lactam therapy among patients with Methicillin-Resistant Staphylococcus aureus P2-CE26 bacteremia, compare to vancomycin monotherapy Artemisinin-based and non-Artemisinin-based combination Jun Hyoung Kim*, Woonji Lee, Hye Seong, Jung Ho Kim, therapies regimen for uncomplicated malaria in pregnancy Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, and its impact on newborn outcomes in Lunionzo, Joon-Sup Yeom Democratic Republic of the Congo Department of Internal Medicine, Yonsei University College of JK Manda1*, JS Yeom2, L Myung-Ken3, H Seong2, A Nkuba4, Medicine, Seoul, Republic of Korea JO Osongu5 1Yonsei University School of Public Health, 2Department of Internal Background: Methicillin-resistant Staphylococcus aureus (MRSA) Medicine, Yonsei University College of Medicine, 3Yonsei University is a common cause of hospital bloodstream infections. In vitro School of Public Health, 4University teaching hospital of Kinshasa, studies demonstrated that vancomycin with various β-lactams DRC, 5Lunionzo health area, DRC shows synergy against MRSA. A few clinical studies provided the outcome of β-lactam and vancomycin combination therapy. Background: During pregnancy, malaria infection in the mother We investigated the clinical efficacy of combination therapy in can cause low birth weight and result in infant death. The choice patients with MRSA bacteremia. of antimalarial is critical in DRC because of its high mortality Methods: We reviewed the electronic medical records of adult and morbidity due to malaria. ACT regimen is recommended patients with MRSA bacteremia retrospectively from January 2006 by WHO for uncomplicated malaria in 2nd or 3rd. trimester of to December 2015 at a 2000-bed tertiary care hospital in Seoul, pregnancy. however, choosing ACT or non-ACT to treat malaria Korea. We compare clinical outcomes between combination during pregnancy in DRC is controversial depending also on the group and vancomycin monotherapy group. prescriber knowledge, price, adherence and available drugs in the Results: A total of 228 patients with MRSA bacteremia were health facility which can trigger poor pregnancy outcomes such enrolled in this study. 66 (28.9%) patients were included in the as low birth weight. Therefore, this study aimed to examine the vancomycin monotherapy group; 162 (71.1%) patients were association between ACT regimen and low birth weight in DRC. included in the combination group. There was no statistical Methods: It was a cross-sectional study in a health area with7 difference in mortality rate (10.6% versus 18.5%, p=0.137) and health facilities in DRC, from January to December 2018. Data microbiologic failure (28.8% versus 21.0%, p= 0.215) between the taken from health information system records, retrospectively two groups. In the multivariate analysis, combination therapy of 364 pregnant women aged 16 to 49 years in 2nd or 3rd trimester (OR 0.477; 95% CI 0.228 – 0.998; p=0.049), Pitt bacteremia score (n=364) and diagnosed with malaria by microscopy from the 1st (OR 1.241; 95% CI 1.082 – 1.423; p=0.002) were statistically to the last who gave birth during our study period. They received significant variables associated with microbiologic failure. The Manalaria®, Quinine (non- ACT) or Luther®, Combiart® and AS- combination therapy (OR 0.895; 95% CI 0.326 – 2.453; p=0.829) AQ tablets (ACT) and we followed their pregnancy outcomes. 264 was not statistically significant variables with the mortality rate in remained after inclusion criteria to analyze. We divided 2 groups: the multivariate analysis. ACT and non-ACT and other variables such as newborn weight, Conclusion: These results suggest that a combination of vanco- sex, pregnancy outcome, socioeconomic status and those who mycin and β-lactam may decrease microbiologic failure in MRSA did ANC or not. bacteremia. Results: Among 264 patients, there were 102(38.6%) using ACT and 162(61.4%) using non-ACT. Among these patients, 134(50.8%) were young women aged 20 to 29 years and majority of women came from kisenso commune 215(81.4%). There were no significant differences in maternal age (28.3±6.4 vs. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S163

P2-CE28 calculated using the data of 9 hospitals of HIMM network and the The Prognostic Role of Neutrophil to Lymphocyte Ratio database of Health Insurance Review and Assessment Service (NLR) in Sepsis and Related Mortality of Korea. The socioeconomic burden of laboratory-confirmed AB. Setyani1*, MF. Adda’i2, JH. Haposan3, AKT. Haruni4 influenza was assessed based on the catchment population, using 1Cempaka Putih General Hospital, Jakarta, Indonesia, 2Johar Baru human capital approach method. Health Care, Jakarta, Indonesia, 3Pediatric Research Office UGM, Results: A total of 2,337 adult patients were diagnosed with Yogyakarta, Indonesia, 4Internal Medicine, Cipto Mangunkusumo laboratory-confirmed influenza in the 9 hospitals. Among them, National General Hospital, Jakarta, Indonesia 663 (28.3%) were hospitalized, 106 (4.5%) admitted to an intensive care unit, and 49 (2.1%) died. The catchment population of the Background: Previous studies reported that NLR is simple yet 9 hospitals was 1,504,297. The incidence of medically-attended a useful biomarker for various clinical conditions. However, the laboratory-confirmed influenza in adults, related admission, role of NLR in predicting sepsis and related mortality remains and related death were 155.3, 54.1, 3.3 per 100,000 population controversial. Thus, we conducted a study to investigate the respectively. The direct medical cost of the population was association between NLR and sepsis and related mortality. 96,177,769,882 KRW, direct non-medical cost was 14,206,060,273 Methods: Major medical databases were systematically searched KRW, and indirect cost was 43,650,174,364 KRW. The total for observational studies which assessed the association of NLR socioeconomic cost was 154,034,004,519 KRW. and sepsis published until July 2019. The databases were searched Conclusion: Although the incidence of seasonal influenza during with predefined protocols based on PRISMA guidelines. Pooled 2015-2016 season decreased compared to the previous season, measures for Risk Ratio (RR) and weighted mean difference the disease burden was still significant, and the socioeconomic (WMD) were obtained using RevMan 5.3. cost showed increasing pattern. Results: Sixteen studies enrolled 3,372 cases and 5,674 controls. A higher NLR indicated an independent predictor of sepsis- related mortality compared to a lower NLR (RR = 1.21; 95% P2-CE30 CI [1.08–1.36], p<0.0001). The mean difference of NLR value Frequency of sequence variations observed in antibiotics between all-mortality and survivor groups among sepsis patients resistant genes of M. pneumoniae PCR positive specimens was statistically significant with (WMD = 6.55; 95% CI [3.39 – 9.72], during 2018 to 2019 in Korea p=0.009). Subgroup analysis showed that the mean of NLR value Sohyeon Kim, Jin Lee, Sang Oun Jung, Jae il Yoo, Kyu Jam Hwang * was also significantly different between in-hospital mortality and Division of Bacterial Disease, Center for Laboratory control of survivor group (WMD = 5.13; 95% CI [1.3 – 8.95], p<0.00001) and Infectious Diseases, Centers for Disease Control & Prevention between 28-day mortality and survivor group (WMD = 9.5; 95% CI [4.6 – 14.4], p=0.0001). Among in-hospital patients, the mean of Mycoplasma pneumoniae is one of the most common causes NLR value between sepsis and non-sepsis group was statistically of community-acquired infections of the human upper and different (WMD = 6.7; 95% CI [5.8 – 7.61], p<0.00001). lower respiratory tract. The pathogen is found in all age groups, Conclusions: Higher NLR value was associated with the with higher prevalence in children aged 5-14 years. In addition, occurrence of sepsis and sepsis-related mortality. Therefore, the periodical increasing of incidences every 3 or 4 years was use of the potential role of NLR should be emphasized due to its reported. Macrolide (ML) antibiotics are recognized generally as affordability and accessibility in the low-resource setting. first-choice agents for M. pneumoniae infections, and these antibiotics were thought to have excellent effectiveness against M. pneumoniae for many years. Macrolide-resistant M. pneumoniae P2-CE29 (MRMP) is highly prevalent in Asian countries (e.g., China, Korea, Disease burden of 2015-2016 seasonal influenza in adults in and Japan). Moreover, it is gradually increasing in other areas of Korea the world as well. SH Ahn1,a, SH Lee1,a, HN Kim1, JY Kang1, SJ Lee1, WS Choi1, From September 2018 to June 2019, 715 respiratory specimens JY Noh1, HIMM Study Group1,2,3,4,5,6,7,8, WJ Kim1 were collected from pediatric patients suspected of M. 1Korea University College of Medicine, 2The Catholic University of pneumoniae infection in national surveillance network. We Korea, College of Medicine, 3Inha University School of Medicine, report here the results of PCR amplification and sequencing of 4Hallym University College of Medicine, 5Wonju College of these M. pneumoniae 10 clinical isolates and 95 PCR positive Medicine, Yonsei University, 6Kyungpook National University specimens. Genetic analysis was conducted to determine any College of Medicine, 7Chonnam National University Medical mutations of the 23S rRNA gene and the ribosomal protein genes School, 8Pusan National University, Republic of Korea (L4, L22). For macrolides, 23S rRNA, and the L4 and L22 genes aThese authors contributed equally to this study. were analyzed and several mutations were confirmed. In domain V of the 23S rRNA gene, A2063G type was observed as 66.3% Background: Evaluating the disease burden of influenza helps (63/95) of frequency in specimens and 80% (8/10) of frequency to establish strategies such as vaccine use. This study aims to in the strains. In L4 gene, mutations in C162 and A 430 sites were measure disease burden in 2015-2016 seasonal influenza in observed. Moreover, mutation at T279 site of ribosomal protein adults in Korea, using the data of Hospital-based Influenza L22 was also identified. Morbidity and Mortality Surveillance (HIMM) network. As the conclusion, several mutations in antibiotics resistant genes Materials & Methods: The adult catchment population was were confirmed from the M. pneumoniae isolates and clinical S164 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

specimens. These mutation profiles were also applicable to rapid infections caused by methicillin-resistant Staphylococcus aureus detection of antibiotics resistant strains by genetic assay. (This (MRSA) in a postnatal care center in Korea. In this study, we study was supported by intramural grant of Korea Centers for describe a practical approach to enhance detection of MRSA Disease Control and Prevention (4800-4851-304). transmission using whole genome sequencing (WGS). Methods: We studied an outbreak of MRSA skin and soft tissue infections occurred in a neonatal care unit of a local hospital in P2-CE31 Busan during the period January to February 2019. Screening Analysis of Serotype prevalence in recently isolated invasive cultures of patients (n=14), postnatal care center workers (n=12), Streptococcus pneumoniae and environmental cultures (n=3) were positive for MRSA. Chae Young Lee, Sang Oun Jung, Jae Il Yoo, Kyu Jam Hwang* All of 29 MRSA isolates were subjected to WGS for further Division of Bacterial Disease, Center for Laboratory control of characterization. Infectious Diseases, Centers for Disease Control & Prevention Results: In silico typing showed that 6 different spa types among the 29 isolates including 5 known spa types (t324, t375, t4705, Streptococcus pneumoniae is a leading cause of respiratory patho- t664, t901) and 1 unknown type. spa types t375 (n=18) and t664 gens resulting in pneumonia, bacteremia, meningitis and blood (n=6) were the predominant. The phylogenetic analysis based on stream infections. Three types of vaccines are being used to pre- the single-nucleotide polymorphisms showed that MRSA isolates vent and control of bacterial meningitis, such as PCV(pneumo- with t375 spa types (group A, n=19) clustered separately with coccal conjugate vaccine)10, PCV13, and PPSV(pneumococcal those of t324, t4705, t664, and t901 (group B, n=10). The MLST polysaccharide vaccine) 23. Since 2013, national vaccine program and SCCmec of all the group A isolates belong to the ST89 and for people older than 65 years has been introduced, and it was ex- type II (2A). On the other hand, the MLST and SCCmec of group panded for children younger than 5 years of age from 2014. From B belonged to the ST72 and type Ivc (2B). Both of two groups over 90 known serotypes, only 24 serotypes(1, 2, 3, 4, 5, 6A, 6B, 7F, indicated that the isolates which were isolated from patients, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, workers and environment were genetically closely-related within and 33F) are covered by vaccination. each group indicating that two different cluster of outbreak In this study, we confirmed serotypes by laboratory tests of isolates showed a clear genetic separation. Streptococcus pneumonia collected from the patients with Conclusion: We performed WGS to investigate the outbreaks invasive pneumococcal disease for 2018 and serotype prevalence caused by MRSA. This will help to provide another major was analyzed. As the results, 38 different serotypes were identified improvement to detect disease outbreaks and define pathogen in the 434 isolates and 257(60.2%) isolates showed vaccine type. sources. Type 3(74 isolates, 17.3%) was the most prevalent type, and followed by 10A(34 isolates, 8.0%), 19A(32 isolates, 7.5%), 11A(31 isolates, 7.3%), 23A(28 isolates, 6.6%), 34(26 isolates, 6.1%). P2-CE34 Among children aged 5 years (n=5), the highest prevalence of The Prognostic Value of Red Cell Distribution width (RDW) 10A(10 isolates, 40%) was revealed in 25 isolates, followed by In Sepsis And Related-Mortality 15C(5 isolates, 20%), 15A(2 isolates, 8%). MF. Adda’i1*, AB. Setyani2, JH. Haposan3, AKT. Haruni4 In the ages over 65 years, type 3(50 isolates, 20.8%) was 1Johar Baru Health Care, Jakarta, Indonesia,2Cempaka Putih predominant, followed by 34(22 isolates, 9.2%), 11A(20 isolates, General Hospital, Jakarta, Indonesia, 3Pediatric Research 8.3%), 23A(18 isolates, 7.5%), 35B(16 isolates, 6.7%) and 19A(13 Office UGM, Yogyakarta, Indonesia, 4Internal Medicine, Cipto isolates, 5.4%) in 240 isolates. Mangunkusumo National General Hospital, Jakarta, Indonesia As the conclusion, surveillance of serotype distribution in invasive S. pneumoniae is important to confirm the vaccine Background: RDW, a measurement retrieved from routine coverage. Therefore, monitoring of serotype prevalence should hematology tests, had been known as a predictor in several be maintained further. (This study was supported by intramural medical conditions. However, the predictive value of RDW in grant of Korea Centers for Disease Control and Prevention (4800- sepsis remains inconclusive. Thus, to produce robust evidence, 48361-303). we conducted a meta-analysis to investigate the association between RDW and sepsis and related mortality. Methods: Major medical databases were systematically searched P2-CE33 for observational studies that assessed the association of RDW Whole genome sequencing for analysis of outbreak of and sepsis published until July 2019. The databases were searched methicillin-resistant Staphylococcus aureus in postnatal with predefined protocols based on PRISMA guidelines. Pooled care center in the Republic of Korea measures for Risk Ratio (RR) and weighted mean difference A K Park, J Park, E Shin, S Kim, H J Jung, J-H Chun, K J Hwang, (WMD) were obtained using RevMan 5.3. J Kim Results: Seventeen studies enrolled 3,183 cases and 5,086 Division of Bacterial Diseases, Center for Laboratory Control controls. The higher RDW was independently associated with of Infectious Diseases, Korea Centers for Diseases Control and sepsis-related mortality compared to lower RDW (RR 1.19; 95% Prevention, Chungcheongbuk-do, Republic of Korea CI [1.13–1.26], p<0.00001), comprising in-hospital (RR 1.22 [1.15–1.3], p<0.00001), 1-month (RR 1.34 [1.08–1.67], p=0.008), Background: In January 2019, we investigated an outbreak of and 4-year mortality (RR 1.15 [1.13–1.17], p<0.00001). The WMD Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S165

of RDW level between survivor and mortality group was 1.62% 1WHO Collaborating Centre for Infectious Disease Epidemiology (95% CI [1.07–1.95], p<0.00001), including mortality in ICU (1.11% and Control, School of Public Health, Li Ka Shing Faculty of [0.26-1.96], p=0.01), in-hospital (2.06% [1.46-2.65], p<0.00001), Medicine, The University of Hong Kong, Hong Kong Special and within 1-month (1.51% [1.07-1.95], p<0.00001). Among in- Administrative Region, China, 2Department of Preventive hospital patients, compared to non-sepsis, sepsis group had Medicine, College of Medicine, Konyang University, Deajeon, higher mean of RDW (WMD 1.91% [0.56–3.25], p=0.006). Republic of Korea Conclusions: Sepsis cases and related mortality are significantly associated with higher RDW value. Thus, along with other clinical Background: School closure has been considered as one of the parameters, this promising finding of RDW could be useful as a non-pharmaceutical control strategies to mitigate influenza simple and affordable prognostic tool, especially in facility with spread. In 2014-2016, the Korean influenza peak seasons limited resources. coincided with spring school breaks which were in mid–February for 2-3 weeks. Here, we examined both influenza-like illness surveillance data and influenza virus activity in South Korea P2-CE35 from 2014 to 2016, to estimate the transmissibility of seasonal Whole Genome Characterization of Shigella sonnei in influenza viruses and estimate the effects of spring school breaks traveler returning to Korea from Philippines during 2005 to on seasonal influenza transmission. 2019 Methods: To assess the effect of spring school breaks on influenza S Kim, J Park, E Shin, H J Jeong, A K Park, J-HChun, K J Hwang, transmission, we estimated influenza transmissibility using the

J Kim effective reproduction number (Rt). We estimated daily Rt from Division of Bacterial Diseases, Center for Laboratory Control epidemiological week 1 to 15 for each influenza season, and of Infectious Diseases, Korea Centers for Diseases Control& compared the mean Rt during the spring school breaks versus Prevention, Cheongju-si, Republic of Korea the preceding and following 2-week period. We also estimated the overall impact of each school break by fitting a regression

Background: The Philippines is the 5th most popular country model for Rt, accounting for the depletion of susceptibles in the where Koreans visited last year. Recently, there was dramatic population increase in the number of imported cases of S. sonnei from Results: TheR t ranged from 1.17 to 1.63 during the 2 weeks before Cebu and Kalibo (Boracay) which are very famous tourist spots the spring breaks, decreased to 0.74-0.95 during the break and for South Koreans. We investigate traveler-associated S. sonnei, remained at 0.84-0.94 in the two weeks following the breaks. especially returning from Philippines during 2005–2019 (first half This suggested an immediate 36%-42% reduction in influenza of 2019). transmission during the breaks, comparing to the preceding

Methods: A total of 80 S. sonnei isolates which were collected two weeks. In the regression analysis for Rt, the spring breaks from the Enteric Pathogens Active Surveillance Network (Enter- in the three years studied were associated with 21.8% (95% CI net) were subjected to whole-genome sequencing (WGS). The 15.9-27.4%), 15.1% (3.3%-30.3%) and 11.0% (95% CI 4.7-16.9%) reads were assembled with SPAdes3.1. The phylogenetic tree reductions in influenza transmission, respectively. based on the single-nucleotide polymorphisms were constructed Conclusions: Our results suggested that spring school breaks using CSI Phylogeny 1. The antibiotic resistance genes were were associated with moderate (11-22%) reduction in influenza identified using ResFinder. transmission in South Korea, 2014–2016. Results: The incidence ofS. sonnei imported from Philippines has been increased since 2017 and a total number of S. sonnei isolated from traveler from Philippines were 4, 28 and 22 in 2017, 2018 and P2-CE37 2019, respectively. Whereas S. sonnei which were isolated from Clinical and Microbiologic Analysis of Risk Factors traveler to Cebu were 28 in 2018, those from traveler to Kalibo for Mortality in Patients with Carbapenem- were 22 in 2019. The results of genotypic antimicrobial resistance resistant Acinetobacter baumannii bacteremia (AMR) indicated that 100% of the isolates carried mdf(A), 86.66% Eunbeen Cho, Yong Pil Chong carried aph(6)-Id ,aph(3’’)-Ib, 95.55% carried sul2, and 93.33% Department of Infectious Diseases, Asan Medical center, Korea carried dfrA14. The analysis of phylogenetic tree indicated that the isolates were classified to three different clustered depending Background: Carbapenem-resistant Acinetobacter bauman- on their geographic region; Manila, Cebu and Kalibo. nii (CRAB) infection is an emerging clinical issue and shows high Conclusions: As international travelers increase, good personal mortality rates. There are a few studies that have evaluated the hygiene care and protection should be required. In addition, microbiologic risk factors for mortality in CRAB bacteremia. Aim continuous monitoring of imported S. sonnei at government level of this study is to identify the clinical and microbiologic risk fac- is required. tors for mortality in CRAB bacteremia. Methods: Adult patients with monomicrobial CRAB bacteremia at a 2700-bed tertiary hospital between December 2012 and P2-CE36 December 2018 were retrospectively enrolled in the study. Risk Impact of spring school breaks on seasonal influenza in factors for 30-day mortality were evaluated through a detailed Korea clinical and microbiological analysis of study patients. All isolates S Ryu1,2*, ST Ali1, BJ Cowling1, EHY Lau1 collected on the first day of bacteremia were subjected to colistin S166 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

susceptibility testing by broth microdilution and genotyping by were isolated P.aeruginosa, but only 18.2% of these patients had multilocus sequence typing (MLST). proper antibiotics for empirical treatment. Results: A total of 164 patients were enrolled and 90 (55%) died Conclusion: PEG site infection is more prominent on head and within 30 days. Of the 164 patients, 111 (68%) were male and neck cancer patients than non-head and neck cancer patients. median age was 66. 5 years. The most common MLST genotype Unlike other skin and soft tissue infection, gram negative bacteria, was ST191 (80 isolates, 49%), followed by ST451 (14%) and ST784 especially P.aeruginosa, were major causative pathogen in PEG (13%), and 12 (7%) isolates were resistant to colistin (MIC ≥4 site infection in Head and neck cancer patients. For appropriate mg/L). Deceased patients were more likely to have hematologic treatment, we should consider P.aeruginosa when start empirical malignancy, neutropenia, pneumonia, and primary bacteremia; therapy of PEG site infection on head and neck cancer patients. less likely to have solid tumor, catheter-related infection, and biliary tract infection; more likely to have a high Pitt bacteremia score; and less likely to receive appropriate antibiotic treatment, P2-CE39 colistin, and combination therapy with colistin and tigecycline, Measles Seroimmunity of International Marriage Immigrant compared with surviving patients (Table 1). Genotype, colistin Women in Sinan, South Korea MIC, and colistin resistance were not associated with mortality Sung Un Shin1*, Hanbich Hong3, Seong Ryeong Choi3, (Figure 1 and 2). In multivariable analysis, neutropenia (aOR, 3. Hae-Young Na3, Soo-yeun Kim3, Yeong-Jun Song3, Sun A Kim3, 25; 95% CI, 1. 18–8. 95), catheter-related infection (aOR, 0. 33; 95% Seung-Ji Kang1,3, Kyung-Hwa Park1, Shin Min-Ho1,2, CI, 0. 11–0. 99), biliary tract infection (aOR, 0. 20; 95% CI, 0. 04–0. Sun- Seog Kweon1,2, Sook In Jung1 99), a high Pitt bacteremia score (aOR,1. 42; 95% CI, 1. 20–1. 67), 1Department of internal medicine, 2Department of Preventive and combination therapy with colistin and tigecycline (aOR, 0. Medicine, Chonnam National University Medical School, Hwasun, 36; 95% CI, 0. 14–0. 92) were independent risk factors for mortality South Korea, 3Jeonnam Communicable Disease Management (Table 2). Support Team, Muan, South Korea Conclusion: Clinical factors such as site of infection, severity of bacteremia, and specific combination therapy rather Background: Despite of recent high measles coverage rate, small- than microbiologic factors contributed to mortality in CRAB scale epidemics have been repeated in Korea since 2013. Interna- bacteremia. Appropriate combination therapy may help tional migrants could be considered as a risk group for being sus- improving outcomes in CRAB bacteremia. ceptible to vaccine preventable diseases such as measles. How- ever, data on immunity of measles in different migrant groups are scarce. Therefore, we have examined measles seroprevalance P2-CE38 among international marriage immigrant women in Sinan, South Appropriacy of Empirical antibiotic therapy in Percutaneous Korea. endoscopic gastrostomy site infection among Head and neck Methods: Serums acquired from 188 international marriage cancer patients; 10-year retrospective study immigrant women were analyzed for specific measles IgG- Jihyu Oh, So Yeon Park, Jin Seo Lee antibody in July, 2019. Age, geographic origin, period residence in Division of Infectious Disease, Kangdong Sacred Heart Hospital, Korea, previous vaccination and diagnosed measles history were Hallym University college of Medicine, Seoul, Korea also investigated. Results: Of total 260 international marriage immigrant women Background: Wound infection is the most common complication living in Sinan, 188 were participated in the study. The countries of associated with Percutaneous endoscopic gastrostomy (PEG) origin were Vietnam (87), China (49), Cambodia (24), Philippine placement, with an incidence between 4% and 30%. In this study, (18), Thailand (5), Japan (3), Laos (1) and Myanma (1). Mean we compare characteristics of PEG site infection between head of age was 36 ± 10 (19-78) years old. Ninety percent of the study and neck cancer group and non-head and neck cancer group. population (170/188) tested positive for measles IgG-antibody. Methods: We retrospectively collected data on patients who The seroprevalences varied substantially between countries of underwent PEG insertion from Jan 2010 through May 2019 at origin (79-100%) and age groups (82% in 20-29, 94% in 30-39, 90% Kandong Sacred Heart Hospital, Seoul, Korea. A total 219 cases in 40-49, 93% in 50-59, 100% in 60 and over). with PEG insertion, 100 cases in head and neck cancer group and Conclusions: Seroprevalence against measles among interna- 119 in non-head and neck cancer group, were included in this tional marriage immigrant women in South Korea varied between study. countries of origin and age. Further study about measles seroim- Results: A total of 219 patients were eligible for this study, 119 for munity among subgroup of immigrant in South Korea should be non-head and neck cancer patients and 100 for head and neck warranted for targeted immunization. cancer patients. PEG site infections were significantly higher rate Keywords: Measles, IgG antibodies, Immigrant, South Korea in head and neck cancer group than non-head and neck cancer group (36.0% vs. 13.4%; p<0.001). Pseudomonas aeruginosa is most common pathogen of PEG site infection. Furthermore, P2-CE40 P. aeruginosa were isolated more frequently in head and neck Quantitative assessment of Salmonella contamination in cancer group than non-head and neck cancer group (13.0% vs. food using real-time PCR assay 2.5%; p =0.003). 26 of 36 head and neck cancer patients (72.2%) Y. Cheong*, W.J. Lee, J.S Jeong, J.W. Yoon with PEG infection were chronic infection. 42.3% of these patients College of Veterinary Medicine & Institute of Veterinary Science, Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S167

Kangwon National University, Chuncheon, Gangwon 24341, survival rates between cidofovir and non-cidofovir group. Republic of Korea Conclusion: HC is a common infectious complication that occurs in about one-third of AML patients after HSCT, and mortality is Salmonella infection is an important zoonotic threat in one also significantly higher when HC is complicated. Further data is health. Methods that can quantitate Salmonella cells in food needed for the role of cidofovir with selective indications. and products may provide a useful toolkit for public health and animal industry. To estimate the number of Salmonella cells in a given sample we performed quantitative real time-PCR, and P2-HV01 attempted to figure out the relationship between Cq value and Survival trend among people living with HIV/AIDS who DNA concentration with the number of existing bacterial cells. started antiretroviral therapy in Korea between 2001 and In this study, Salmonella Typhimurium ATCC 14028 was used to 2015 set a standard curve. Salmonella Typhimurium ATCC 14028 was Yong Chan Kim1,2, Jin Young Ahn3, 4, Hyo Youl Kim5, incubated overnight in BPW, and then diluted cells in 1 ml saline Joon Young Song6, Dae Won Park6, Min Ja Kim6, Hee-Jung Choi7, serially. Diluents were plated on XLD agar plates for Salmonella Shin Woo Kim8, Mee-Kyung Kee9, Myung Guk Han9, cell number, and genomic DNA was extracted from each diluent Myeongsu Yoo9, Su Min Kim10, Yun Su Choi10, Bo Youl Choi11, using commercial kit. DNA concentration from each diluent Sang Il Kim12, Jun Yong Choi3,4§ was measured using nano-drop. Quantitative real time-PCR was 1Department of infectious diseases, Ajou University School of performed using DNA samples from each diluents and invA gene Medicine, Suwon, Korea, 2Department of Medicine, Yonsei targeting primers. We then analyzed the relation between Cq University College of Medicine, Seoul, South Korea, 3Department values with genomic DNA concentration and the Salmonella cell of Internal Medicine, Yonsei University College of Medicine, Seoul, number. The Cq values increased while the gDNA concentration South Korea, 4AIDS Research Institute, Yonsei University College of and the number of Salmonella cells in the diluents decreased. To Medicine, Seoul, South Korea, 5Department of Internal Medicine, validate this study, quantitative real time-PCR with random food Yonsei University Wonju College of Medicine, Wonju, Korea, samples may be accomplished. 6Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea, 7Department of Internal Medicine, Ewha Womans University P2-CE41 College of Medicine, Seoul, 8Department of Internal Medicine, Hemorrhagic cystitis after allogeneic hematopoietic stem School of Medicine, Kyungpook National University, 9Division of cell transplantation in acute myeloid leukemia patients viral disease research, Center for infectious disease research, Korea Sung-Yeon Cho1,2,3, Dong-Gun Lee1,2,3, Yunmi Yi1,2,3, Jae-Ki Choi1,2, National Institute of Health, 10Institute for Health and Society, Hyo-Jin Lee1,2, Si-Hyun Kim1,2, Sun Hee Park1,2, Su-Mi Choi1,2, Hanyang University, Seoul, 11Department of Preventive Medicine, Jung-Hyun Choi1,2, Jin-Hong Yoo1,2 Hanyang University College of Medicine, Seoul, 12Division of ¹Division of Infectious Diseases, Department of Internal Medicine, Infectious Disease, Department of Internal Medicine, Seoul St. ²Vaccine Bio Research Institute, ³Catholic Hematology Hospital, Mary’s Hospital, College of Medicine, The Catholic University of College of Medicine, the Catholic University of Korea, Seoul, Korea Korea, Seoul, Korea

Backgrounds: Although hemorrhagic cystitis (HC) is a serious Background: Acquired immune deficiency syndrome (AIDS)- complication after hematopoietic stem cell transplantation related mortality has decreased since the introduction of highly (HSCT), there are limited data for the characteristics as well as active antiretroviral therapy (HAART). However, data on survival effective treatment option. The aim of this study was to determine trends among human immunodeficiency virus (HIV)-infected the characteristics of HC developed after HSCT and evaluate the Koreans in the HAART era are limited. outcome of patients. Methods: HIV-positive adult patients older than 18 years, who Methods: We retrospectively reviewed all consecutive HSCT started HAART between 2001 and 2015 in the Korean HIV/AIDS episodes between June 2012 and January 2018 in the acute cohort study were enrolled. We compared clinical characteristics, myeloid leukemia (AML) cohort of Catholic Hematology Hospital, mortality, and causes of death in the enrolled subjects based on Seoul St. Mary’s Hospital. the time period of HAART initiation. We used Cox regression Results: Among 613 AML patients received HSCT, HC was analysis to estimate unadjusted and adjusted hazard ratios of complicated in 33.1% of cases (n = 203). BK polyomavirus mortality according to the period of HAART initiation. (BKPyV) (n = 83) was most common cause of HC, followed by Results: Among the total of 1,970 patients included, 105 patients JC virus (n = 35) and adenovirus (n = 9). The median time to (5.33%) died during the follow-up period of 9,077 patient-years. BKPyV-HC diagnosis from HSCT was 31 days (range, 2–742), CD4 cell counts at the time of HAART initiation were low during whereas it was 99 days (range, 13–783) in adenovirus-HC. The the study period (196 [interquartile range (IQR) 76 to 359] in administration of cidofovir was performed in 22 cases in this 2001–2003, 219 [IQR 93 to 347] in 2004–2006, 210 [IQR 94 to 308] cohort, which were either BKPyV-HC unresponsive to supportive in 2007–2009, 200 [IQR 79 to 319] in 2010–2012, and 253 [IQR treatment including intravenous hydration and bladder irrigation 90 to 390] in 2013–2015). The rate of all-cause mortality was the and adenovirus-HC. Mortality was significantly higher in HC lowest in 2004–2006, and the highest in 2010–2012 (12.21, 7.78, group than non-HC group (57.1% vs. 26.3%, p <0.001) in this 12.92, 13.65, and 11.14 deaths/1,000 patient-years in 2001–2003, cohort. In BKPyV-HC, there was no significant difference in the 2004–2006, 2007–2009, 2010–2012, and 2013–2015, respectively). S168 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

The proportion of AIDS-related deaths was higher than non- nutrition status of wasted PLWHA. However, at least 12.5 and 8 AIDS-related deaths during the study period, except 2007–2009. months of nutritional programs are required to recover BMI and In multivariate Cox regression analysis, the incidence of all-cause MUAC of wasted PLWHA. Furthermore, it is necessary to improve mortality was similar in patients who started HAART between food security of household for PLWHA to sustain nutrition 2001 and 2015. improvement. Conclusion: Despite excellent HIV care in late HAART era, survival in people living with HIV/AIDS receiving HAART did not improve between 2001 and 2015 in Korea. AIDS-related death P2-HV03 is still a leading cause of death in HIV-infected persons with low Gemcitabine inhibits HIV-1 replication through inhibiting CD4 cell counts. HIV-1 Tat-mediated viral transcription YoungHyun Shin1*, Dong-eun Kim1, Hong Gi Kim2, Chul Min Park2, Byeong-Sun Choi1, Kisoon Kim1, Cheol-Hee Yoon1 P2-HV02 1Division of Viral Disease Research, Center for Infectious Disease Effectiveness of supplementary feeding for wasted people Research, Korea National Institute of Health, Chungbuk, Republic living with HIV/AIDS on Antiretroviral treatment in Rwanda of Korea, 2Center for Convergent Research of Emerging Virus Dukuzimana Justine1,2,Kayitesi Alice2, Jun Yong Choi3 Infection, Korea Research Institute of Chemical Technology, 1Master’s student in Global Health Security, Graduate School of Daejeon, 34114, Republic of Korea Public Health, Yonsei University, Seoul, South Korea, 2Department of Human nutrition, District Hospital, Rwanda. 3Department of Tat (transactivator)-mediated human immunodeficiency virus Internal Medicine and AIDS Research Institute, Yonsei University type 1 (HIV-1) transcription is essential for viral replication College of Medicine, Seoul, South Korea and is considered as a potent therapeutic target for HIV-1 inhibition. We recently developed a dual-reporter screening Introduction: Underweight in people living with HIV/AIDS system to discriminate precisely the inhibition of Tat-mediated (PLWHA) is still prevalent in resource limited countries including transcription from off-target effects. In this study, Library of Rwanda. Low Body Mass Index (BMI), Mid-Upper Arm Pharmacologically Active Compounds (LOPAC1280) were screened Circumference (MUAC) and Z-score<-3 are strong risk factors using our system for repositioning as Tat-inhibitory compounds. of mortality and morbidity for PLWHA on antiretroviral therapy In the primary screen, five compounds were identified that (ART). Nutrition supplements became a standard and integrated exhibited inhibitory effects on Tat-mediated transcription. In a with HIV care for copying with wasting of PLWHA initiating subsequent confirmatory test, two of these compounds showed ART in Rwanda. The objective of this study was to assess the potent inhibitory effects against viral infection, production effectiveness of fortified Soya Corn Blended (SCB+) supplement and replication correspondingly to their inhibition of Tat- on nutrition improvement of wasted PLWHA. mediated transcription without sever cytotoxicity. One was Methods: Retrospective cohort study was conducted to assess Roscovitine known Tat-inhibitory compound and the other the improvement of nutrition status for a total of 149 wasted was Gemcitabine that were newly identified as inhibitors of Tat- PLWHA who were on antiretroviral treatments and received mediated transcription. In additional screening with nucleoside nutrition support for a period of six months consecutively. The analogues of Gemcitabine, two ribonucleoside analogues showed nutritional status of the subjects was determined by BMI, MUAC, antiviral activity related to their Tat-inhibitory effect. Our results and Z-score. BMI < 18.5kg/m2, Mid-Upper Arm Circumference indicated that the dual-reporter screening system was applicable MUAC<21cm and z-score<-2 were defined as malnutrition to identification of compounds that inhibited Tat-mediated according to World Health Organization (WHO) guideline. viral transcription by screening a large number of compounds. Results: A total of 149 PLWHA were included in the analysis. The mechanism of inhibition of viral transcription by identified Mean BMI at admission of SCB+ was 17.448±0.546 kg/m2 and compounds may suggest a strategy to develop a new class of at sixth month was18.631±0.535 kg/m2 in general subjects. The therapeutic anti-HIV drugs. mean BMI for male and female subjects at the time of admission for SCB+ supplement were 17.2±0.53 kg/m2 and 17.5±0.53 kg/m2, respectively. At 6 months of taking SCB+ supplement, the mean P2-HV04 BMI for male and female subjects were 21.9±24.4 kg/m2 and Novel regulatory effects on HIV-1 Infection by Diverse Actin 18.6±0.52 kg/m2. Mean MUAC at admission for SCB+ supplement Dynamic Inhibitors was 18.47±0.455 cm, and it increased to 20.40±0.532 cm at sixth YoungHyun Shin, Dong-eun Kim, Byeong-Sun Choi, Kisoon Kim, month. The BMI and MUAC significantly increased during 6 Cheol-Hee Yoon* months of nutritional supplement (P-value for BMI and MUAC Division of Viral Disease Research, Center for Infectious Disease <0.001). At the sixth month of supplements, overall prevalence Research of malnutrition was 35.2% based on BMI, and 66.7% according to MUAC. The prevalence of malnutrition did not significantly HIV-1 utilizes the cellular actin dynamics network to achieve decrease during study period (P-value =0.306 ). The minimum the viral entry, migration of the pre-integration complex into time requirement to gain normal BMI (18.5kg/m2) and normal the nucleus and viral release. Although some inhibitors have MUAC (21cm) were 12.5 and 8 months, respectively. been analyzed with regard to HIV-1 infection, their effects Conclusion: Our study suggests that the supplements improve are sometimes disputed and the exact mechanisms for actin Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S169

dynamics in HIV infection have not been well clarified. Here, the JH Kim1, NK Hong2, JY Ahn1, SJ Jeong1, NS Ku1, HC Kim3, small molecules regulating HIV-1 infection from diverse inhibitors YM Rhee2, JS Yeom1, JY Choi1 of the actin dynamic network were tested. Chaetoglobosin A and 1Department of Internal Medicine, AIDS Research Institute, Yonsei CK-548 were observed to specifically inhibit the viral infection, University College of Medicine, South Korea, 2Department of while cytochalasin and Rho GTPase families increased the viral Internal Medicine, Endocrine Research Institute, Yonsei University infection without cytotoxicity within a range of several μM. College of Medicine, South Korea, 3Department of preventive Otherwise, previously known inhibitory compounds of HIV- medicine, Yonsei University College of Medicine, South Korea 1 infection, such as Latrunculin A, Jasplakinolide, Wiskostatin and Swinholide A, exhibited either an inhibitory effect on HIV- Background: Individuals with HIV infection is at increased risk 1 infection combined with severe cytotoxicity or showed no of low area bone mineral density (BMD) and fracture. However, effects. Our data suggest that Chaetoglobosin A and CK-548 may data regarding volumetric BMD (vBMD) of central bone be considerable for development as new therapeutic agents determined by quantitative computed tomography (QCT) which against HIV infection. In addition, the newly identified effects can distinguish the cortical and trabecular bone component are of Cytochalasins, and inhibitors of Rho GTPase family and LIM limited. Kinase on viral infection may be helpful to understand the exact Methods: We measured spine and hip vBMD in HIV-infected roles of divers actin dynamic signals during HIV-1 infection and to men aged 30 years or older. QCT data were compared to 1:2 develop new anti-HIV drugs that target the actin network, which matched control by age- and body mass index (BMI) sampled are required for HIV infection. from a community-based healthy individual cohort. HIV-specific risk factors for low total hip vBMD as a primary outcome were identified using multivariate linear regression models. P2-HV05 Results: A total of 83 HIV-infected men and 166 control were an- Trabecular bone scores in young HIV-infected men: matched alyzed. In HIV-infected men, vBMD of trochanter, intertrochanter case-control study and total hip was significantly lower than that of non-infected Youn Jeong Kim*, Yoonhee Jun, Yang Ree Kim, Sang Il Kim men. Association between HIV infection and lower total hip The Catholic University of Kore, Seoul, Korea vBMD remained robust after adjustment for age, diabetes, smoking, and vitamin D status. In HIV cohort, low CD4 T cell count at Background: In HIV-infected patients, screening for osteoporosis initial diagnosis and use of protease inhibitor were negatively as- with dual-energy X-ray absorptiometry (DXA) is recommended sociated with total hip vBMD, after adjustment for age, BMI, and in men aged ≥ 50 years Recently, trabecular bone score (TBS) is duration of HIV infection, whereas tenofovir disoproxil fumarate introduced to be a novel tool for bone microarchitecture using use was not. In HIV-infected men with low tertile total hip vBMD, lumbar spine DXA. There have been few studies investigating TBS the levels of β-crosslaps and osteocalcin were higher than those in HIV-infected individuals under 50 years. This study compared with middle-upper tertile total hip vBMD. the TBS assessment between HIV-infected young male and Conclusion: HIV-infected men had lower hip vBMD compared matched control, and investigated the association between the to age- and BMI-matched non-infected men. Low baseline TBS and demographic, clinical parameters and BMD. CD4 T cell count and protease inhibitor use were independent Methods: We conducted cross-sectional study that enrolled HIV- risk factors for lower total hip vBMD. High born turnover is infected patients (n=80) aged between 18 and 50 years and age- attributable to negative effect on born health of HIV infected men. and sex- matched controls (n=80) for assessment of bone mineral density and TBS. Results: The proportion of a low BMD (Z score -2 and less than) P2-HV08 was found highly in HIV-infected patients compared in control A Phase 3b, Multicenter, Open-Label Study Switching from group (21.3% [17/80] vs. 8.8% [7/80], p=0.027). The mean TBS Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide value in HIV-infected patients was significantly lower than in (E/C/F/TAF) or a Tenofovir Disoproxil Fumarate Containing matched control group (1.41±0.07 vs. 1.45±0.07, p=0.008). In both Regimen to Bictegravir/Emtricitabine/Tenofovir group, TBS showed positive correlation with BMD at the lumbar Alafenamide (B/F/TAF) in Virologically-Suppressed, HIV-1 spine, femoral neck and total hip (P<0.001), however did not Infected Subjects Aged ≥65 Years showed the correlation with BMI. In HIV groups, TBS correlated Maggiolo F1, Rizzardini G2, Molina JM3, Pulido F4, De Wit S5, negatively with duration of tenofovir exposure (p=0.04). Vandekerckhove L6, Piontkowsky D7, Martin H7, McNicholl I7, Conclusion: HIV infected young men had abnormal bone Haubrich R7, Yang S8*, Gallant J7 trabecular microarchitecture assessed by TBS as well as bone 1ASST Papa Giovanni XXIII, Italy, 2Luigi Sacco Hospital, Italy, mass, and TBS was correlated with BMD and duration of duration 3University Paris Diderot, France, 4Hospital Universitario 12 de of tenofovir exposure. Octubre, Spain, 5Université Libre de Bruxelles, Belgium, 6Ghent University Hospital, Belgium, 7Gilead Sciences, USA, 8Gilead Sciences, South Korea P2-HV06 Impaired bone health at proximal femur in HIV-infected Background: It is important to study the long-term safety and men and its risk factors: comparison with age-matched efficacy of antiretroviral therapy in older individuals. B/F/TAF uninfected men is a single-tablet regimen with few drug-drug interactions and a S170 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

high barrier to resistance; it contains TAF, resulting in less renal with or without other mutations. At W48, 0.4% on B/F/TAF and and bone toxicity than TDF-based regimens. We evaluated the 1.1% on DTG+F/TAF had HIV-1 RNA ≥50 c/mL demonstrating efficacy and safety of switching participants ≥65 years to B/F/TAF noninferiority. There was no treatment emergent resistance. No from TDF-containing regimens at Week (W) 24. participant with NRTI-resistance had HIV-1 RNA ≥50 c/mL at Methods: Virologically-suppressed (HIV-1 RNA <50 c/mL) W48. Overall, 93% on B/F/TAF and 91% on DTG+F/TAF had HIV- participants >65 years who were currently receiving either E/C/F/ 1 RNA ≤50 c/mL. The most common AEs were nasopharyngitis, TAF or a TDF-based regimen were switched to B/F/TAF. Primary diarrhea, and upper respiratory tract infection. Six (2%) in each endpoint was viral suppression at W24. group discontinued study drug due to AEs. Results: Of 86 participants, mean age was 70 years (range 65-80); Conclusions: At W48, switching to B/F/TAF was noninferior to 91% (78/86) of participants were receiving E/C/F/TAF at baseline DTG+F/TAF, with high viral suppression rates in both groups. B/ (BL). At W24, HIV RNA < 50 c/mL was 98% for B/F/TAF; 2 partici- F/TAF is an effective option for people virologically suppressed on pants had no virologic data in window and there were no virolog- DTG+F/TDF or F/TAF, with or without NRTI resistance mutations ic failures. No Grade 3-4 study-drug related adverse events(AEs) including M184V, K65R and TAMs. were observed. Three AEs led to study drug discontinuation; one related to study drug. There were no discontinuations of B/F/ TAF due to a renal or bone AEs. Median changes from BL in fast- P2-HV10 ing total cholesterol (TC), LDL, HDL, triglycerides and TC:HDL Previously Undocumented Preexisting Resistance and were -14, -7, -3, -17 mg/dL and -0.1, respectively. Median change Maintenance of Virologic Suppression in HIV-1 RNA- from BL in eGFR was -4.5 mL/min. Median % change in urine Suppressed Patients Switching to Bictegravir/Emtricitabine/ beta-2-microglobulin:creatinine and urine retinol binding pro- Tenofovir Alafenamide (B/F/TAF) tein:creatinine ratios were 20.8 and -15.6, respectively. K Andreatta, R Martin, S Chang, M Willkom, L Wei, H Graham, Conclusion: Through W24, high rates of virologic suppression H Martin, S Yang*, K White were maintained in older participants who switched to B/F/TAF. Gilead Sciences, USA and South Korea The safety and efficacy data support the switch to B/F/TAF in virologically-suppressed individuals aged ≥65 years. Background: Studies 1844 and 1878 demonstrated non-inferior efficacy of switching suppressed HIV-1-infected adults to B/F/ TAF versus continuing dolutegravir (DTG)- or boosted protease P2-HV09 inhibitor (bPI)-containing triple therapy. Here, resistance Switching to a Single-Tablet Regimen Bictegravir/ analyses and virologic outcomes for these participants are Emtricitabine/Tenofovir Alafenamide (B/F/TAF) from described. Dolutegravir (DTG) plus Emtricitabine and either Tenofovir Methods: Participants were randomized at baseline to contin- Alafenamide or Tenofovir Disoproxil Fumarate (F/TAF or F/ ue their DTG- or bPI-based regimen, completed 48 weeks, and TDF) switched to B/F/TAF in the open label extension (OLE). Preexist- PE Sax1, J Rockstroh2, A Luetkemeyer3, Y Yasdanpanah4, S Collins5, ing HIV-1 drug resistance was assessed by historical genotypes D Brainard5, HY Wang6*, Martin H5 and retrospective proviral DNA genotyping. Virologic outcomes 1Brigham and Women’s Hospital, USA, 2Bonn University Hospital, were based on last available HIV-1 RNA during B/F/TAF treat- Germany, 3University of California San Francisco, USA, 4Hôpital ment. Bichat Claude Bernard, France, 5Gilead Sciences, USA, 6Gilead Results: 510 participants switched to B/F/TAF in the OLE. Sciences, Taiwan Cumulative baseline reverse transcriptase genotypic data were available for 73% (373/510); integrase data were available for 49% Background: B/F/TAF, is a guideline-recommended treatment (248/510). Primary NRTI resistance (-R) and INSTI-R substitutions for HIV-1. We evaluated whether people receiving DTG plus F/ preexisted in 11% (41/373) and 3.6% (9/248), respectively. TAF or F/TDF can safely and effectively switch to B/F/TAF. DNA genotyping detected previously undocumented M184V/ Methods: In this phase 3, double-blinded study, virologically- I in 5.4% (20/373), and thymidine analog mutations (TAMs) in suppressed adults taking DTG plus either F/TAF or F/TDF 8.0% (30/373). Through the time of analysis, 99% (503/510) of were randomized (1:1) to switch to B/F/TAF or DTG+F/TAF. participants had HIV-1 RNA < 50 copies/mL at last visit, including Documented or suspected prior resistance to NRTIs (ie, M184V, 95% (19/20) with archived M184V/I, 100% (30/30) with TAMs, K65R and thymidine analogue mutations [TAMs]), NNRTIs and/ and 100% (9/9) with INSTI-R. During the OLE, 5 participants or PIs was permitted; INSTI-resistance was exclusionary. Primary met criteria for resistance testing with no treatment-emergent endpoint was the proportion with HIV-1 RNA ≥50 c/mL at Week resistance. (W) 48. Noninferiority was assessed through 95% confidence Conclusions: Among participants who switched to B/F/TAF in intervals (CI) using a margin of 4%. Secondary endpoints were the the OLE, high rates of virologic suppression were maintained proportion with HIV-1 RNA <50 c/mL and change from baseline for >1 year with no resistance development despite underlying in CD4 counts at W48. Safety was assessed by adverse events preexisting resistance substitutions. These findings indicate that (AEs) and laboratory results. B/F/TAF may have utility as a switch option in a broad range of Results: 565 participants were randomized (284 B/F/TAF, patients, including those with certain preexisting resistance. 281 DTG+F/TAF): 14% women, 24% had resistance to NRTIs including 5% with K65R or ≥3 TAMs, and 14% with M184V/I Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S171

P2-HV11 Characteristics N (%) HIV exposures among healthcare workers: number of Unknown 1 (3.6) incidences and characteristics of HIV exposures in South Exposed body parts Finger 6 (21.4) Korea * Eyes 3 (10.7) H Choi , HJ Shi, JS Eom, YK Cho, J Won, J Lee Unknown 19 (67.9) Division of Infectious Diseases, Gil Medical Center, Gachon PEPa 21 (75) University College of Medicine, Incheon, Republic of Korea Antibiotics use 0 (0) aPost-exposure prophylaxis Background: Healthcare workers (HCWs) are at increased risk of blood-borne infections through occupational exposures. Needlestick injuries and blood or body fluid contacts are hard to P2-OT01 avoid among HCWs, and a little is known about the characteristics Implementation of global antimicrobial resistance of such occasions in Korea. In this study, we assessed the number surveillance system (GLASS) in patients with bacteriuria of incidents and the characteristics of HIV exposures among R Sirijatuphat1*, S Pongsuttiyakorn1, O Supapueng2, P Kiratisin3, HCWs. V Thamlikitkul1 Methods: A cross-sectional study was conducted through self- 1Department of Medicine; 2Department of Research and Develop- reported data of the HCWs who experienced occupational ment, 3Department of Microbiology, Faculty of Medicine Siriraj exposure from March 2010 to November 2018 at Gil Medical Hospital, Mahidol University, Bangkok, Thailand Center, 1,490-bed, tertiary-care hospital in Incheon, South Korea. Results: During 2010 through 2018, total 757 occupational Background: Global Antimicrobial Resistance Surveillance exposures occurred. 28 HIV exposures occurred out of 757 total System (GLASS) was launched by WHO in 2015. GLASS combines occupational exposures during the study period. 16 (57.1%) clinical data and microbiological data with deduplication of female HCWs experienced HIV exposures, and doctors were microbiological repetitive results. This study aimed to evaluate the exposed to HIV the most frequently (N=14, 50%), following nurses practicality and benefit of GLASS for surveillance of urine culture (N=13, 46.4%). HCWs who have worked at the department lesser samples. than 3 years constituted 60.7% (N=17). Needlestick injury was the Methods: GLASS was implemented at Siriraj Hospital using most common type of modality which led to HIV exposure (N=17, locally developed software to collect clinical data and urine 39.3%). 75% (N=21) HCWs who were exposed to HIV had gone culture data from patients with positive urine cultures. through PEP prophylaxis, and HIV infection did not occur. Results: There were 5,085 urine samples from 3,545 patients that Conclusion: A total of 28 HIV exposures out of 757 occupational were sent to the microbiology laboratory during June-December exposures occurred at Gil Medical Center during March 2017. Bacteriuria was found in 1,944 patients. Of those, 952 had 2010-November 2018. Needlestick injury was the most common urinary tract infection (UTI). Hospital-acquired infection (HAI) modality of the occupational HIV exposure. Most of the HIV was observed in 74.2%, and community-acquired infection (CAI) exposed HCWs have worked at the correspondent department for was found in 28.7%. E. coli and S. agalactiae were more observed lesser than 3 years. Training and education on preventive method in CAI, but P. aeruginosa, P. mirabilis, E. faecium, and A. bauman- is strongly warranted. nii were more prevalent in HAI. UTI isolates demonstrated less resistance to antibiotics than colonized isolates. Non-duplicate Table. Baseline Characteristics of the Participants (N=28) isolates of bacteria demonstrated less resistance than duplicate Characteristics N (%) isolates. E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis, E. fae- Sex calis, and E. faecium causing HAI were more resistant to antibiot- Male 12 (42.9) ics than those causing CAI. Female 16 (57.1) Conclusion: GLASS is feasible to implement and more beneficial Age (years) than laboratory-based surveillance for differentiating causative 21~30 16 (57.1) 31~40 10 (35.7) bacteria from colonized bacteria, distinguishing HAI from 41~50 2 (7.1) CAI, aggregating antibiotic susceptibility data of non-duplicate Occupation isolates of causative bacteria from urine samples, and developing Doctor 14 (50) appropriate local antibiotic treatment guidelines for UTI patients. Nurse 13 (46.4) Dental hygienist 1 (3.6) Number of years at the department (years) < 3 17 (60.7) P2-OT02 3~10 9 (32.1) Non-clinical Determinants of Antibiotic Prescribing in the > 11 1 (3.6) Emergency Department: A Mixed-Methods Study Unknown 1 (3.6) A Chow*, MA Ibrahim, J Loh, CK Ooi Types of exposure Tan Tock Seng Hospital, Singapore Needlestick 11 (39.3) Blood stained sharp objects 2 (7.1) Blood or body fluid splash 5 (17.9) Background: Antibiotics are often prescribed for upper Blood or body fluid contact with non-intact skin 3 (10.7) respiratory tract infections (URTI) when they provide little or no Blood or body fluid contact with intact skin 6 (21.4) benefit. In the fast-paced and time-strapped environment of the S172 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

emergency department (ED), antibiotic prescribing decisions for with women having ≥2 children (19.5%) and have repeated abor- URTI are often suboptimal. This study sought to understand non- tion or miscarriage. Chronic cervicitis was predominant in nul- clinical determinants of antibiotic prescribing for uncomplicated liparous women (n= 22, 73.3%) and cervical neoplasia and carci- URTI using a mixed methods approach. noma occupies 13.3% and 26.5% respectively. 33.1% had normal Methods: Qualitative in-depth interviews (n=9) of a purposive menstrual history while 18.2% and 2.7% has irregular menses sample of junior physicians were analysed using thematic and menorrhagia respectively. Menopause accounts for 12.2%. analysis. Emerging themes were included in the subsequent Frequency of carcinoma was seen to be higher in women having cross-sectional survey involving all junior physicians (n=126) irregular menses (43.75%). 10.8% cases diagnosed on cytology working in the ED of 1600-bed adult hospital in Singapore, June turned out to be malignant on biopsy. Cervical abnormalities was 2016-Sept 2017. Principal components analysis was performed to found to be positively correlated with age (r = 0.032, p <0.05) and derive the latent factor structure that was applied in multivariable menstrual abnormalities (r = 0.212, p < 0.05 ) respectively. analyses. Conclusion: Mostly women at older ages and have multiple births Results: Physicians relied strongly on their clinical knowledge are considered to be prone to cervical neoplasia and carcinoma and judgement for antibiotic prescribing. Although cognizant of but my study concluded that even nulliparous women at their the organizational norm of no antibiotics for URTI, they would younger ages are also at high risk and menstrual abnormalities prescribe antibiotics when faced with demanding patients under may also be a factor for cervical abnormalities. time constraints. After adjusting for years of practice and place of medical education, a physician who perceived over prescription in the ED or need for self’s reduction in prescribing (Adj OR 0.50, P2-OT04 95%CI 0.30-0.82, P=0.006) or who managed >50% of patients with Bioinformatics approach to tackle drug resistance URTI in a day (Adj OR 0.14, 95%CI 0.05-0.37, P<0.001) was less in Neisseria gonorrhoeae using homology modeling of likely to report low antibiotic prescribing rate (<10%). Physicians protein and drug docking studies who prescribed antibiotics prudently (Adj OR 2.10, 95%CI 1.33- R. Kant1*P. Jha 1, A. Pawar1, M. Chopra1, D. Saluja1 3.33, P=0.002) or who were confident of their clinical judgement 1Dr.B R Ambedkar Center for Biomedical Research, University of in a supportive ED working environment (Adj OR 1.73, 95% CI Delhi, Delhi-7, India 1.05-2.84, P=0.031) were twice as likely to report low prescribing rates. Background: Neisseria gonorrhoeae, a causative agent of gonor- Conclusion: Non-clinical determinants of antibiotic prescribing rhea, has developed resistance to most of the drugs and hence for URTI in the ED included patient demands, physician clinical aptly declared as ‘Superbug’. Glutamate racemase (MurI) consid- competency and antibiotic prescribing habits, and practice ered as an important drug target for its integral role in bacterial norms. Patient education, clinical decision support tools and cell wall synthesis. Therefore, identification of novel drugs for the guidelines can optimise antibiotic prescribing at the ED. treatment of gonorrhea is urgently required. Methods: The amino acid sequence of MurI of Neisseria gonorrhoeae (YP_208550) was retrieved from NCBI. Based P2-OT03 on query coverage, e-score and percentage similarity, 3OUT Incidence of cervical carcinoma in different age groups and (glutamate racemase from Francisella tularensis) was selected comparision pattern between nulliparous and women with as template after PDB BLAST, homology model was generated multiple birth in tertiary care hospital in Nepal by Modeller programme of Discovery Studio 4.0.Best model was Sunita Neupane*, Subas Subedi selected based on DOPE score and PDF energy score and further Manmohan Cardiovascular and Transplant Centre, Nepal verified by Verify-3D protocol and Ramachandran Plot. Receptor binding site was identified after superimposition of template Background: Cervical cancer is the most common, preventable structure and modelled structure and the co-crystalized ligand cancer and is presented by a spectrum of intraepithelial neoplasia. of the template was docked into the modeled MurI structure. The study aimed to find out the incidence of cervical carcinoma Based on docking score, best pose was selected and receptor- with respect to different age groups along with the difference in ligand pharmacophore model was generated. Virtual screening of pattern of cervical abnormalities among women with multiple inhibitors against the pharmacophore model was performed, best births and nulliparous one. hits were selected based on ADMET profile and further refined. Methods: This is a prospective study conducted at a tertiary care Results: The best homology model generated was selected based centre in Department of pathology. on the verify score of 107.93 from Verify 3D program of Discovery Results: On PAP smear, majority (n = 81, 54.7%) were of inflam- Studio 4.0. Validation of the selected model by Ramachandran matory smears. LSIL and HSIL were reported in 5.4% and 18.2% plot showed 214 residues(91.8%) fall in most favored region. Root- respectively. ASCUS accounts for 18.9% (n = 28) whereas HGSI mean-squared deviation (RMSD) of 0.2475 A0 was generated was seen in 2.7% of cases. On cervical biopsy, it was found that by superimposition of query and template structures. Quality chronic cervicitis was dominant (n= 106, 71.6%) followed by factorof 84% for the protein models wasobtained using ERRAT. squamous cell carcinoma ( n= 17, 11.5%) , Leiomyoma (n = 7, Six pharmacophores were generated using best docking pose 4.7%) and microinvasive adenocarcinoma (n= 2, 2%) CIN, CIN2 between D-glutamate and MurI. These were subjected to virtual and CIN3 accounts for 2%, 3.5% and 2% respectively. Incidence screening with DrugBank database.586 hits so obtained were of cervical cancer was found higher in age group 41-61 years and filtered by fit value of 3.51which resulted in 268 hits.Further Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S173

refinement done by subjecting these 268 hits to Lipinski and veber filter followed by ADMET, gave 73 hits. These were subjected to energy minimization and docking to obtain the best hits. Conclusions: The study identifies potential compoundsthat interact with active site of MurI protein, opening new avenues for the treatment option against multidrug resistant strains.

P2-OT05 Observational Study of IV to Oral Switch Practice in Malaysian Teaching Hospital CL Lau*, J Azman, N Shaharuddin, C Bacha Lal, MA Rosli, Petrick Periyasamy IV Oral switch among discharges Medical (N = 16) Surgery (N =7) Hospital Canselor Tuanku Muhriz, National University of While in ward 3 (18.8 %) 2 (28.6 %) Malaysia Upon discharge 13 (81.2 %) 5 (71.4 %)

Background: Parenteral antimicrobials were commonly initiated observed, in which only 3 (18.8%) medical patients were switched in hospitalised patients to treat infection and continue even when to oral during ward stay but majority (81.2%) of this occurred oral route was possible. It was estimated that about one third of beyond 4 days of therapy. Among surgical patients, only one of 7 inpatients’ intravenous (IV) antimicrobials could be switched to eligible patients was switched to an oral alternative on third day oral agents [McLaughlin et al. 2005]. Changing the antimicrobials of therapy. On the fourth day, there were more switches among administration to oral route was beneficial to patients as it could 8 eligible cases (50%, 4 /8), however this also occurred in 2 other lower the risk of IV route complications such as extravasation, non-eligible cases. Total 7 (38.9%, N = 18) surgical patients were thrombophlebitis, catheter related infection, pain at the IV site, discharged with oral antibiotics during observational period but less fluid requirement and increased mobility. Furthermore, early only 2 (28.6%) were done while in the ward, and 5 (71.4%) were IV-Oral switch was also labour and cost effective as it allowed only performed at the stage of discharge. earlier discharge leading to reduction in the length of hospital Conclusion: The practice of IV to Oral switch was poor among stay. This practice was also shown to be safe without increase in medical and surgical patients. In the case where IV-Oral switch hospital readmission and mortality. [Nathwani et al. 2015]. In were performed, the minimum duration taken among medical addition, it is an antimicrobial stewardship strategy that could be patients was 4 days although earlier switch was possible. Most performed even at low resource setting. were switched only upon discharge. The barriers to an early Methods: This observational study was conducted prospectively switch could be due to the lack of knowledge and awareness over 4 weeks in June 2015, using convenient sampling of patients on the bioavailability of oral option and the benefit on patient admitted to 2 general medical wards and 3 surgical wards. Patients outcome. Some might still perceive that IV antibiotic was superior would be included when they were prescribed intravenous and should be maintained till completion. (Halm et al.2001). antibiotics for infection that was suitable for oral switch when Therefore efforts should be taken to increase awareness through oral alternative was available. However, the patient would be educational activities such as campaign and posters. The current excluded if they were only initiated with oral antibiotic or therapy study was limited by the short duration and small sample size. was escalated from the initial antibiotics. Daily chart review were performed for 1 hour during office hours on weekdays for up to 7 days for each included patient and oral switch suitability were P2-OT06 assessed from the third day onwards. The intravenous antibiotic Antibiotic Prescribing in the Emergency Department: prescription was considered to be suitable for oral switch if all the Patient Expectations and Non-Verbal Expressions following criterias were fulfilled : clinically improving, afebrile for A Chow*, AA Hein, J Loh, CK Ooi at least 24 hours, no signs of sepsis, tolerating oral or nasogastric Tan Tock Seng Hospital Singapore feed, and not having deep seated infections such as endocarditis. Background: Patients’ expectations of antibiotics for upper Results: respiratory tract infections (URTIs) have been observed to increase A total 113 medical patients and 120 surgical patients were antibiotics prescribing in primary care. The phenomenon is less screened. 47% of Medical patients and 28.3% of surgical patients well understood in time-strapped emergency departments (EDs). were on antibiotics. 8.8% of medical patients and 3% of surgical We assessed for the effects of patient expectations and expression patients were given oral antibiotic. During the study period, 24.8% of expectations on antibiotic prescribing in the ED. (28/113) medical patients and 15 % (18/120) surgical patients Methods: We conducted a cross-sectional study on 717 consecu- who were initiated IV antibiotic, were evaluated for potential of tive adults who visited the ED of a 1600-bed tertiary-care hospital switching to oral route. Among medical patients, at the third day for URTI, June 2016-Nov 2018. An interviewer-administered ques- of therapy, 78.6% (22/28) were eligible but none was switched to tionnaire and electronic medical records were used. Multivariable oral route. Subsequently, 2 patients (8%, N=25) were switched to logistic regression models were constructed to assess for the effect oral antibiotics on the fourth day of therapy. At the end of follow of patient expectations on antibiotic prescribing. up, a total of 16 (57%, N=28) discharges with oral antibiotics were Results: Participants were young (median age 36.0 years) and S174 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

healthy (67.8% had no comorbidities), and predominantly male ED visit. Addressing patients’ needs can reduce inappropriate (61.2%). More than one-third (40.7%) had high educational visits to the ED, conserving it for emergency care. levels (diploma and above). Antibiotics were prescribed for 35.2% of participants. Although 282 (39.3%) participants reported expecting antibiotics, only 16.3% (46/282) informed P2-OT08 their physicians about their expectations. Patients who expected Ni-doped ZnO nanoparticles: Excellent antibacterial agent antibiotics but did not verbally express it were significantly more against multidrug resistant Gram-negative bacteria likely to receive antibiotics than those who verbally expressed Atanu Naskar*, Sohee Lee, Kwang-sun Kim expectations and those who did not expect antibiotics (43.6% Department of Chemistry, Pusan National University vs. 34.8% vs. 30.6%, P=0.003). After adjusting for age, gender, comorbidities, and illness duration, non-verbal expression of Nanomaterials or nanocomposites can be used as alternatives antibiotic expectation (aOR 1.75, 95%CI 1.25-2.44, P=0.001) to the traditional antibiotics and are emerging as excellent was associated with antibiotic prescribing, as were high weapon in the battle against multidrug resistant bacteria. Low educational level (aOR 1.54, 95%CI 1.11-2.16, P=0.011) and temperature solution technique was adopted to synthesize Ni- medical consultation in prior 14 days (aOR 1.39, 95%CI 1.01-1.91, doped ZnO nanoparticles in the present work. Crystallinity and P=0.043). crystal phases of the nanoparticles were confirmed by X-ray Conclusion: Patients’ non-verbal expression of antibiotic diffraction (XRD) analysis. Successful Ni doping into ZnO crystal expectations was associated with antibiotic prescribing in the ED. lattice was confirmed by the gradual decrement of crystallite size Further studies are needed to understand the reasons, in order to (ZnO = 27 nm, 10 % Ni doped ZnO = 18 nm) after increasing the guide antibiotic stewardship. Ni doping concentration and shifting of 2θ values (~0.16°) towards higher diffraction angles. The presence of nanoparticles and their microstructure were characterized by transmission electron P2-OT07 microscopic (TEM) analysis. The particle size of 5 % Ni doped Patients Seeking Care for Upper Respiratory Tract Infections ZnO nanoparticles was also corroborated with the crystallite at the Emergency Department: Expectations and Needs size. X-ray photoelectron spectroscopic (XPS) analysis was A Chow*, J Loh, AA Hein, CK Ooi performed to confirm the formation of the nanomaterials and Tan Tock Seng Hospital Singapore Ni doping. Furthermore, the antibacterial activity of synthesized nanomaterials was evaluated by the zone of inhibition and SEM Background: Emergency departments (EDs) are often over- microstructural analysis. Results showed that the materials crowded with non-emergency cases, including acute upper respi- expressed a superior activity against Gram-negative strains than ratory tract infections (URTIs). Despite highly accessible primary Gram-positive strains including carbapenem- or colistin-resistant care clinics and high fees for ED visits, URTIs accounted for a Escherichia coli and Pseudomonas aeruginosa. The reduction substantial proportion of ED attendances. This study seeks to un- of particle size can be the reason behind the antibacterial derstand the expectations of patients seeking care for URTI at the activity. Therefore, this new nanobiomaterial can be applied in ED. antibacterial application of Gram-negative with high efficiency. Methods: We conducted a questionnaire study on 717 consecutive URTI patients at the busiest adult ED in Singapore, June 2016-Nov 2018. Multivariable logistic regression models were P2-OT09 constructed to assess for independent patient factors for specific Development of effective surgical site infection(SSI) expectations of ED visits. surveillance program based on electronic screening system Results: Patients were predominantly healthy (67.8% had no pre- SM Jung1*, ES Park1, OM Kweon1, IA Yu1, DH Woo1, JH Lee1, EJ Ha1, existing comorbidities), with median age of 36 (IQR 28-51) years. DS Lee1, YA Kim2, HS Shin2, JG Lee3, JY Choi4 Expectations for the ED visit included chest X-ray (46.0%), blood 1Division of Infection Control, 2Division of Medical Information test (45.9%), injection (15.3%), hospital admission (11.4%), and and Technology, 3Division of Surgery and 4Division of Infectious influenza virus test (8.7%). Disease, Severance Hospital, Yonsei University Healthcare System, After adjusting for gender, educational level, comorbidities, illness Seoul, Republic of Korea duration, prior medical consultation, patients aged >40 were more likely to expect influenza virus test (aOR 1.88, 95%CI 1.07- Background: The entire surgical site infection (SSI) surveillance 3.30) or chest X-ray (aOR 1.49, 95%CI 1.07-2.07). Patients who had requires a lot of time and effort. Therefore, electronic surveillance been ill for >7days were more likely to expect chest X-ray (aOR system (ESS) were required, the efficient system was established 2.50, 95%CI 1.74-3.60) or injection (aOR 2.13, 95%CI 1.19-3.79) and evaluated. during the visit. Those with pre-existing comorbidities were more Methods: The doctors were required to fill in the form of surgical likely to expect hospital admission (aOR 2.54, 95%CI 1.54-4.14), site records that were linked to IV antibiotics prescription within whereas patients who had sought medical consultation in past 14 POD 5-30 on the electronic health record (EHR). The form days were more likely to expect blood test (aOR 1.44, 95%CI 1.07- included the depth of wound and condition of site. The infection 1.95). control nurse (ICN) reviewed the only recording cases written Conclusion: Patients aged>40, with comorbidities, illness >7days, on the problem. The form was changed mandatory record for or had prior medical consultation, had clear expectations of the antibiotics and discharge prescriptions. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S175

Results: The ESS has been applied to 20 type’s surgeries from Tan Tock Seng Hospital, National Healthcare Group Polyclinics, 2017 to 2018. When monitoring selected cases, ICN monitored National University Health Systems, National University 2 to 4% of operative patients, so one ICN could proceed the SSI Polyclinics, Singapore surveillance. ICN could give timely feedback about SSI cases within 7 to 15day after surgery. The recording rate has increased Understanding prescribing practice is necessary to address anti- 50% to 80% after we changed in discharge mandatory form since microbial use in primary care. Primary healthcare in Singapore is August 2017. (P-value <0.0001). The negative predictable value provided by 20 government-funded polyclinics and 1700 private were over 97%. general practitioner (GP) clinics. This study aims to explore phy- Conclusion: The ESS is efficient because of reducing the work- sician attitudes, practices and perceptions of factors influencing load of ICN. But there are a few limitation, such as accuracy and antibiotics prescribing in Singapore primary care clinics. performance rate of record. Therefore, Clinical cooperation and Semi-structured in-depth interviews were conducted with 3 GP efforts to improve integrity is required. and 4 polyclinic physicians, who have practiced in their respective clinic settings for more than 10 years. Data were analyzed using thematic analysis and further interpreted using the Social P2-OT10 Ecological Model. Prevalence, antibiotic-resistance, and virulence Themes that emerged included: (1) Physician and patient factors, characteristics of Vibrio parahaemolyticus in restaurant fish (2) Patient–physician interaction, (3) Organizational governance, tanks in Seoul, South Korea (4) Patient load, and (5) Information access. Physicians’ medical HW Jeong*, JA Kim, SJ Jeon, SS Choi, MK Kim, HJ Yi, YO Hwang, training, access to Continuing Medical Education and antibiotic YH Oh guidelines shaped their antibiotic prescribing behaviors. The Seoul Metropolitan Government Research Institute of Public patient’s presenting medical condition, age, clinical history, Health and Environment, South Korea demands, autonomy, rapport, trust in the physician, and the physician’s clinical judgement further influenced antibiotics Background: Vibrio parahaemolyticus is a marine bacterium prescribing. A manageable patient load enabled deeper patient that causes foodborne diarrhea. Many seafood restaurants keep engagement to understand their social reasons and address live fish and shellfish in fish tanks for use in raw seafood dishes; their requests for antibiotics. Whether the antibiotics formulary thus, the present study aimed to investigate the prevalence, was controlled by a government-funded pharmacy or by the GP antibiotic-resistance, and virulence characteristics exhibited by V. practice also influenced antibiotic prescribing practice. parahaemolyticus detected in restaurant fish-tank water samples Antibiotic prescribing by primary care physicians is influenced collected in Seoul, South Korea. by intra-personal, inter-personal, and organizational factors. Methods: Fish-tank water samples were collected from 69 A deeper understanding of the organizational, societal and restaurants in Seoul, and screened for the presence of V. individual barriers and enablers of appropriate antimicrobial use parahaemolyticus via both a commercial detection kit, and a is needed to establish antimicrobial stewardship in primary care real-time polymerase chain reaction (RT-PCR) to detect the toxR in Singapore. gene. Antibiotic susceptibility and virulence determinants of V. parahaemolyticus isolates were evaluated and identified using standard disk-diffusion and PCR methods, respectively. P2-OT12 Results: Thirty-five (50.7%) of the 69 analyzed water samples Knowledge, Attitudes and Perceptions of Antibiotic Use and were found to be contaminated with V. parahaemolyticus. Antibiotic Resistance among the General Public in Singapore Detected isolates were most often resistant to ampicillin (51.4% of N.Roslan*, J.Yeo, H.Guo, M.Bin Ibrahim, L.Wong, J.Tan, A.Chow isolates). Thirty out of the 35 isolates carried all four cytotoxicity- Tan Tock Seng Hospital, Singapore inducing type-III secretion system I (T3SS1) genes. However, virulence determinants such as the hemolysin (tdh and trh), Misuse of antibiotics is a major cause of antibiotic resistance, a urease (ureC), T3SS2α or T3SS2β that are known to be associated growing public health threat. Public knowledge, attitudes, and with enterotoxicity were not detected in all isolates. perceptions play an important role in appropriate antibiotic use Conclusions: Although some known major virulence genes were and the consequent development of antibiotic resistance. This not detected in the V. parahaemolyticus isolates, the results of this study aims to explore the knowledge, attitudes, and perceptions study indicate that restaurant fish tanks are a potential source of antibiotic use and antibiotic resistance in the general of antibiotic-resistant V. parahaemolyticus. The presented data Singaporean population. 3 exploratory focus group discussions support the need for guidelines to regulate the maintenance of comprising of 6-8 participants each were conducted in the restaurant fish tanks to prevent antibiotic-resistant foodborne community among Singaporean Chinese and Malays aged 35-50 vibriosis. and >50 years respectively. The discussions were transcribed in verbatim and data were analyzed using thematic analysis. Four main themes emerged: 1) Misperception of antibiotic efficacy 2) P2-OT11 Misunderstanding on antibiotic resistance 3) Trust in physicians Antibiotic use in primary care: Perspectives of primary care on antibiotic use 4) Self-responsibility for health maintenance. physicians in Singapore Many participants were unaware that antibiotics were only H Guo*, W Tang, V Loh, M Sundram, A Chow effective against bacterial infections, with a large proportion S176 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

perceiving that antibiotics could relieve “flu”. Participants P2-OT14 appeared to have a lack of understanding on the terminology Effects of providing manuscript editing through a “antibiotic resistance” and the science behind it, perceiving that combination of in-house and external editing services in an their personal risk for antibiotic resistance to be low. However, academic hospital the majority trusted their physicians for advice on the use of JS Lim*, K Bailey, S-H Kim, TW Kim antibiotics. Furthermore, many participants felt personally Scientific Publications Team, Clinical Research Center, Asan responsible for maintaining their health through various activities Medical Center, University of Ulsan College of Medicine, Seoul, including vaccination, healthy eating and engaging in physical Korea activity. The common Singaporean has misperceptions about antibiotics and antibiotic resistance. Educational interventions Background: English editing services are effective for improving through trusted physicians could address the knowledge gaps manuscript quality as well as providing learning opportunities for and reduce inappropriate antibiotic use. Antibiotic misuse could non-native English-speaking authors. We established a combined be further reduced by promoting personal ownership of health system of in-house and external editing services for handling maintenance. large volumes of editing requests and providing personalized editing service in academic hospitals. Methods: We established the Scientific Publications Team (SPT), P2-OT13 an in-house editing team in Asan Medical Center in Seoul, Human resources required for antimicrobial stewardship Korea. The SPT is composed of two professional editors who programs in Korean hospitals manage editing requests sent to external companies while also Se Yoon Park1, Hyun-Ha Chang2, Chisook Moon3, Mi Suk Lee4, providing one-on-one in-house editing services. We gathered Jin Yong Kim5, Dong Sik Jung6, Shin-Woo Kim2, Hong Bin author satisfaction data from 936 surveys between July 2017 and Kim7, Bongyoung Kim8*, Eu Suk Kim7: Korea Study Group for December 2018 and analyzed the number of editing requests Antimicrobial Stewardship (KOSGAP) and research publications by segmented regression analysis of 1Division of Infectious Diseases, Soonchunhyang University, interrupted time series data. 2Kyungpook National University, 3Inje University, 4Kyung Hee Results: The SPT processed 3931 editing requests during the University, 5Incheon Medical Center, 6Dong-A University, 7Seoul study period, which was a marked increase compared with prior National University, 8Hanyang University to its establishment (P = 0.0097). The authors were generally satisfied with the quality of editing services from both in-house Background: The purpose of the study is to calculate human and external editors. The in-house editors received significantly resources required for antimicrobial stewardship programs (ASP) higher satisfaction scores than most external vendors in both in Korean hospitals. blind and non-blind surveys. Importantly, the number of research Material and methods: The time required for performing ASP publications significantly increased (P = 0.0007) at one year after activities for all hospitalized patients under antibiotic therapy was the establishment of the SPT. estimated and converted into hours per week. Then, full-time Conclusion: Providing a combination of in-house and external equivalent (FTE) was measured according to labor law in Korea editing services resulted in high author satisfaction and (52 hours per week). The study for measuring time spent per subsequent hospital-wide increases in manuscript writing and patient review was conducted in 4 hospitals. One or two infectious publication. Our system may be adapted in hospitals to better diseases specialists or fellows in each hospital classified 60 address the needs of non-native English-speaking researchers. antibiotic consults into 10 types of expected ASP activities, which were determined by the study group, and measured time per patient review. If two or more activities were observed in a single P2-OT15 patient, we divided them into main and additional activities. A Modified Simple Scoring System Using the Red Blood The study for estimating the number of each ASP activity for Cell Distribution Width, Delta Neutrophil Index, and Mean hospitalized patients per day was conducted in 8 hospitals. Platelet Volume-to-Platelet Count to Predict 28-day Mortality Each hospital randomly sampled 210 (one hospital sampled 64) in Patients with Sepsis/Septic Shock hospitalized patients under antibiotic therapy on a single day and Nam Su Ku1,2, Yongseop Lee1, Yun Suk Cho1, Yu Jin Sohn1, measured the number of required ASP activities for them. Jong Hoon Hyun1, Sang Min Ahn1, Woon Ji Lee1,2, Results: The median time spent for main activities were ranged Jun hyoung Kim1,2, Hye Seong1,2, Jung Ho Kim1,2, Jin Young Ahn1,2, 10-16 minutes and that for additional activities were 2 minutes. Su Jin Jeong1,2, Jun Yong Choi1,2, Joon-Sup Yeom1,2, The personnel requirement was calculated as 1.02 FTEs/100 Young Goo Song1,2 beds for main activities and 1.18 FTEs/100 beds for main and 1Department of Internal Medicine, Yonsei University College of additional activities. Medicine, Seoul, South Korea, 2AIDS research Institute, Yonsei Conclusion: Estimated human resources required for ASP for University College of Medicine, Seoul, South Korea hospitalized patients in Korean hospitals were 1.02-1.18 FTEs/100 beds. Background: Many biomarkers have been investigated to identify patients with sepsis who are at risk of death. Recently, authors reports a new scoring system using the red blood cell distribution width (RDW), delta neutrophil index (DNI), and platelet count Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S177

was useful for predicting the mortality in patients with sepsis/ mean ages of the patients were 42.2 years and 78% were male. septic shock. The mean platelet volume-to-platelet count (MPV/ The mean body weight was 72.95 kg and the mean chloroquine PC) ratio also is readily available parameter that might have dosages were 21.7mg/kg. Only 20% of patients received more discriminative power regarding outcome in critically ill. Thus, we than 25mg/kg of chloroquine. Seventy one percent of the patients investigated whether a modified simple scoring system based on revealed delayed parasitemia clearance as having parasitemia RDW, DNI, and MPV/PC ratio was associated with the prognosis 72 hours after chloroquine treatment. The pvmdr1 and pvcrt-o of patients with sepsis, and whether this new scoring system was genes mutations were identical in all the patients. All revealed the more useful than previous scoring system. F1076L mutations in pvmdr1. None had Y976F in pvmdr1 nor K10 Material and insertion in pvcrt-o. Methods: We conducted a retrospective cohort study involving Conclusion: The 71% of the patients revealed the delayed adult patients who received intensive therapy due to sepsis/ parasitological clearance. No known drug resistance mutations septic shock (Sepsis-3 criteria) among the patients who visited were associated with the delayed parasitological clearance. Under the emergency department from January 2016 to February 2019 dosage of chloroquine with increasing body weight was associated at a tertiary teaching hospital in South Korea. Each patient was with the delayed parasitological clearance. Chloroquine dosage rated on a scale of 0 to 3 according to the modified scoring system increment according to the body weight is needed. using the RDW, and DNI, and MPV/PC ratio. Point values were assigned based on the following definitions: RDW > 14.5%, DNI > 5.0%, and MPV/PC ratio > 9.87fL10-5uL-1. P2-OT18 Results: A total of 264 patients were finally enrolled in this study. Cephalosporin DDD relationship with the incidence of ESBL The 28-day mortality rate was 14.4% (38/264). The nonsurvivors in Kariadi Central Hospital Semarang, Indonesia had higher scores than the survivors (1.55 ± 0.92 vs 0.93 ± 0.78, P MMDEAH Hapsari1, E.S. Sutrisnaningsih2, D. Kumalasari3, < .001). In the multivariate Cox proportional hazard analysis, the D. Sari4, Mujahidah5 modified scoring system was an independent predictor of the 28- 1Pediatric Clinician, Kariadi Central Hospital, Indonesia, day mortality (p<0.001). In the Kaplan-Meier analyses, patients 2Pharmacist, Kariadi Central Hospital, Indonesia, 3Pharmacist, with scores of 2 or 3 had lower survival probabilities at 28 days Kariadi Central Hospital, Indonesia, 4Microbiologist, Kariadi than the patients with scores of 0 or 1 (p value from the log-rank Central Hospital, Indonesia, 5Microbiologist, Kariadi Central test < 0.001). In addition, the area under the curve for the scoring Hospital, Indonesia system is higher than previous scoring system (0.685 vs 0.645). Conclusion: A modified scoring system using the RDW, DNI, and Background: The increasing use of cephalosporin antibiotics is MPV/PC ratio was very good independent predictor of the 28- believed to cause increased resistance such as ESBL (Extended day mortality. In addition, it was more useful for predicting lethal Spectrum Beta-Lactamase). The purpose of this study was to look outcome in sepsis/septic shock than previous scoring system. at the relationship between the use of cephalosporin antibiotics to the level of ESBL resistance. Methods and Results: DDD calculations are performed on the P2-OT17 surgical and disease sections, which are the most used parts of Analysis of clinical characteristics and drug resistance antibiotics, in Kariadi Central Hospital Semarang during 2016, genes of Plasmodium vivax in malaria patients with delayed 2017 and 2018. Calculation of ESBL resistance was carried out treatment response on culture samples in the Microbiology Laboratory during 2016, MJ Kim1, YS Park2, SY Park3, YG Kwak4, JE Song4, SY Shin5, 2017 and 2018. From a total sample of 800 samples, the total YC Kim6, JH Baek7, S-H Cho8, S-E Lee8, H-I Shin8, J-S Yeom9 DDD of cephalosporin antibiotics obtained during 2016, 2017 1Asan Medical Center, 2NHIS Ilsan Hospital, 3Dongguk University and 2018 was 32.1; 25.8; and 27.9 in sequence. The most widely Ilsan Hospital, 4Inje University Ilsan Paik Hospital, 5Catholic used cephalosporin group is ceftriaxone. The results of ESBL Kwandong University International St. Mary’s Hospital, 6Ajou germs during 2016, 2017 and 2018 are 79.8%; 62.7%; and 62.9%, University Hospital, 7Inha University Hospital, 8Korea Center for respectively. Disease Control and Prevention, 9Yonsei University College of Medicine Background: Around 500 patients suffer from malraia caused by P. vivax in Korea. Chloroquine, total dose of 25mg/kg, and primaquine remain as the first line treatment. However, previous research suggests that parasitological clearance is delayed recently with chloroquine treatment. Methods: We prospectively enrolled patients diagnosed with vivax malaria. Demographics, treatment regimen and parasitological clearance at 72 hours after chloroquine treatment were identified. The known drug resistance gene mutations of pvmdr1 (F1076L, Y976F), pvcrt-o (K10 insertion) of the P. vivax were also identified. Conclusion: The DDD amount of third-generation cephalosporin Results: A total of 53 patients were enrolled in the study. The antibiotics decreased in 2016-2017, the same thing also applies S178 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

to ESBL resistance which also declined. In 2017-2018 there was Background: In this work, we investigated the gut microbiome an increase in the use of third-generation cephalosporins, the and ARGs in healthy people in Korea and compared the incidence of ESBL resistance also increased. The relationship abundance and types of ARGs with other countries. between the use of third-generation cephalosporins and ESBL Methods: A total of 61 healthy Korean people aged 30–59 years events is directly proportional. without underlying disease or admission history within the recent 1 year were included. Whole metagenome sequences of the gut microbiome were obtained using Illumina HiSeq shotgun P2-OT19 sequencing. The abundance of ARGs is presented as GPM (genes The antimicrobial use in patients at the end-of-life in the era per million). of Life Sustaining Treatment Decision Act Results: The median age was 46 (1Q, 3Q; 37, 51) and 47.5% of the Ki Tae Kwon1, Soyoon Hwang1, Yoonjung Kim1, Sohyun Bae1, subjects was female. Median abundance of ARG was 89.7 GPM Hyun-Ha Chang1, Shin-Woo Kim1*, Sang Taek Heo2, Jeong Rae Yoo2 (1Q, 3Q; 67, 105). According to ARG abundance, 61 people were 1Department of Internal Medicine, School of Medicine, Kyungpook classified into high ARG group (HARG) with ≥120 GPM and low National University, Daegu, Korea; 2Division of Infectious Diseases, ARG (LARG) with ≤60 GPM. HARG and LARG contained each 10 Jeju National University School of Medicine, Jeju, Korea people. In principal component analysis of ARGs, HARG was completely Introduction: Although life sustaining treatments could be legally separated from LARG. In the comparison of ARGs abundance withheld or withdrawn after Life-Sustaining Treatment Decision between HARG and LARG, nine resistance determinants were Act was enacted on February 2016 in Korea, antimicrobial therapy significantly abundant in HARG (p-value< 0.01). In particular, has rarely been discussed in the decision-making framework for beta-lactam was the most significant, followed by aminoglycoside. end-of-life care and not included in that Act. We performed this In these two groups, 8 genera showed significantly differential study to determine the status of antimicrobial use in patient at the abundance. Notably, Coprococcus, Dorea, Eubacterium, and end-of-life in Korea. Clostridiales_XIII were more abundant in LARG than in HARG, Materials and Methods: A retrospective review of antimicrobial whereas Flavonifractor, Bacteroides, Eggerthella, and Escherichia use during two weeks before patients died between November were more abundant in HARG than in LARG (p-value < 0.05). 2018 to December 2018 was performed in 3 university hospitals. Shannon’s diversity index of microbiome of each group was as Results: A total of 285 patients were enrolled. Male to female follows: 3.11 in LARG, 3.07 in middle ARG, and 3.03 in HARG ratio was 169:116 and mean age was 69±14 years. Among them, group. However, a statistical significance was not proved (P value 251 patients (88.1%) received antimicrobial therapy during 2 by Kruskal-Wallis test=0.85). weeks before patients died and 212 patients (73.9%) received Conclusion: Bacterial composition and ARG distribution of gut antimicrobial therapy until the last day of death. Most frequently microbiome in healthy Korean people was different according to used antimicrobial agent was piperacillin/β-lactamase inhibitor the abundance of antibiotic resistance genes. (43.9%), followed by meropenem (43.9%), vancomycin (30.9%), ciprofloxacin (16.5%), levofloxacin (13.1%), and so on. There were 55 patients (19.3%) receiving palliative care and 214 patients P2-OT21 (75.1%) who decided to withhold or withdraw the life sustaining Study of Lapsi (Choersospondias axillaris) as an Immune treatments before death. After that decision, same antimicrobial modulant with Immune boosting and anti-inflammatory agents were continued in 90 patients (42.5%), antimicrobial potency therapy were escalated in 52 patients (24.5%), on the other hand, Ravi Gautam1, Su Jeong Yang1, Manju Acharya1, Anju Maharjan1, antimicrobial therapy were de-escalated in 22 patients (10.4%) Ji hun Jo1,2, Chang Yul Kim1,2, Yong Heo1,2* and were discontinued in 13 patients (6.1%). 1Daegu Catholic University, Department of Occupational Health, Conclusions: In Korea, antimicrobial use in end-of life care is very Daegu, Republic of Korea, 2Dragon Immuno Inc, Daegu, Republic frequent, even after the decision to withhold or withdraw the life of Korea sustaining treatment was made. We should start to discuss that antimicrobial therapy is legally considered as the life-sustaining Lapsi (Choerospondias axillaris) commonly known as Nepali treatment which can be withheld or withdrawn in patients at the hog plum is a large, deciduous, edible fruit tree native to Nepal. end-of-life. Although it has been explored less in Nepal, the neighbouring country China has been using it as traditional medicine for cardiovascular diseases since many years. It has been barely P2-OT20 studied for its immunological significance, thus we intended Comparison according to the abundance of antibiotic to perfom a study on its efficacy in immune modulation and resistance genes on the healthy gut microbiome stimulation in mice model. Normal mice and cyclophosphamide- J Kim1*, M Seo1, B Kim1, M Rho2, H Pai1 induced immune-suppressed mice were administered with low, 1Department of Internal Medicine, College of Medicine, Hanyang medium and high concentration of ethanolic extract of Lapsi University, Korea, 2Department of Computer Science and orally for three weeks. In normal mice, lapsi induced Th1 response Engineering and Department of Biomedical Informatics, Hanyang in humoral immunity by increasing IgG2a/IgG1 ratio and also University, Korea the IgA level whereas lowered serum IgE level, a prominent marker of allergic response. Level of IFN-gamma and TNF-alpha Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S179

was reduced by extract at a lower and medium concentration in 1 case of culex flavi virus, 1 case of chaoyang virus and 1 case of Splenocytes T-cell culture. Meanwhile, in immunosuppressed unknown flavi virus. mice, extract significantly increased the number of lymphocytes and decreased the monocytes percentage. Similar to normal mice, lapsi increased the level of IgA and IgG2a/IgG1 ratio and did P2-OT23 not significantly alter the levels of IgG1 and IgE in the serum of Use of multidisciplinary antimicrobial stewardship strategies mice. T-cell culture and B-cell culture of splenocytes also revealed to manage antibiotic shortage the immune boosting nature of lapsi in immune suppressed mice. PE Ow Yong, SY Tan, R Fong, J Seah, WB Lee, SG Donoghue, Similarly, splenocyte phenotyping showed immune boosting H Shafi, J Chien, C Wong, SH Tan nature of lapsi with an increase in CD4+, CD8+, B-cells together Changi General Hospital, Singapore with NKT and NK cells. TGF-beta-1, an inflammatory marker showed lowering tendency with administration of lapsi extract Background: In early 2019, there was a global shortage of aztre- at low and medium concentration in both normal and immune onam, an antibiotic which is commonly used as an alternative suppressed mice. Furthermore, we are on the verge of assaying in beta-lactam allergy. Penicillin allergy is the most common the effect of lapsi as an anti-inflammatory product. The extract has beta-lactam reported, affecting 10 – 20% of the population. To shown an effective reduction in the level of nitric oxide (NO) and control usage and to prevent out-of-stock situation, several multi- reactive oxygen species (ROS) in Raw 264.7 cells stimulated with disciplinary interventions were instituted. This study reviewed the lipopolysachharide (LPS), an in-vitro model of inflammation. impact of these antimicrobial stewardship (AMS) strategies on Atlast, we certainly believe that lapsi, one of the indigenous reducing aztreonam usage. unexplored fruit of Nepal has potential propensity towards Method: Between Mar–May 2019, we utilised various AMS immune modulation and act as a potent immune booster in strategies. (1) Prescribing restriction was implemented, where immune suppressed mice with promising anti-inflammatory aztreonam use would require approval by infectious diseases effect, which shall be further confirmed with ongoing (ID) physicians. (2) Microbiology suppressed aztreonam experiments. Nepal, although rich in various herbal plants still susceptibilities in culture reports, where alternatives were remains concealed to their importance, such herbal plants need available. (3) Prospective audit and feedback by the hospital AMS to be researched and studied for the benefit of all mankind along team, which comprises of pharmacists, ID physicians and clinical with advocacy of Nepali diversity which furthermore can stand as microbiologists. a developmental step of the entire nation. Result: This multidisciplinary strategy led to a 37% year-on-year decrease in aztreonam usage; 4.09 (in 2018) vs 2.58 (in 2019) defined daily doses per 1000-inpatient days. There was also a P2-OT22 27% drop in number of aztreonam courses from 82 (2018) to 60 A Study of the distribution of mosquito and Flavi virus in (2019). There was poor compliance with prescribing restrictions, Gwangju Metropolitan City (2017~2018) with only 1/3 found to be compliant [17/60, 28%]). Thereafter, the Sujin Mun, Mihyeon Lim, Uiryeong Kim, Giseong Lee, AMS team reviewed 41 courses and made 23 recommendations, Jungwook Park, Jinjong Seo, Sunhee Kim, Jaegeun Chung mainly to discontinue aztreonam or switch antibiotics. Health & Environment Research Institute of Gwangju, Korea Acceptance rate was 83% for the recommendations. Furthermore, we found that 3 patients (7%) had incorrect beta-lactam allergy Mosquitoes are the best known disease vector. They transmit records. Zika virus, Japanese encephalitis, malaria, dengue fever etc. Conclusion: A shortage in aztreonam supply was successfully The mosquito species distribution survey is important for handled through the use of various multidisciplinary AMS mosquito-borne infectious disease prevention and epidemiology strategies in combination. This process with contributions from because it mediates other infectious diseases depending on the various disciplines can be used to manage future shortages. mosquito species. Therefore we conducted monitoring project on distribution pattern of Mosquito in Gwangju city and status of mosquitos with pathogens. P2-TM01 The period of study is from April to October, 2017~2018, and An artificial intelligence-based approach using machine there are three research sites, including waterside, mountain, and learning to differential diagnosis in tuberculous and viral urban forests. Collected using BG sentinal traps, attracted with meningitis dry ice and smell. We classified the collected mosquitoes by type, YS Jeong1, MJ Jeon1, JH Park2, MC Kim2,3, SI Choi4, EY Lee5, extracted the genes, and then try to detect the flavi virus genus SY Park5, YM Lee6, SY Park4, KH Park6, SH Kim2, EJ Choo7, Japanese encephalitis virus, yellow fever virus, West Nile virus, TH Kim5, MS Lee6, T Kim7* dengue virus, zika virus. The pathogen analysis method was real- 1SCH Media Labs, Soonchunhyang University, 2Asan Medical time RT-PCR analysis using a primer targeting the nonstructural Center, 3Chung-Ang University Hospital, 4Dongguk University Ilsan protein 5 gene of flavi virus. The result of species classification, we Hospital, 5Soonchunhyang University Seoul Hospital, 6Kyung Hee collected 9 species, 14,389 mosquitoes, and pooled 639 samples. University Hospital, 7Soonchunhyang University Bucheon Hospital, The predominant species were Aedes albopictus (47.1%), followed Republic of Korea by Armigeres subalbatus (18.0%) and Culex pipiens (16.0%). Flavivirus analysis revealed 1 case of Japanese encephalitis virus, Background: Differential diagnosis between tuberculous S180 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

meningitis (TBM) and viral meningitis (VM) is difficult. Therefore, at 0.002 μg/mL. A few test results showed the lowest MIC of 0.001 we investigated the role of machine learning for differentiating ug/ mL, while 1 isolate test result gave MIC at 0.016 μg/mL. Figure TBM with VM. shows cumulative (cum.) values, and cumulative percentage Materials and Methods: For training data, confirmed or probable distribution of the test results of isolates. It can be seen that the TBM and confirmed VM were retrospectively collected at five 50% cum. value was at 0.002 μg/mL , which approximated to teaching hospitals in South Korea between Jan 2000 and Jul 2018. wild type values (unexposed to drug effects). This value is of Various machine learning algorithms were used for training. importance in future clinical laboratory testing, and monitoring Machine learning algorithm was tested by leave-one-out cross- the test drug DST in public health surveillance. validation. Four residents and two infectious disease specialists were tested using the summarized chart. Cohen’s kappa statistics were used to compare the accuracy of machine learning and human judgment. Results: For training, the study comprised of data of 60 patients with confirmed or probable TBM and 143 patients with confirmed VM. Older age, longer symptom durations before the visit, more frequent vomiting, lower serum sodium, lower CSF glucose, higher CSF protein, and CSF ADA were found in TBM. Among various machine-learning algorithms, a deep neural network with imputing strategy of iterative round-robin fashion was the most accurate (87.1%). Sensitivity, specificity, positive predictive value, and negative predictive values were 79.7%, 90.2%, 92.7%, and 94.3%, respectively. The percent of correct diagnosis by machine learning (86.7%) was higher than those with human judgment (range 75.9% − 80.8%, P < 0.001). Conclusions: Artificial intelligence may play a role in differentia- P2-TM03 tion between TBM and VM. Detection of Mycobacterium tuberculosis in Patients with Empyema Thoracis Using Nucleic Acid Amplification Test (GeneXpert MTB/RIF Assay) P2-TM02 N. Gomez*, L. Simpao In vitro activity of delamanid against wild type clinical strains Department of Internal Medicine, Jose B. Lingad Memorial of Mycobacterium tuberculosis strains in Hong Kong Regional Hospital, Philippines K Kam*, D Chan, V Wei, K Kwok, S Lee Stanley Ho Centre for Emerging Infectious Diseases, The Chinese Background: Tuberculosis (TB), caused by the acid fast bacilli, University of Hong Kong, Hong Kong Mycobacterium tuberculosis, brings significant morbidity and mortality especially in developing countries. According to the Hong Kong is a tuberculosis (TB)-intermediate burden area, Centers for Disease Control and Prevention, one third of the with low levels of multidrug resistance amongst both new world’s population is infected with TB; in 2015 about 10.4 million and previously treated cases. We tested clinical isolates from people around the world was affected by TB, causing 1.8 million a hospital TB laboratory on Middlebrook 7H11 medium that TB-related deaths worldwide. Sputum culture is the gold standard contained a critical concentration of 0.2 µg/mL of delamanid. for diagnosis of pulmonary TB; however, it will take up to 4 to Drug susceptibility tests (DST) procedure was performed by 8 weeks of incubation period. The most commonly used test is inoculating a standardized inoculum onto media with and the Acid Fast Bacilli microscopy (AFB), but it has a low yield of without delamanid. For a valid test, distinct, countable colonies M. tuberculosis with sensitivity of 20 – 80% in culture-confirmed were observed on the control medium (without delamanid). cases of tuberculosis. Different test systems based on nucleic When organisms were observed on delamanid-containing acid amplification of the mycobacterium bacteria have recently medium, colony counts on this medium and the control medium been developed. An example of which is the GeneXpert MTB/ were compared and expressed as a percentage. Resistance was RIF assay (GeneXpert), which enables rapid diagnosis within 2 detected when more than 1% of the organisms were growing hours and also provides rifampin resistance result. At present, the on delamanid- containing medium compared with drug-free accepted specimens for use are pulmonary specimens including medium. After the laboratory passed the validation using H37Rv, expectorated, or induced sputum, bronchoalveolar lavage fluid, a panel of 5 clinical isolates of drug-susceptible strains, along bronchial washings, bronchial biopsy specimen, gastric aspirates, with H37Rv, were used for the 2nd step of validation. The clinical cerebrospinal fluid, tissue samples from lymph nodes, pleura and isolates were from patients not previously exposed to delamanid. others. DST assay was then performed on two or more separate days over Objectives: To determine the utility of GeneXpert assay in the a one or more week(s) period, which depended on the laboratory diagnosis of tuberculosis in patients with Empyema thoracis availability, for a total of at least 12 runs. using empyema fluid MIC distribution showed modal concentration at MIC 0.004 μg/ Methods: This is a cross-sectional study among patients admitted mL. This was followed by the next lower concentration which was in Jose B. Lingad Memorial Regional Hospital under Department Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S181

of Internal Medicine, diagnosed with empyema thoracis. Samples of empyema fluid after chest tube insertion were collected and then sent to the hospital’s Department of Pathology for empyema fluid analysis and GeneXpert assay. Result And Conclusion: GeneXpert assay is a clinically acceptable tool in detecting tuberculosis among empyema thoracis cases which yielded high sensitivity of 91.7% and specificity of 100%. Hence, based on the result of this study the use of GeneXpert assay may be a viable option in diagnosing TB among patients presenting with empyema thoracis where available. The use of empyema fluid AFB smear in the detection of tuberculosis cannot be recommended due to its low sensitivity result.

P2-TM04 Diagnostic yield of post-bronchoscopy sputum for P2-TM05 diagnosing smear-negative pulmonary tuberculosis in Extrapulmonary Nontuberculous Mycobacteria Infections immunocompromised patients and Differences of Species according to Isolated Sites JH Park1, K-W Jo2, H Sung3, S-H Choi1, S-O Lee1, TS Shim2, JH Kim*1, JH Kim1, WJ Lee1, H Seong1, IY Jung2, EJ Kim3, JE Song4, YS Kim1, JH Woo1, S-H Kim1* JY Ahn1, SJ Jeong1, NS Ku1, JY Choi1, JS Yeom1, YG Song1 1Departments of Infectious Diseases, 2Pulmonology, 3Laboratory 1Yonsei University College of Medicine, South Korea, 2Yonsei Medicine, Asan Medical Center, Seoul, South Korea University Wonju College of Medicine, South Korea, 3Ajou University School of Medicine, South Korea, 4Inje University Background: Atypical presentations are common in immuno- College of Medicine, South Korea compromised patients with pulmonary tuberculosis (PTB), so the diagnosis of PTB in these patients heavily rely on microbiologic or Background: Nontuberculous mycobacteria (NTM) disease is molecular diagnostic tests. The diagnosis of pauci-bacillary increasing worldwide and is an important cause of morbidity PTB could be delayed if rapid diagnostic tests such as and mortality. However, Studies about extrapulmonary NTM acid-fast bacilli (AFB) smear reveal negative results. Thus, infections have been limited. Thus, we aim to describe the bronchoscopic examinations are usually performed in these diversity of NTM infections and correlate these observations with patients. However, rapid diagnostic tests from bronchoscopic clinical data. examinations sometimes revealed negative results, and further Methods: We analyzed all symptomatic patients with positive microbiologic tests from post-bronchoscopy sputum (PBS) NTM cultures in sterile extrapulmonary sites at four tertiary care occasionally exhibited positive results. We thus evaluated the centers in South Korea. Predisposing factors, diversity of NTM diagnostic yield of PBS for diagnosing smear-negative PTB in isolates, antimicrobial susceptibility testing, treatment regimens, immunocompromised patients. and outcomes were collected. Methods: Immunocompromised adult patients with smear- Results: A total of 117 patients (46 male vs. 71 female) were negative PTB, who underwent bronchoscopic examinations, included. The mean age of the patients was 53.1 years. Skin and were retrospectively enrolled at a tertiary hospital, in Seoul, South soft tissue infections predominated (34.2%), followed by bone Korea, during a 5-year period. and joint infections (28.2%). Of 117 NTM isolates, 66 NTM sub- Results: A total of 76 patients were tested with bronchoscopic species were identified. M. intracellulare (34.8%) was the most examinations and PBS. The comparison of AFB smear and culture common species identified, followed RGM species such as M. results among various respiratory specimens are shown in Figure fortuitum complex (21.2%), and M. abscessus (15.2%). In skin and 1. Bronchial aspiration or BAL samples exhibited AFB smear soft tissue infections, RGM species were predominantly identified negativity in all 76 patients, but PBS revealed AFB smear positivity (26/28, 92.9%), whereas SGM species were mainly identified in in 6 (8%) patients. In addition, 12 (16%) patients revealed bone and joint infections (18/26, 69.2%), and the difference of mycobacterial culture positivity from PBS only. isolated sites was verified by post hoc test (P < 0.001). Multivariate Conclusion: PBS could improve the diagnostic yield by 24% logistic regression analysis revealed that female sex (vs. male sex; when diagnosing smear-negative PTB in immunocompromised OR 5.30, 95% CI 1.35 – 24.26); P = 0.020) and skin and soft tissue patients. About 8% of the patients could be diagnosed rapidly infections (vs. bone and joint infections; OR 18.10; 95% CI 3.28 – because of AFB smear microscopy positivity from PBS. Therefore, 157.07; P = 0,002) were identified as predictors of RGM, whereas PBS should be performed after bronchoscopic examinations in SGM was the opposite. immunocompromised patients with suspected pauci-bacillary Conclusion: Skin and soft tissue infection was predominantly PTB. caused by RGM, whereas bone and joint infection is mainly caused by SGM. Clinicians should be aware of the species-specific microbiologic information of extrapulmonary NTM infections. S182 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P2-TM09 Results: During 2013–2016, a total of 351 NTM isolates In Silico Multidrug Resistant Prediction in Tuberculosis were reported. The most frequently isolated organism was Using Whole Genome Sequence Analysis Mycobacterium intracellulare (n=181, 51.6%), followed by M. SR Ramli*1, HF Zamri1, NA Md Dali2, Z Abu Bakar2 avium (n=44, 12.5%), M. abscessus (n=19, 5.4%), and M. kansasii 1Bacteriology Unit, Institute for Medical Reserch, Jalan Pahang, (n=18, 5.1%). A total of 25 NTM isolates (7.1%) were isolated from 50588 Kuala Lumpur, Malaysia, 2Institute for Respiratory Health, non-pulmonary specimens. The most common mycobacteria Jalan Pahang, 53000 Kuala Lumpur, Malaysia among extrapulmonary NTM diseases were M. intracellulare (n=6, 24.0%), followed by M. ulcerans/M. marinum (n=5, 20.0%), Background: The burden of multidrug resistant tuberculosis and M. chelonae (n=4, 16.0%). Most common sources were (MDR-TB) is increasing both globally and locally. World Health bone and joint in 15 (60.0%) and SST in 9 cases (36.0%). Twenty- Organization (WHO) had estimated about 480,000 people three patients received specific treatment for the NTM. Two M. developed MDR-TB worldwide in 2013. Timely anti-TB sensitivity mucogenicum isolates from skin tissue and cerebrospinal fluid testing is important in order to make accurate decisions on anti- were not treated because they were not considered pathogenic. TB management. In this study, we described detection of anti-TB Conclusions: Our study shows that extrapulmonary NTM drug resistant using whole genome sequence and its correlation infections remain rare. The most common mycobacteria causing to phenotypic drug sensitivity test. extrapulmonary NTM disease were M. intracellulare and M. Methods: An isolate of an MDR-TB patient (K0419) with resistant ulcerans/M. marinum. to rifampicin, isoniazid, streptomycin and ethambutol, was sequenced for whole genome using Miseq, Illumina. The draft genome was compared against Mtb H37Rv genome to elucidate P2-TM11 the polymorphism that is related to its resistance using online The ESAT-6 family protein induce Interferon g levels from T bioinformatic tools i.e. Comprehensive Antibiotic Resistance cell culture as cut off point to diagnose Latent TB Infection Database (CARD). In silico spoligotyping and detailed lineage (LTBI) in Indonesia were analysed using CASTB and PhyResSe. D.F. Leona*, A.E. Putra, T. Faadhilah Results: A draft genome of 4.46Mb was produced with 65% GC Andalas University, Padang, Indonesia content, N50 134,912 and 4493 coding sequences. Mutations were detected in rpoB for rifampicin, katG and inhA for isoniazid, Background: Treatment of active TB is not sufficient to eliminate murA for fosfomycin and embC, embR embB and embA for the disease, because individuals with LTBI outnumber those with ethambutol. Presence of protein homolog model for drug-efflux active TB, and LTBI can progress to active disease at any time. pumps and antibiotic inactivation pathway such as mtrA, Erm and Diagnosis of LTBI is problematic because the Tuberculin skin test, AAC(2’)Ic may have important role in survival and adaptation of which has been widely used for centuries, has several limitations this strain to its surrounding environment. In silico spoligotyping with low specificity. The aim of this study was to obtain cut-off and phylogenetic analyses demonstrated that the strain belongs value of IFN-g that can be used for diagnosis of LTBI, combined to an East African-Indian lineage. with history of close contact and the absence of clinical/ Conclusion: Our work indicates that K0419 harbors both classical radiological manifestations. and uncommon SNPs that allow it to escape from inhibition by Materials and Method: There were 120 subjects, consisted many antibiotics. Polymorphism analysis showed that the pattern of 40 patients with active TB, 40 healthy people and 40 of resistance mutations correlated with drug-susceptibility profile. with suspected LTBI. T cells isolated from PBMC Sand cultured on RPMI complete medium and induced by Esat- 6 protein for 6 days. IFN-g levels were examined from P2-TM10 the supernatant by sandwich Elisa technique. Statistical Extrapulmonary nontuberculous mycobacterial infections analysis was used to determine the cut-off value of IFN-g. at a Korean hospital Results: The concentration of IFN-g obtained from patients with CH Jeon*, YM Wi active TB is higher than that found in the other 2 groups, ie 1.044 Division of Infectious Diseases, Samsung Changwon Hospital, ng/ml, LTBI group was 0.745 ng/ ml and the healthy group was Sungkyunkwan University 0.455 ng/ml. The highest suitability index (Kappa value) that can differentiate between healthy and suspected LTBI groups Background: Although nontuberculous mycobacteria (NTM) was 0.925 for the concentration of IFN-g 0.792 ng/ml, so IFN-g diseases manifest as primarily pulmonary illnesses, recent level 0.792 ng/ml was considered as the cut-off value. Based on retrospective studies have found that 20 to 30% of NTM isolates this value, from 40 suspected cases of LTBI found as many as 17 are of extrapulmonary origin. (42.5%) and 23 were not LTBI (57.5%). Methods: We investigated NTM isolates from 351 patients at Conclusion: The levels of IFN-g from T cells cultured 0.792 ng/ml Samsung Changwon Hospital between January 2013 and June was the cut-off point for LTBI diagnosis. 2019. The REBA Myco-ID test was performed according to the manufacturer’s instructions for the rapid identification of NTM species in clinical samples or cultured mycobacterial species. Clinical features and their treatments of the patients were reviewed through medical records. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S183

Table 1. (P2-TM10) Characteristics of twenty-five cases Demographic characteristics Radiologic and pathologic and microbiologic findings Treatments and outcomes Symptoms MRI findings Medication Age/ Predisposing durations Affected site Culture AFB Surgical Underlying diseases (clinical Pathology REBA Myco-ID (duration, outcomes Sex factors (days) growth stain intervention diagnosis) months) 1 64/M HTN fisherman 55 wrist, hand tenosynovitis CGI c abscess Yes Yes M. ulcerance/ M. I&D CRE(6) Cure marinum 2 58/F no Exposure to 110 wrist, hand tenosynovitis, CGI c abscess No No M. abscessus Synovectomy, CACe(1.5) Cure fish bone arthritis, OM, Tenosynovectomy, àADM(4.5) abscess, cellulitis I&D 3 69/M LT on fisherman 43 forearm, tenosynovitis, CGI Yes Yes M. ulcerance/ M. Synovectomy, HERZ(1.5) Cure immunosuppressant hand arthritis, OM, marinum Tenosynovectomy, àCRE(9) abscess, cellulitis I&D 4 40/F no liposuction 7 liposuction (skin nodules) Suppurative No No M. chelonae I&D CD(1)àCDL(1.5) Recur site inflammation àLTCe(1)àCDL(3) 5 25/F no liposuction 28 liposuction cellulitis Infiltrates No ND M. chelonae I&D Transfer to other hospital site of many neutrophils 6 75/M DM no 132 finger tenosynovitis CGI c Yes No M. intracellulare Synovectomry CRE(5)àCREA(3) Cure necrosis àCRE(1)àCA(1.5) àC(1.5) 7 69/M HTN, DM, CKD on trauma 52 forearm tenosynovitis, CGI c Yes No M. kansasii Tenosynovectomy, CRE(0.25) Die HD myositis, necrosis I&D necrotizing fasciitis, cellulitis 8 78/M no trauma 30 forearm, tenosynovitis, CGI c Yes Yes Mycobacterium I&D ClRDa Improved hand arthritis, OM, necrosis species (àM. abscess, cellulitis leprosy) 9 61/F HTN, RA on steroid trauma 30 finger arthritis, cellulitis ND No ND M. ulcerance/ M. I&D CRES(1) Die marinum àRSD(0.5) àSDCi(0.5) 10 59/M HTN farmer 60 forearm, tenosynovitis, CGI c No No M. intracellulare Synovectomy CRDM(1.5) Follow up hand arthritis, OM, necrosis àSAzRE(7) loss abscess, cellulitis 11 63/F no no 360 Both arm (skin nodules) granuloma Yes Yes M. massiliense I&D CD(1.5)àCACe(1) Cure àC(1.5) 12 74/M DM, LT on trauma 2 toe (diffuse erosive ND No ND M. mucogenicum ND No medication immunosuppressant patch) 13 60/F no no 150 finger tenosynovitis CGI c Yes No M. intracellulare Synovectomy CRE(6) Cure necrosis 14 61/F HTN trauma 360 finger tenosynovitis CGI Yes No M. intracellulare I & D HERZ(1.5) Cure àCRE(2)àCRS(7) 15 76/M no no 1 CSF (encephalitis) ND No ND M. mucogenicum ND No medication 16 74/F no no 25 foot, finger tenosynovitis, Acute and No Yes M. ulcerance/ M. I & D CREA(1) Cure myositis, chronic marinum àAzRE(11) necrotizing inflammation fasciitis, cellulitis c necrosis 17 61/M no farmer 28 shoulder, tenosynovitis, CGI Yes Yes M. intracellulare I & D CRE(1) Die wrist arthritis 18 70/F no farmer 180 hand tenosynovitis chronic No No M. chelonae Synovectomry, I&D CD(6) Cure inflammation 19 65/F CHF, HTN, DM, CKD, no 84 finger tenosynovitis CGI c Yes No M. intracellulare I & D CRES(0.5) Cure RA on steroid necrosis àAzRES(1.5) àAzRE(8) 20 52/M no no 360 face (cellulitis) ND No No Mycobacterium ND No medication Recur species 21 60/F DM fisherman 120 hand tenosynovitis CGI c No Yes M. ulcerance/ M. I & D CRE(12) Cure necrosis marinum 22 33/F asthma on steroid acupuncture 300 Acupuncture (skin nodules) ND No No Mycobacterium I & D CD(1) Cure site species 23 40/F no acupuncture 90 Acupuncture (skin nodules) ND No No M. chelonae I & D CD(1/4) Cure site 24 49/M no no 60 face (skin nodules) ND No No Mycobacterium I & D Da(2) Recur species 25 34/F no acupuncture 90 Acupuncture (skin nodules) ND No No M. scrofulaceum/ I & D CD(3) Cure site M. kansasii/ M. intracellulare HTN, hypertension; LT, liver transplantation; DM, diabetes; CKD, chronic kidney disease; HD, hemodialysis; RA, rheumatoid arthritis; CSF, cerebrospinal fluid; OM, osteomyelitis; CGI, chronic granulomatous inflammation; ND, not done; C, clarithromycin; R, rifampin; E, ethambutol; A, amikacin; Ce, cefoxitin; D, doxycycline; M, moxifloxacin; H, isoniazid; Z, pyrazinamide; L, levofloxacin; T, tobramycin; Ci, ciprofloxacin; Da, dapsone; S, streptomycin; Az, azithromycin

P2-TM12 Introdution: Tuberculosis (TB) is one of the top 10 causes of The effect of immunonutrien intake on severity of pulmonary death worldwide. The severity of pulmonary TB symptoms is tuberculosis clinical symptoms affected by the immune status which is strongly influenced by T.Faadhila1*,D.Sulastri2, A.Ana3, IM. Sari1 nutrition. Immunonutrient can be defined as the effect of the 1School of Medicine, Andalas University, Padang, Indonesia, provision of specific nutrients on immune function.Vitamin 2Department of Nutrition, Andalas University, Padang, Indonesia, D is known to enhance immune response to mycobacteria.In 3Department od Public Health and Community Medicine, Andalas addition, protein products cytokine which help body defense to University, Padang, Indonesia mycobacteria.The aim of this study was to determine the effect S184 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

vitamin D and protein intake as the immunonutrient on severity Results: The average intake of vitamin D is 5.86 mcg/day, SD 5.45. of pulmonary tuberculosis clinical symptoms. The average intake of protein is 78,477 gram/day, SD 29,30. The Materials and methods: The method of this study is cross respondents who have degree TBScore I is 92.3% (48 persons), sectional study of 52 pulmonary tuberculosis patients. They were TBScore II is 7.69% (4 persons), TBScore III is 0% (0 persons). The interviewed with questionnaire of FFQ. The amount of vitamin D average of TBScore is 2,04 ± 1,89. and protein intake is calculated by using the nutrisurvey. Clinical Conclusions: Based on the statistical analysis, vitamin D and pro- symptoms of TB patients are measured by using Bandim TBScore. tein intake are not significantly affect the severity of pulmonary Statistical analysis of the two variables is allegedly linked using TB clinical symptoms. However, the average intake of TBScore II SPSS. group is much lower than the intake of TBScore I group. Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S185

Late Breaking Abstracts center in Thailand. Methods: We retrospectively collected data of monomicrobial S. aureus isolated from patients who attended King Chulalongkorn P2-LB02 Memorial Hospital, Thailand during January to December 2017. Immunogenicity and safety of influenza vaccination in Culture proven S. aureus from clinical specimens was classified as cancer patients receiving immune checkpoint inhibitor MSSA or MRSA by cefoxitin disk diffusion test. Primary outcomes C.K.Kang*, K. I. Jun, S. M. Moon, E. S. Kim, H. B. Kim, N.-J. Kim, were 90-, 180-, and 365-day all-cause mortality rates. Cox B. Keam, W. B. Park, M.-d. Oh regression analyses were used to determine the associations. Department of Internal Medicine, Seoul National University Results: Of 439 patients, MRSA was found in 54/439 samples College of Medicine, Seoul, Republic of Korea (12%). The overall cumulative 90-, 180-, and 365-d all-cause mortality rates were 9.8%, 10.7, and 11.8%, respectively. Patients Background: The immunogenicity and safety of influenza with MRSA infection exhibited higher mortality rates at 90 days vaccination in cancer patients receiving immune checkpoint (9% VS 17%; HR, 2.11; 95% CI, 1.00-4.44; p<.05), 180 days (9% inhibitors (ICIs) have not been elucidated. We explored VS 19%; HR, 2.17; 95% CI, 1.07-4.39; p<.05), and 365 days (10.1% immunogenicity and safety in cancer patients receiving ICIs VS 24.1%; HR, 2.65; 95% CI, 1.41-5.05; p<.05) when compared to compared to cancer patients receiving cytotoxic chemotherapy. those with MSSA infection. Methods: Adult cancer patients receiving ICIs or cytotoxic agents Conclusion: Patients with MRSA infection should be carefully were prospectively enrolled in a 1:2 ratio. They received an monitored at least one year after diagnosis. Strategies to identify intramuscular seasonal quadrivalent influenza vaccine on day patients at risk should be developed to prevent death in these 1 of the chemotherapeutic cycle. The serum hemagglutination patients. inhibition (HAI) antibody titers were examined before and 4 weeks after vaccination. The primary endpoint was seroprotection rate, and immune-related adverse events (irAEs) were screened P2-LB04 by pre-defined measures. Accuracy and cross reactivity of rapid diagnostic tests for Results: Among 154 eligible patients, 46 and 90 patients in the norovirus and rotavirus in real clinical setting ICI and cytotoxic chemotherapy groups, respectively, were S.Thangjui, N.Sripirom, S.Titichoatrattana*, J.Mekmullica finally examined for HAI antibody titers. Seroprotection rates Bhumibol Adulyadej Hospital, Thailand were higher in the ICI group than in the cytotoxic chemotherapy group (H1N1, 76% vs. 68%, P=0.111; H3N2, 89% vs. 70%, Norovirus and rotavirus are responsible for more than half of P=0.005; B-Yamagata, 83% vs. 54%, P=0.002; B-Victoria, 85% vs. acute gastroenteritis among children worldwide. The rapid 48%, P<0.001) and seroconversion rates were also higher in the diagnostic test (RDT) based on immunochromatography is ICI group (H1N1, 57% vs. 39%, P=0.086; H3N2, 52% vs. 27%, widely used due to its easiness and less time-consuming. The P=0.006; B-Yamagata, 54% vs. 30%, P=0.007; B-Victoria, 65% vs. studies of the accuracy of these tests are still inconsistent and 28%, P<0.001). The frequency of vaccine-related adverse events lack evidence in real clinical settings. The primary purpose of this was comparable between the two groups. Only 4 (8.5%) irAEs study is to provide the accuracy of norovirus and rotavirus RDT. occurred during the study period, which were all grade 1. The secondary objective is to analyze the cross-reactivity of both Conclusion: Cancer patients receiving ICIs reach higher levels of tests. influenza immunity by vaccination than those receiving cytotoxic Stool samples were collected from every acute diarrhea patient chemotherapy, without increased frequency or severity of irAEs. aged < 15 years old who were admitted at Bhumibol Adulyadej Annual influenza vaccination should be encouraged in cancer Hospital, Bangkok, Thailand from November 2014 to September patients receiving ICIs. 2016. The samples were run with the following test: QuickNaviTM – Norovirus2 for norovirus, VIKIA® Rota-Adeno for rotavirus, and bacterial culture. Realtime-PCR was used as a gold standard for P2-LB03 virus detection. Cross-reactivity was determined by false-positive Comparison of Survival Outcomes between Methicillin- results. Sensitive and Methicillin-Resistant Staphylococcus aureus From 358 stool specimens, the sensitivity of RDTs for norovirus infections and rotavirus was 27.45% and 44.79% respectively. The specificity P Waitayangkoon*, T Benjamungkalarak, M Rachayon, of RDTs for norovirus and rotavirus was 97.66% and 91.60% A Thongthaisin, A Thongkam, A Thammahong, T Chatsuwan, respectively. False-positive result of RDT for norovirus occurred D Chiewchengchol in 6 samples (1.7%) and 22 samples (6.1%) in RDT for rotavirus. Department of Microbiology, Faculty of Medicine, Chulalongkorn Among them, false positives RDT for rotavirus were found to have University, Bangkok, Thailand cross-reactivity with 11 norovirus infection 3 bacterial infected stools. On the contrary, 6 of the false positives RDT for norovirus Background: Methicillin-resistant Staphylococcus aureus (MRSA) were found to have no cross-reactivity against other viral and infection is associated with increased mortality but survival bacterial infections. outcomes have not yet been explicitly demonstrated. This study In conclusion, we found that the RDTs for both rotavirus and aims to compare all-cause mortality rates between MRSA and norovirus have high specificity but low sensitivity. The cross- methicillin-sensitive S. aureus (MSSA) infections in a tertiary care reactivity was rare in norovirus RDT. Positive rotavirus RDT could S186 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

prove to be norovirus. leukocyte counts were 8970/mm3 (66.5% neutrophils, 3.1% eosinophils, and 22.1% lymphocytes), and the platelet counts were 341,000/mm3. Computed-tomography (CT) scan showed P2-LB06 suspicion of lung cancer, then endobronchial ultrasound-guided Endobronchial fungal infection: Candida albicans trans-bronchial needle aspiration (EBUS-TBNA) was per-formed. Jin Young Lee*,1, Taeyun Kim2, Jehun Kim2 IPA was diagnosed histologically. To treat the IPA, intravenous 1Department of Infectious disease, Kosin University Gospel voriconazole was administered at a dose of 6 mg/kg q12h x 2 Hospital, Busan, South Korea, 2Department of Pulmonary disease, doses for induction and 4 mg/kg q12h for maintenance. After Kosin University Gospel Hospital, Busan, South Korea treating the IPA with voriconazole for 4 weeks, a chest X-ray showed a decreased focal consolidation lesion in the median Background: Fungal infections are caused by inhalation or portion of the RUL zone. In Korea, this is the first report of IPA inoculation of large amounts of fungi. Fungal colonies specifically diagnosed through EBUS-TBNA. in the upper or lower respiratory tract. We describe a rare case Discussion: The role of EBUS-TBNA in the histological diagnosis of Endobronchial fungal infection (EBFI) caused by Candida of mass like lung lesions is expected to expand. albicans obstructing a major bronchus. Case presentation: A 68-year-old female patient was admitted to the emergency room with altered level of consciousness. At P2-LB08 the time of admission, her blood pressure was 80/60 mmHg, The value of bronchial washing for diagnosing smear pulse rate was 112 beats/min, respiratory rate was 24 breaths/ negative pulmonary tuberculosis min and body temperature was 34.9°C. Despite fluid resuscitation Jin Young Lee*,1, Jehun Kim2 and catecholaminergic therapy, the patient deteriorated and 1Department of Infectious disease, Kosin University Gospel developed septic shock with metabolic acidosis (lactate:5.9mmol/ Hospital, Busan, South Korea, 2Department of Pulmonary disease, L; blood pH: 6.965; and bicarbonate: 5.5 mmol/L). Kosin University Gospel Hospital, Busan, South Korea She received continuous renal replacement therapy and antibiotics (piperacillin/tazobactam). The patient developed Background: Bronchoscopy with bronchial washing is a dyspnea, and a chest X-ray examination showed atelectasis in useful procedure for diagnosis of pulmonary tuberculosis (TB), the upper lobe of the right lung. Chest computed tomography when sputum smears are negative. But their indication is not (CT) scan showed partial atelectasis in the right upper lobe (RUL) standardized. Therefore, we conducted a retrospective study to and prominent wall thickening. Bronchoscopic biopsy showed assess the diagnostic value of bronchial washing in suspected fungal infection with necrosis and yeast-like fungus with positive pulmonary TB patients. periodic acid–Schiff (PAS) stain. Candida albicans grew from the Methods: A retrospective analysis was performend on patients endobronchial aspirate. The EBFI was treated with one dose of diagnosed with pulmonary tuberculosis at a tertiary hospital with intravenous fluconazole 400 mg for induction followed by 200 969 beds in South Korea, from March 2017 to December 2018. We mg once daily by mouth. The patient’s electrolyte imbalance and obtained three serial sputum samples for AFB smear and culture uremia worsened during hospitalization. She signed a do-not- and all patients underwent bronchoscopy with bronchial washing resuscitate order and died. specimen for AFB smear and culture. Discussion: EBFI has been under-recognized because of Results: Fifty-six patients were recruited. Smear negative difficulties in confirming the diagnosis. The role of bronchoscopy pulmonary tuberculosis (SNPT) was diagnosed 42/56 (75%). Of in the diagnosis of infectious diseases of the trachea or main the patients with smear positive sputum, 14/14 (100%) showed bronchi is expected to widen in the future. the results of culture positive sputum, the results of smear positive bronchial washing was 7/14 (50%) and results of culture positive bronchial washing were 85.7%. Of the patients with SNPT, 17/42 P2-LB07 (40.47%) had the result of culture negative sputum, and diagnosed Invasive Pulmonary Aspergillosis Diagnosed by EBUS- by the bronchoscopic washing. TBNA, diagnosed incorrectly as Lung Cancer Conclusions: For patines with negative sputum smear, it is Jin Young Lee*,1, Jehun Kim2, Taeyun Kim2 necessary to confirm by bronchoscopic washing to raise the 1Department of Infectious disease, Kosin University Gospel diagnostic rate of pulmonary tuberculosis. But only a few patients Hospital, Busan, South Korea, 2Department of Pulmonary disease, were diagnosed by the result of smear positive bronchial washing, Kosin University Gospel Hospital, Busan, South Korea the others were diagnosed by culture positive bronchial washing. In order to control transmission of pulmonary tuberculosis, it is Background: Aspergillus can cause life-threatening invasive necessary to use a high-speed accurate examination method in pulmonary aspergillosis (IPA) in patients with impaired immune confirmingM.tuberculosis. function. IPA is difficult to diagnose because the symptoms are nonspecific, and the radiologic findings can be various. Case presentation: A 68-year-old female was referred to the department of pulmonology for right upper chest pain for two weeks. She had worked in a restaurant and had no family history of respiratory disease or a smoking history. The peripheral blood Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S187

P2-LB09 examined women was 46%. Repeated pregnancy was detected Xpert Carba-R assay for the detection of Carbapenemase in 54% of 62% of sick women were from dysfunctional families. Producing Organisms in Emergency room 77% of patients had bad habits (smoking, drinking). The first Jin Young Lee*, Ji Young Park identified patients accounted for 69%, previously treated - 31%. Department of Infectious disease, Kosin University Gospel Hospital, Mycobacterium tuberculosis was isolated in 54% of patients. Busan, South Korea In 23% of sick women, the presence of drug resistance to chemotherapy was established. Among the clinical forms of TB Background: Carbapenemase-producing organisms (CPO) in pregnant women with HIV, disseminated TB prevailed (31%), have been identified by global health leaders as an urgent threat. followed by fibro-cavernous TB and infiltrative - 23%, respectively. Different methods for detection of CPO in rectal swabs have been Exudative pleurisy of etiology of TB was found in 15% of patients. used, including culture with specific chromogenic media and In 85% of patients, changes in the picture of peripheral blood commercial molecular tests. Culture-based methods are limited were revealed in the form of anemia of 1-2 degrees, cachexia by sensitivity and specificity, and the requirement of 24 to 48 h for in 61% of patients. The clinical manifestations of tuberculosis growth. Recently, Xpert Carba R assay has been used from clinical have long been associated with pregnancy. In 61% of patients, a samples for CPO detection, and it requires less an hour. This progressive course of TB was observed against the background of study focused on the use of the Xpert Carba R assay to determine HIV infection, which negatively affected the course of pregnancy. intestinal colonization rates of CPO in patients admitted to the Conclusion: TB in HIV-infected women with pregnant women is emergency room (ER). difficult, and prevailing clinical forms prevail. Methods: This was a retrospective review of medical records of patients admitted to ER at a tertiary hospital with 969 beds in South Korea, from July 2017 to June 2018. Screening for CPO P2-LB11 by Xpert Carba R assay was done for patients transferred from Changes in the status of cytokines in patients with lung other hospitals or had history of CRE growth at culture method tuberculosis recurrence under the influence of standard in three months. We compared the results of Xpert Carba R assay antuberculosis therapy and culture based CRE. Screening for VRE colonization was also Abror Makhmarasulov, Bakhrom Sherkhonov, Khasan Farmonov, performed. Firuza Nizomova, Kiyomkhon Akhmedov Results: Total 705 patients were recruited. Of the patients, 31/705 Tashkent Medical Academy, nternal Medicine, Uzbekistan (4.4%) showed positive by the Xpert Carba R assay. The Xpert Carba-R assay amplified positive targets (15 blaKPC, 8 blaIMP-1, The aim of the study was: to study the status of cytokines in 7 blaNDM, 1 blaVIM). All of them with positive Xpert Carba R patients with relapse of pulmonary tuberculosis (RPT) under the assay were transferred from ER to ward with isolation room. And influence of standard anti-tuberculosis therapy (ATT). 38/705 (5.4%) showed positive CRE culture. There were several Materials and methods: There were 130 people under cases with the Xpert Carba R assay that did not correlate with the observation who were divided into groups: 1st patients with RTL results of reference culture. Of the patients with Xpert Carba R (n = 100) and 2nd relatively healthy people (n = 30). To determine assay positive or culture positive for CRE, 25/54 (46.3%) showed the status of cytokines, it was studied in serum of venous blood: also positive screening results for VRE. interleukin (IL) -2, IL-4, IL-8, IL-10 and interferon-γ (IFN-γ) by Discussion: The Cepheid Xpert Carba-R assay is an accurate enzyme-linked immunosorbent assay. All patients received and rapid test to identify rectal colonization with CPO, which standard ATT, which included isoniazid (0.3 g), rifampicin (0.6 g), can guide infection control programs to limit the spread of these pyrazinamide (2.0 g), ethambutol (1.2 g) and / or streptomycin organisms. (1.0 g) at the intensive stage. Results: During hospitalization, it was observed that the state of cytokines was significantly changed in patients with RTL (IL-2 P2-LB10 (39.44 ± 0.71); IL-4 (9.55 ± 0.24); IL-8 (21.14 ± 0.32); IL-10 (40.04 Tuberculosis in pregnant women with HIV infection ± 0.74) and IFN-γ (106.20 ± 0.67) pg / L) when compared with Saidrakhim Lukmonov, Abror Makhmarasulov, Khasan Farmonov, the 2nd group (IL-2 (21.60 ± 0.80); IL-4 (29.99 ± 1.27); IL-8 (9.96 Firuza Nizomova, Bakhrom Sherkhonov, Khiyomkhon Akhmedov ± 0.62); IL-10 (50.25 ± 1.26); IFN-γ (63 82 ± 2.27) pg / L) (p <0.05). Tashkent Medical Academy, Uzbekistan After 2 months of PTT, there was a significant decrease in pro- inflammatory (IL-2: 29.59 ± 0.55; IL-8: 18.22 ± 0.22; IFN-γ: 71.14 ± Purpose: to study the features of the clinical course of 1.21) and an increase in anti-inflammatory (IL-4: 16.68 ± 0.44 and tuberculosis (TB) in pregnant women with HIV infection who IL-10: 48.53 ± 0.87) cytokines (p <0.05). were hospitalized at the 1st City Clinical Tuberculosis Hospital in Conclusions: Prior to ATT, there was a significant increase in Tashkent in the period 2015 - 2018. IL-2, IL-8, IFN-γ and a decrease in IL-10, IL-4 compared with Material and Methods: 13 pregnant women undergoing relatively healthy donors. After 2 months of chemotherapy, inpatient treatment for pulmonary TB were examined. The there was a significant decrease in pro-inflammatory and an medical and social status, methods for detecting tuberculosis, increase in anti-inflammatory compared to the initial values. the clinical manifestations of the TB process in the lungs were Thus, the standard two-month ATT has an anti-inflammatory and studied. immunostabilizing effect against the background of an overall Results: It was found that the first pregnancy among the positive clinical and radiological picture. S188 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

P2-LB12 of meatball including T. molitor larvae powder induced Hepcidin-ferroportin axis controls the iron content of improvement of storage stability such as redness of meat color, Salmonella-containing vacuoles in macrophages volatile basic nitrogen (VBN), and 2-thiobarbituric acid reactive Daejin Lim1,2, Jae-Ho Jeong1,2, Miryoung Song3, Hyon E. Choy1,2* substances (TBARS). Altogether, we suggest that the edible insect 1Department of Microbiology, Chonnam National University having the anti-oxidative and antibacterial activities is very useful Medical School, Republic of Korea,2Department of Molecular resources to develop a functional food. Medicine(BK21plus), Chonnam National University Graduate School, Republic of Korea, 3Department of Bioscience and Biotechnology, Hankuk University of Foreign Studies, Yong-In, P2-LB14 17035, Republic of Korea. The Potential Combination of Young Coconut Water (cocos Macrophages release iron into bloodstream via the membrane- nucifera L.) and Honey (Apis mellifera) As Anti-Plasma bound iron export protein, ferroportin (FPN). The hepatic iron- Leakage Agent in Dengue Hemorrhagic Fever Patients: A regulatory hormone hepcidin controls FPN internalization Pilot Project and degradation in response to bacterial infection. Salmonella Rafik Prabowo1*, Muhammad I. Rimbadi1, Intan S. Rafsanjani1, typhimurium is capable of invading macrophages and Putrya Hawa2 proliferating in the Salmonella-containing vacuole (SCV). 1Medical Student, Undergraduate Program of Medicine, Faculty Hepcidin is reported to increase the mortality of Salmonella- of Medicine, Universitas Islam Indonesia, 2Department of infected animals by increasing the bacterial load in macrophages. Pharmacology, Faculty of Medicine, Universitas Islam Indonesia Here, we assess the iron levels and find that hepcidin increases iron content in the cytosol but decreases it in the SCV through Background: Dengue hemorrhagic fever (DHF) is a tropical FPN on the SCV membrane. Loss of FPN from the SCV via the infectious disease that causes damage to blood vessels. Plasma action of hepcidin impairs the generation of bactericidal reactive leakage occurs due to increased levels of interleukin-6 and tumor oxygen species (ROS) as the iron content decreases. We conclude necrosis factor alpha are produced due to stimulation of cell that FPN is required to provide sufficient iron to the SCV, where it transcription factors called Nuclear Factor Kappa B (NFkB). One serves as a cofactor for the generation of antimicrobial ROS rather of the natural resources that has been proven to be able to inhibit than a nutrient for Salmonella. the NFkB is young coconut water (YCW) and honey (H). In this pilot project, we want to know the potency of combination of YCW and H as anti-plasma leakage agent in DHF patients. P2-LB13 Methods: This pilot project used 8 subjects obtained from the Characterization of Tenebrio molitor larvae extracts in Hospital of PDHI Yogyakarta which was divided into intervention antioxidant and antimicrobial activities group and control group. Subjects were patients identified as C.W Lee, H.S Yang, Y.K Son, W.Y Bang* DHF aged 18-55 years of age of male and female who had entered Biological and Genetic Resources Assessment Division, National fever on days 5 or more. A combination of YCW and H were made Institute of Biological Resources, Incheon 22689, Korea with a formulation of 1 liter of YCW mixed with 300 ml of H and then pasteurized. The drink has given every 6 hours to patients in Insects have been highly evaluated for availability as new food the intervention group for 3 days. platelet counts and hematocrit materials in recent years owing to a high protein source and levels are evaluated every 12 hours from the first day of the functional potential. Here we identified the antioxidant activity intervention as anti-plasma leakage parameter. The data obtained of extracts from Tenebrio molitor, to find a new material for is then analyzed using descriptive methods. functional foods. After extraction from the freeze-dried T. molitor Results: The mean of platelet in the intervention group were (µL) larvae with various solvents on time course, the ones, extracted 31000, 32500, 77000. In the control group were (µL) 12000, 10000, with water for 5 h and 10 h, showed the highest DPPH activities 23500. The mean of hematocrit level in the intervention group per total protein and solid, respectively. When the water extract were (%) 44.3, 43.95, 42.35. In the control group were (%) 33.45, was fractionated depending on methanol concentration, high 30.9, 32.4. concentration of methanol led to the reduced level of the high Conclusion: The intervention of combination of YCW and H has molecular weight proteins and the increased level of the DPPH the potential as anti-plasma leakage agent through increase platelet activity in supernatants, suggesting that the low molecular weight counts and improves hematocrit levels in patients with DHF. peptides may mediate the antioxidant activity in the supernatant. The most of organic solvents excluding butanol also showed similar activity. Thermal stability of the organic solvent partition P2-LB15 fraction exhibited a 28~44% decrease in the activity, implying Mortality Risk Factors for Septic Patients in Emergency that the unstable components to heat is present in the fraction. Department The treatment of proteinase K to water extract increased 10~20% Nur Farhanah1* , Fenda Andita2, Muhammad Hussein Gasem1 of DPPH activity, suggesting that peptides, released from total 1Division of Tropical Medicine and Infectious Diseases, Department proteins, partially increased the antioxidant activity. When of Internal Medicine, Faculty of Medicine, Diponegoro Univerity/ induced with Salmonella Typhimurium CK110 against T. molitor Kariadi Hospital Semarang Indonesia, 2Department of Internal larvae, antibacterial activities exhibited apparently against Medicine, Faculty of Medicine Diponegoro University / Kariadi Salmonella Typhimurium and Bacillus cereus. Preparation Hospital Semarang, Indonesia Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190 S189

Background: Early identification risk factors of sepsis in univariate and multivariate aspects in SPSS 21. emergency department (ED) are important, despite appropriate Results: The subject of this research are thirty two patients as management, mortality and morbidity rates remain very high. case samples and 19 patients as control samples. Chi-Square test For this reason, many biomarkers and scoring system had been had been done to determine the significant correlation between investigated. The Third International Consensus Definitions each variable with mortality and the result was: gender (p = 0,489 for Sepsis and Septic Shock (Sepsis-3) proposes the use of a [RR = 1,167]), age (p = 0,389 [RR = 0,829]), diffuse peritonitis (p = simplified SOFA (Sequential Organ Failure Assessment) score, 0,262 [RR = 1,630]), preoperative duration (p = 0,015 [RR = 1,981]), termed quickSOFA (qSOFA), for patients with suspected infection exudate characteristic (p = 0,405 [RR = 0,833]), origin of peritonitis outside intensive care unit to identify rapidly those at high risk (p = 0,443 [RR = 1,148]), organ failure (p = 0,000388 [RR = 2,945]), for mortality. The qSOFA score consists of altered mental status, malignancy (p = 0,611 [RR = 0,790]). respiratory rate ≥ 22x/minutes, and systolic blood pressure ≤100 Conclusion: Preoperative duration and organ failure had mmHg could be relevance in low or moderate income countries. significant correlation with mortality in complicated intra Methods: We did the preliminary prospective cohort study with abdominal infections, while other variables were not significant. 27 patients sepsis and septic shock who admitted to Emergency Department Dr Kariadi hospital in Semarang, Central Java Indonesia. Patients were analyzed for the risk factors of septic P2-LB18 mortality including age, infection sources, white blood count, Measles Revisited: Do we need a routine antibody test in glucose serum, lactate serum, CD4, body mass index (BMI), healthcare workers? albumin, neutrophil to lymphocyte ratio (NLR), C-reactive protein Sukbin Jang1,2*, Si-Hyeoun Han2*, Ji-Young Rhee1,2 (CRP), procalcitonin, DIC score, SOFA score, and APACHE II score. 1Department of Infectious diseases, Dankook Medical Center, Result: Twenty seven patients with sepsis or septic shock were University College of Medicine, Cheonan, Korea, 2Office of Infection analyzed for the mortality. According to the sepsis-3 definition, Control, Dankook Medical Center, Cheonan, Korea 48.1 and 51.9% fullfiled the criteria for septic and septic shock, respectively. The mortality rate were 77%. The SOFA score, Background: Since 2014, Dankook medical center has been vac- procalcitonin (PCT), and CRP were more accurated for diagnose cinating MMR in accordance with ‘Guidelines for adult immuni- septic patients in ED (p= 0.016, 0.037 ; 0.049 respectively). The zation’ for high risk department health care workers(HCWs) by SOFA score, APACHE II score, NLR, PCT, and CRP on admission, distributing vaccines to each department. After series of intrahos- could predicted mortality. No one parameter was specific for pital outbreak reported, we performed measles IgG tests for point sepsis mortality on admission in ED. surveillance and estimating vaccine efficacy. Conclusion: The SOFA score, APACHE II score, NLR, PCT, and Methods: A total of 317 high risk department HCWs underwent CRP could predict septic mortality in ED. measles antibody tests on February 2019. HCWs were asked about their past history of measles and their vaccination history and vaccination certificate records were obtained. Based on P2-LB16 the results, antibody-negative HCWs received two vaccines and Risk Factors for Mortality in Complicated Intra-Abdominal antibody-indeterminate HCWs received single vaccination. After Infection vaccination they underwent the last antibody test in June 2019. Elisabeth Sukma Puspitadewi1, Nur Farhanah2*, Abdul Mughni3 Results: The overall seropositivity was 80.7%, and seroprevalence 1Faculty of Medicine, Diponegoro University, Semarang, was 80.4% in HCWs born after 1967. The seroprevalence was Indonesia, 2Division of Tropical Medicine and Infectious Diseases, 38.1% in the HCWs born in 1995. Among twenty-four HCWs who Department of Internal Medicine, Faculty of Medicine, Diponegoro suffered measles previously, the rate of antibody positive was Univerity/Kariadi Hospital Semarang Indonesia, 3Division of 91.6%. Of the 211 vaccinated HCWs with the MMR vaccine at our Digestive Surgery, Department of Surgery, Faculty of Medicine, hospital, 176 (83.4%) were antibody positive (Figure 1-2). Sixty- Diponegoro University/Kariadi Hospital Semarang Indonesia one HCWs who were negative were vaccinated directly in the infection control office. As a result, 60 HCWs turned seropositive. Background: Complicated Intra Abdominal Infection is an Conclusion: This study shows that seroprevalence of young intra abdominal infection that requires more attention due to HCWs with two vaccinations can also be negative. It also shows its bad prognosis and high mortality. Some factors that affect that the history of illness based on HCWs past recalls is inaccurate CIAIs mortality are gender, age, diffuse peritonitis, preoperative without checking medical records. Interestingly, after vaccine was duration, exudate characteristic, origin of peritonitis, organ injected face-to-face in the infection control office and 98% of the failure, and malignancy. We did the study to analyze risk factors antibody conversion was obtained. Our data ensure that routine that affect mortality in CIAIs patients based on Mannheim antibody tests are needed in young HCWs, even though they had Peritonitis Index (MPI) score. a history of measles or vaccination. Methods: The study was a cohort retrospective method, which was conducted from August-September 2017. Case samples were patients with CIAIs who died after being hospitalized at Kariadi Hospital Semarang indonesia, while control samples were CIAIs patients who survived after being hospitalized.The data were taken from patients’ medical records and then analyzed using S190 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S83-S190

burden of HZ according to various definitions of HZ using the nationwide health insurance database of Korea. Materials & Methods: We used three kinds of definition of HZ from the 2013 data of the Health Insurance Review and Assessment Service (HIRA). Definition 1 of HZ was given when KCD-6 code for HZ (B02, G02.01, G05.1J, G53.0, G63.0F, H03.1F, H13.1J, H19.0C, H19.2F, H22.0E, H62.1B) was used. Definition 2 of HZ was given when KCD-6 code for HZ was used and antiviral agents were used for treatment. Definition 3 of HZ was given when KCD-6 code for HZ was mandatorily used for main Figure 1. diagnosis and antiviral agents were used. According to three kinds of definition of HZ, we calculated the number of new HZ patients and compared the disease burden (direct medical cost, direct non-medical cost which consists of the transportation and nursing, indirect cost which means the cost from income loss due to the lost workdays, and total socioeconomic cost) using the human capital approach method. New episode of HZ was defined as a new occurrence of HZ in a person who the KCD-6 code for HZ was never given within one year. This study was supported by a research grant from Merck Sharp & Dohme Corp. Results: There were 820,138 new herpes zoster patients diagnosed in Korea in 2013 using the definition 1, 534,121 using definition 2, and 420,697 using definition 3 (Table 1). The direct medical cost was 155,469,609,361 Korean Won (KRW) for definition 1, 105,789,197,570 KRW for definition 2, and 83,530,312,913 KRW for definition 3. The direct non-medical cost was 238,903,037,422 KRW for definition 1, 99,069,152,715 KRW for definition 2, and 28,056,333,572 KRW for definition 3. The indirect cost was Figure 2. 82,943,536,558 KRW for definition 1, 34,999,549,152 KRW for definition 2 and 11,247,142,456 KRW for definition 3. The total socioeconomic cost was 477,316,183,341 KRW for definition 1, P2-LB19 239,857,899,437 KRW for definition 2, and 122,833,788,941 KRW Disease burden of herpes zoster in Korea analyzed using the for definition 3. nationwide insurance database: comparison according to Conclusion: In 2013, the number of new patients of HZ in Korea the definition was estimated to be between 420 thousand and 820 thousand, 1 2 1 Won Suk Choi , Seong Hui Kang , Hee Jin Cheong and the socioeconomic burden was estimated to be between 123 1 Division of Infectious Diseases, Department of Internal Medicine, billion KRW to 477 billion KRW. In the disease burden study using 2 Korea University College of Medicine, Seoul, Korea, Division of the health insurance data, the results can vary significantly by Infectious Diseases, Department of Internal Medicine, Konyang definition, so the method of study should be carefully determined. University College of Medicine, Daejon, Korea Table 1. Comparison of the disease burden of herpes zoster in Korea using three kinds of definition for HZ Backgrounds: The disease burden of Herpes zoster (HZ) is Definition 1 Definition 2 Definition 3 reported to increase year by year. The analysis performed in Number of HZ patients 820,138 534,121 420,697 many countries has used the health insurance data. However, Direct medical cost (KRW) 155,469,609,361 105,789,197,570 83,530,312,913 the results using the health insurance data have been differently Direct non-medical cost (KRW) 238,903,037,422 99,069,152,715 28,056,333,572 reported according to the definition of HZ. Therefore, we aimed Indirect cost (KRW) 82,943,536,558 34,999,549,152 11,247,142,456 to calculate the number of HZ patients and compare the disease Total socioeconomic cost (KRW) 477,316,183,341 239,857,899,437 122,833,788,941 Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S191-S197 S191

Infection & Chemotherapy

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Author Index

Abd Razak Mohd Fuat, S130 (P1-MM06) Bae SM, S86 (P1-BT12), S116 (P1-GN45), Cheon Jae Hee, S72 (O1-PT03) Abdul Jabar K, S85 (P1-BT10) S117 (P1-GN46), S127 (P1-HI20) Cheong Hae Suk, S107 (P1-GN19) Abdul Samat M, S74 (O2-PT02), S94 (P1-CM17) Bae So hyun, S111 (P1-GN30) Cheong Hee Jin, S139 (P1-VR16), S190 (P2-LB19) Abdulmenan Semira, S77 (O3-PT05) Bae Sohyun, S178 (P2-OT19) Cheong HJ, S137 (P1-VR14) Abebe Abinet, S89 (P1-CM02), S77 (O3-PT05) Baek JH, S177 (P2-OT17) Cheong Hyangmin, S86 (P1-BT11) Abera Adugna, S77 (O3-PT05), S89 (P1-CM02) Baek JY, S118 (P1-GP01) Cheong Y., S166 (P2-CE40) Abeywardana K.D.S.T, S73 (O1-PT06), Baharuddin S, S105 (P1-GN14) Chetia D., S78 (O3-PT06) S104 (P1-GN12) Bailey K, S176 (P2-OT14) Chew J., S83 (P1-BT03) Abu Bakar Z, S182 (P2-TM09) Bang DW, S161 (P2-CE25) Chia J, S94 (P1-CM16) Abu-Bakar N.A., S120 (P1-GP09) Bang Ji Hwan, S152 (P2-CE03) Chien J, S179 (P2-OT23) Acharya Manju, S178 (P2-OT21) Bang W.Y, S188 (P2-LB13) Chieng S, S94 (P1-CM17) Adda’i MF., S163 (P2-CE28), S164 (P2-CE34) Banhaw RL, S97 (P1-CM23) Chiewchengchol D, S185 (P2-LB03) Adisasmito Amar W, S143 (P2-AG03) Banu Mazlina, S96 (P1-CM20) Chiewchengchol D., S119 (P1-GP06), Affendy N.B., S84 (P1-BT04) Basuki PS, S112 (P1-GN33) S129 (P1-MM04) Affendy NB, S128 (P1-MM01) Bekele Worku, S77 (O3-PT05) Chin Bum Sik, S70 (S12-3) Ahn A, S122 (P1-HI06) Benjamungkalarak T, S185 (P2-LB03) Chiu CH, S157 (P2-CE15) Ahn Jin Young, S72 (O1-PT03), S143 (P2-AG04), Bhugai Nabaraj, S128 (P1-MM02) Cho Eunbeen, S165 (P2-CE37) S162 (P2-CE27), S167 (P2-HV01), Bi Xuezhi, S96 (P1-CM20) Cho HJ, S122 (P1-HI07) S176 (P2-OT15) Bilar JM, S97 (P1-CM23) Cho Hyejin, S103 (P1-GN09) Ahn JY, S126 (P1-HI15), S156 (P2-CE12), Bolonne B, S85 (P1-BT09) Cho Hyun Kyung, S127 (P1-HI19) S169 (P2-HV06), S181 (P2-TM05) Boteju C, S123 (P1-HI08) Cho OH, S85 (P1-BT08), S150 (P2-CC09) Ahn Sang Min, S176 (P2-OT15) Bou khalil Jacques, S98 (P1-CM25), S98 (P1-CM26) Cho SH, S159 (P2-CE18), S177 (P2-OT17) Ahn SH, S137 (P1-VR14), S163 (P2-CE29) Brainard D, S170 (P2-HV09) Cho Sun Young, S118 (P1-GP02), S119 (P1-GP03) Aisyah Syakirah, S101 (P1-GN03) Buddhadasa P.C.L.S, S73 (O1-PT06) Cho Sung-Yeon, S167 (P2-CE41) Aisyah Syakirah S, S101 (P1-GN04) Bugayong MG, S97 (P1-CM23) Cho SY, S79 (O4-PT04), S128 (P1-HI21), Akhmedov Khiyomkhon, S187 (P2-LB10) Bui M.T., S109 (P1-GN23) S131 (P1-MM09), S136 (P1-VR13) Akhmedov Kiyomkhon, S187 (P2-LB11) Byun JH, S130 (P1-MM05), S131 (P1-MM09), Cho YK, S171(P2-HV11) Al-Gharawi AA, S161 (P2-CE25) S136 (P1-VR13) Cho Yun Suk, S176 (P2-OT15) Ali ST, S165 (P2-CE36) Choe Pyoeng Gyun, S152 (P2-CE03) Ali W Ibraheem, S161 (P2-CE25) Cao T.M.T., S99 (P1-CM28) Choi Bo Youl, S167 (P2-HV01) Ali Hakeem L, S161 (P2-CE25) Carascal M, S102 (P1-GN08) Choi Byeong-Sun, S168 (P2-HV03), Alice Kayitesi, S168 (P2-HV02) Carroll Karen, S65 (S11-2) S168 (P2-HV04) Alles M, S150 (P2-CC07) CH Tan, S75 (O2-PT06) Choi Byung Min, S127 (P1-HI19) Al-Timimi H, S161 (P2-CE25) Cha KW, S123 (P1-HI09), S126 (P1-HI15) Choi JY, S134 (P1-VR06) Amran F, S84 (P1-BT04), S128 (P1-MM01) Cha Myoung Hee, S124 (P1-HI10) Choi Eun Jin, S97 (P1-CM21) Amran Fairuz, S130 (P1-MM06) Chae Myeong-Hun, S124 (P1-HI12) Choi GE, S110 (P1-GN26) An Yewon, S86 (P1-BT11) Chaemsupaphan T., S148 (P2-CC04) Choi H, S171 (P2-HV11) Ana A., S183 (P2-TM12) Chan D, S180 (P2-TM02) Choi Hee-Jung, S167 (P2-HV01) Andayani P., S113 (P1-GN34) Chan D., S89 (P1-CM01) Choi HeeKyoung, S127 (P1-HI19) Andita Fenda, S188 (P2-LB15) Chanchaithong P., S119 (P1-GP06) Choi Heun, S72 (O1-PT03) Andreatta K, S170 (P2-HV10) Chandra M.A., S83 (P1-BT02) Choi Hyeah, S106 (P1-GN16) Ang B., S158 (P2-CE17) Chandrasiri S, S74 (O2-PT03) Choi I., S132 (P1-VA02) Apisarnthanarak Anucha, S21 (S3-2), S45 (S7-4) Chang Hwan-You, S126 (P1-HI17) Choi JA, S117 (P1-GN46) Assefa Ashenafi, S77 (O3-PT05) Chang Hyun Ha, S111 (P1-GN30) Choi Jae-Ki, S167 (P2-CE41) Aung A.H., S158 (P2-CE17) Chang Hyun-Ha, S176 (P2-OT13), S178 (P2-OT19) Choi Jae-Phil, S136 (P1-VR11) Awal B.K., S121 (P1-HI01) Chang S, S170 (P2-HV10) Choi JH, S128 (P1-HI21), S130 (P1-MM05), Awal Bal, S93 (P1-CM12) Chang S.E., S93 (P1-CM14) S131 (P1-MM09), S136 (P1-VR13) Awal Bal Krishna, S102 (P1-GN05), Chang YJ, S157 (P2-CE15) Choi JK, S128 (P1-HI21), S130 (P1-MM05), S102 (P1-GN06) Chatsuwan T, S90 (P1-CM05), S93 (P1-CM13), S131 (P1-MM09), S136 (P1-VR13) Azman J, S173 (P2-OT05) S185 (P2-LB03) Choi JS., S109 (P1-GN25) Chatsuwan T., S107 (P1-GN18), S108 (P1-GN22), Choi Jun Yong, S72 (O1-PT03), S143 (P2-AG04), Bacha Lal C, S173 (P2-OT05) S109 (P1-GN24), S110 (P1-GN27), S162 (P2-CE27), S167 (P2-HV01), Bae HY, S126 (P1-HI15) S111 (P1-GN29), S119 (P1-GP06) S168 (P2-HV02), S176 (P2-OT15) Bae IG, S85 (P1-BT08), S150 (P2-CC09) Chatsuwan Tanittha, S107 (P1-GN17) Choi Jung-Hyun, S167 (P2-CE41) Bae M., S93 (P1-CM14) Chen Shih-Ying, S126 (P1-HI17) Choi JY, S123 (P1-HI09), S126 (P1-HI15), Bae Mi-Hyun, S78 (O4-PT01) Chen L., S156 (P2-CE13), S157 (P2-CE14) S156 (P2-CE12), S169 (P2-HV06), Bae S., S132 (P1-VA02) Chen YC, S157 (P2-CE15) S174 (P2-OT09), S181 (P2-TM05) Bae SB, S137 (P1-VR15) Cheng C., S89 (P1-CM01) Choi S, S76 (O3-PT03)

Choi Sang-Ho, S79 (O4-PT05), S135 (P1-VR10) Faadhila T., S183 (P2-TM12) Huh Kyungmin, S118 (P1-GP02), S119 (P1-GP03) Choi Seong Ryeong, S166 (P2-CE39) Faadhilah T., S182 (P2-TM11) Hur J, S78 (O4-PT02), S159 (P2-CE20) Choi SH, S86 (P1-BT12), S137 (P1-VR15), Farhanah Nur, S188 (P2-LB15), S189 (P2-LB16) Hur Kyu-Hwa, S135 (P1-VR10) S181 (P2-TM04) Farmonov Khasan, S187 (P2-LB10), Hurst C, S90 (P1-CM05), S93 (P1-CM13) Choi SI, S179 (P2-TM01) S187 (P2-LB11) Husada D, S112 (P1-GN33) Choi SM, S128 (P1-HI21), S131 (P1-MM09), Fong R, S179 (P2-OT23) Hussaini J., S83 (P1-BT02) S136 (P1-VR13) Fontanini Anthony, S98 (P1-CM26) Hussaini Jamal, S101 (P1-GN03), S101 (P1-GN04), Choi SS, S175 (P2-OT10) Fowler Vance, S11 (S1-2) S152 (P2-CE02) Choi Su-Mi, S167 (P2-CE41) Huynh T.Q., S109 (P1-GN23) Choi Won Suk, S127 (P1-HI19), S190 (P2-LB19) G Rizzardini, S169 (P2-HV08) Hwang K.J., S113 (P1-GN35), S113 (P1-GN36), Choi Won-Hee, S91 (P1-CM08), S91 (P1-CM07), G/Tsadik Abeba, S89 (P1-CM02) S114 (P1-GN37), S120 (P1-GP08), S92 (P1-CM09) Gallant J, S169 (P2-HV08) S164 (P2-CE33), S165 (P2-CE35) Choi WS, S137 (P1-VR14), S163 (P2-CE29) Gamage S, S105 (P1-GN15) Hwang Kyu Jam, S163 (P2-CE30), S164 (P2-CE31) Choi Youngsill, S86 (P1-BT11) Gasem Muhammad Hussein, S188 (P2-LB15) Hwang Soyoon, S111 (P1-GN30), S178 (P2-OT19) Choi Yun Su, S167 (P2-HV01) Gatherer D, S76 (O3-PT02) Hwang Sun Young, S146 (P2-AR02) Chon Y, S132 (P1-VA01) Gautam Anil, S128 (P1-MM02) Hwang YO, S175 (P2-OT10) Chong Yong Pil, S79 (O4-PT05), S165 (P2-CE37) Gautam Ravi, S178 (P2-OT21) Hyun BH, S146 (P2-AR03) Chong YP, S86 (P1-BT12) Gidey Bokretsion, S77 (O3-PT05), S89 (P1-CM02) Hyun Jong Hoon, S176 (P2-OT15) Chongtrakool P., S119 (P1-GP05) Ginsapu Stephanie Jane, S130 (P1-MM06) Hyun Miri, S94 (P1-CM15), S159 (P2-CE19) Choo EJ, S179 (P2-TM01) Gnyawali I., S144 (P2-AG05) Chopra M., S172 (P2-OT04) Go E.B., S120 (P1-GP08) I. Nurhafiza, S88 (P1-BT15) Chotpitayasunondh Tawee, S40 (S6-3) Golassa Lemu, S89 (P1-CM02) Ibrahim M, S127 (P1-HI18) Chow A, S76 (O3-PT01), S127 (P1-HI18), Gomez N, S149 (P2-CC05) Ibrahim M., S74 (O2-PT04) S153 (P2-CE04), S171 (P2-OT02), Gomez N., S180 (P2-TM03) Ibrahim M.Bin, S175 (P2-OT12) S173 (P2-OT06), S174 (P2-OT07), Gorman N, S122 (P1-HI06) Ibrahim MA, S171 (P2-OT02) S175 (P2-OT11) Graham H, S170 (P2-HV10) Ibrahim R, S128 (P1-MM01) Chow A., S74 (O2-PT04), S158 (P2-CE17), Gunasekara P, S123 (P1-HI08) Iresha GK, S73 (O1-PT06) S175 (P2-OT12) Guo H, S127 (P1-HI18), S175 (P2-OT11) Choy Hyon E., S188 (P2-LB12) Guo H., S74 (O2-PT04), S175 (P2-OT12) J. Beatrice Susan, S121 (P1-HI05) Chu EH, S161 (P2-CE25) Gurung Rajendra, S84 (P1-BT06) Jaber Al Allawee AS, S161 (P2-CE25) Chuluunkhuu Baigali, S117 (P1-GN47) James R, S75 (O2-PT06) Chun HS, S131 (P1-MM09), S136 (P1-VR13) H Rohaidah, S121 (P1-HI05) Jang Hee-Chang, S117 (P1-GN47) Chun J-H, S113 (P1-GN35), S113 (P1-GN36), H Yoo, S134 (P1-VR06) Jang Hyuna, S124 (P1-HI11) S114 (P1-GN37), S164 (P2-CE33), Ha EJ, S174 (P2-OT09) Jang Ok Hwa, S133 (P1-VR02) S165 (P2-CE35) Ha Kam Pou, S10 (S1-1) Jang S., S112 (P1-GN31) Chung Doo Ryeon, S23 (S3-4), S118 (P1-GP02), Hackel M., S154 (P2-CE09), S155 (P2-CE10) Jang Sukbin, S189 (P2-LB18) S119 (P1-GP03) Hamer Davidson, S17 (S2-3) Jayatilleke K, S85 (P1-BT09), S105 (P1-GN15), Chung DR, S79 (O4-PT04), S118 (P1-GP01) Han Myung Guk, S167 (P2-HV01) S123 (P1-HI08), S150 (P2-CC07) Chung J., S74 (O2-PT04) Han Sang Hoon, S155 (P2-CE11) Jayatilleke K., S105 (P1-GN13) Chung Jae Keun, S115 (P1-GN40), S160 (P2-CE21) Han Si-Hyeoun, S189 (P2-LB18) Jayatilleke SK, S73 (O1-PT06), S104 (P1-GN12) Chung Jaegeun, S179 (P2-OT22) Han Sunghee, S103 (P1-GN10), S104 (P1-GN11) Jee Youngmee, S134 (P1-VR04) Chung You Seung, S132 (P1-MM10) Hanafiah A, S94 (P1-CM17) Jeevajothi Nathan J, S72 (O1-PT04) Clarke Rebecca S., S10 (S1-1) Haposan JH., S163 (P2-CE28), S164 (P2-CE34) Jeon CH, S135 (P1-VR08), S182 (P2-TM10) Collins S, S170 (P2-HV09) Hapsari MMDEAH, S177 (P2-OT18) Jeon Jeong Ho, S101 (P1-GN01) Corea E, S105 (P1-GN15) Harbarth Stephan, S20 (S3-1) Jeon Jong Ik, S84 (P1-BT05) Cowling Benjamin, S2 (K-1), S36 (S5-3) Haruni AKT, S163 (P2-CE28), S164 (P2-CE34) Jeon MJ, S179 (P2-TM01) Cowling BJ, S165 (P2-CE36) Hatta M, S74 (O2-PT02) Jeon S.M., S120 (P1-GP08) Cube RA, S97 (P1-CM23) Haubrich R, S169 (P2-HV08) Jeon SJ, S175 (P2-OT10) Hawa Putrya, S188 (P2-LB14) Jeong HJ, S113 (P1-GN35), S113 (P1-GN36), Dang N.T., S140 (P1-VR18) Hein AA, S153 (P2-CE04), S173 (P2-OT06), S165 (P2-CE35) Das Shukla, S91 (P1-CM06) S174 (P2-OT07), S76 (O3-PT01) Jeong HG, S110 (P1-GN26) De PP, S94 (P1-CM16) Heo Dae-Hyuk, S152 (P2-CE03) Jeong HS, S122 (P1-HI07) de Silva N, S105 (P1-GN15) Heo Sang Taek, S133 (P1-VR02), S151 (P2-CE01), Jeong HW, S137 (P1-VR14), S175 (P2-OT10) de Silva S, S105 (P1-GN15) S178 (P2-OT19) Jeong J.S, S166 (P2-CE40) De Wit S, S169 (P2-HV08) Heo Yong, S178 (P2-OT21) Jeong Jae-Ho, S188 (P2-LB12) Deeudom M., S125 (P1-HI13) Hisada Akiko, S98 (P1-CM26) Jeong Jin, S160 (P2-CE21) Desa M.N.M., S84 (P1-BT04) Ho Pooi Leng, S96 (P1-CM20) Jeong S., S112 (P1-GN31) Destura R, S102 (P1-GN08) Hon P.Y., S158 (P2-CE17) Jeong Seok Hoon, S44 (S7-3) Dharmayanti A., S113 (P1-GN34) Hong Chae-Kyu, S103 (P1-GN10), S104 (P1-GN11) Jeong SJ, S156 (P2-CE12), S169 (P2-HV06), Dhungana G.R., S144 (P2-AG05) Hong Hanbich, S166 (P2-CE39) S181 (P2-TM05) Dillu Dereje, S77 (O3-PT05) Hong Junshik, S87 (P1-BT14) Jeong Su Jin, S72 (O1-PT03), S79 (O4-PT03), Dinh L.N., S108 (P1-GN21) Hong KW, S85 (P1-BT08), S150 (P2-CC09) S124 (P1-HI12), S143 (P2-AG04), Dixon Dennis, S59 (P4-1) Hong Kyung-Wook, S78 (O4-PT01) S162 (P2-CE27), S176 (P2-OT15) Dong Jae June, S124 (P1-HI12) Hong NK, S169 (P2-HV06) Jeong Tae Cheon, S87 (P1-BT13) Donoghue SG, S179 (P2-OT23) Hong SI, S85 (P1-BT08), S150 (P2-CC09) Jeong YJ, S117 (P1-GN48) Dowzicky M., S154 (P2-CE09), S155 (P2-CE10) Hong Sun In, S92 (P1-CM09) Jeong YS, S179 (P2-TM01) Hong Yoon-Kyoung, S114 (P1-GN38) Jha P., S172 (P2-OT04) Edwards Andrew, S10 (S1-1) Houssaini J., S120 (P1-GP09) Jhun BW, S134 (P1-VR06) Eom Hong Sik, S146 (P2-AR02) HS Oh, S134 (P1-VR06) Ji Sehyeon, S117 (P1-GN47) Eom Joong Sik, S135 (P1-VR09), S106 (P1-GN16) Hsueh Po-Ren, S42 (S7-1), S61 (P5-1) Jin Young-hee, S103 (P1-GN10), S104 (P1-GN11) Eom JS, S171 (P2-HV11) Huh HJ., S109 (P1-GN25) Jo Hyun-uk, S78 (O4-PT01) Huh K, S79 (O4-PT04), S134 (P1-VR06) Jo Ji hun, S178 (P2-OT21) Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S191-S197 S193

Jo JW, S144 (P2-AG06) Kim Anes, S79 (O4-PT03) Kim MK, S175 (P2-OT10) Jo K-W, S181 (P2-TM04) Kim B, S178 (P2-OT20), S71 (O1-PT02) Kim MN, S86 (P1-BT12) Jo Sujin, S133 (P1-VR02) Kim Bongyoung, S78 (O4-PT01), S176 (P2-OT13) Kim Moon-Ju, S153 (P2-CE06) Johari BM, S75 (O2-PT06) Kim C., S112 (P1-GN31) Kim N.-J., S185 (P2-LB02) Johnson A., S154 (P2-CE08), S154 (P2-CE09), Kim Chang Yul, S178 (P2-OT21) Kim Nam Joong, S87 (P1-BT14), S152 (P2-CE03) S155 (P2-CE10) Kim Choon Mee, S90 (P1-CM03) Kim S, S113 (P1-GN35), S113 (P1-GN36), Joo Eun-Jeong, S135 (P1-VR09) Kim Dokyun, S44 (S7-3) S114 (P1-GN37), S164 (P2-CE33), Joo S.J., S120 (P1-GP08) Kim Dong-eun, S168 (P2-HV03), S168 (P2-HV04) S165 (P2-CE35) Joshi Bindira, S84 (P1-BT06), S102 (P1-GN06) Kim Dong-Min, S90 (P1-CM03) Kim Sang Il, S167 (P2-HV01), S169 (P2-HV05) Jumahat N.M., S83 (P1-BT02) Kim E.S., S185 (P2-LB02) Kim SB, S117 (P1-GN48), S139 (P1-VR17) Jumahat Noor Masyitah, S101 (P1-GN03), Kim EJ, S181 (P2-TM05) Kim Seong Eun, S117 (P1-GN47), S147 (P2-CC03) S152 (P2-CE02) Kim ES, S86 (P1-BT12) Kim S-H, S76 (O3-PT03), S79 (O4-PT04), Jun K.I., S185 (P2-LB02) Kim Eu Suk, S152 (P2-CE03), S176 (P2-OT13) S176 (P2-OT14), S181 (P2-TM04) Jun Kang Il, S87 (P1-BT14), S152 (P2-CE03) Kim Eun Jin, S79 (O4-PT03) Kim SH, S86 (P1-BT12), S116 (P1-GN45), Jun Yoonhee, S169 (P2-HV05) Kim H.B., S185 (P2-LB02) S128 (P1-HI21), S130 (P1-MM05), Jung Dong Sik, S176 (P2-OT13) Kim HC, S169 (P2-HV06) S131 (P1-MM09), S136 (P1-VR13), Jung HJ, S114 (P1-GN37), S164 (P2-CE33) Kim Hee Soon, S103 (P1-GN10), S104 (P1-GN11) S137 (P1-VR15), S179 (P2-TM01) Jung In Young, S79 (O4-PT03) Kim HN, S137 (P1-VR14), S163 (P2-CE29) Kim S-H., S93 (P1-CM14) Jung IY, S181 (P2-TM05) Kim Hong Bin, S152 (P2-CE03), S176 (P2-OT13) Kim Shin Woo, S167 (P2-HV01) Jung J, S100 (P1-CM30) Kim Hong Gi, S168 (P2-HV03) Kim Shin-Woo, S111 (P1-GN30), S124 (P1-HI11), Jung J., S93 (P1-CM14) Kim Hong Jae, S124 (P1-HI12) S176 (P2-OT13), S178 (P2-OT19) Jung Jihye, S127 (P1-HI19) Kim Hoon Seok, S80 (O4-PT06) Kim Si-Hyun, S167 (P2-CE41) Jung Jin, S115 (P1-GN40) Kim Hye In, S78 (O4-PT01) Kim SJ, S117 (P1-GN48) Jung Jiwon, S79 (O4-PT05) Kim Hye Mee, S118 (P1-GP02) Kim So Yeon, S107 (P1-GN19), S115 (P1-GN42) Jung JK, S161 (P2-CE25) Kim Hyo Youl, S167 (P2-HV01) Kim Sohyeon, S163 (P2-CE30) Jung Jung-Min, S133 (P1-VA03) Kim Hyun Ah, S78 (O4-PT01), S94 (P1-CM15), Kim Song Yee, S79 (O4-PT03) Jung JW, S86 (P1-BT12) S159 (P2-CE19) Kim Soo Hyun, S153 (P2-CE06) Jung Sang Oun, S163 (P2-CE30), S164 (P2-CE31) Kim Hyung Yoon, S147 (P2-CC03) Kim Soo sung, S117 (P1-GN47) Jung SM, S174 (P2-OT09) Kim Hyunjo, S141 (P2-AG01) Kim Soo-yeun, S166 (P2-CE39) Jung Sook In, S117 (P1-GN47), S153 (P2-CE06), Kim In A, S97 (P1-CM21) Kim Soo-Young, S80 (O4-PT06) S166 (P2-CE39) Kim Inho, S87 (P1-BT14) Kim Su Hyun, S127 (P1-HI19) Jung Sunhee, S134 (P1-VR05) Kim J, S71 (O1-PT02), S113 (P1-GN35), Kim Su Min, S167 (P2-HV01) Jung TS, S73 (O2-PT01) S113 (P1-GN36), S114 (P1-GN37), Kim Sun A, S166 (P2-CE39) Jung Yochun, S147 (P2-CC03) S164 (P2-CE33), S165 (P2-CE35), Kim Sun Bean, S132 (P1-MM10) Justine Dukuzimana, S168 (P2-HV02) S178 (P2-OT20) Kim Sun Hee, S160 (P2-CE21) Kim J., S132 (P1-VA02) Kim Sung-Han, S79 (O4-PT05) Kam K, S180 (P2-TM02) Kim J.Y., S93 (P1-CM14), S141 (P2-AG02) Kim Sunhee, S179 (P2-OT22) Kamaruddin Nur Amalina, S130 (P1-MM06) Kim JA, S175 (P2-OT10) Kim Sunjoo, S91 (P1-CM07), S91 (P1-CM08), Kamarudin N, S74 (O2-PT02) Kim Jehun, S186 (P2-LB06), S186 (P2-LB07), S92 (P1-CM09), S92 (P1-CM10) Kamolwit W., S119 (P1-GP05) S186 (P2-LB08) Kim Sunju, S116 (P1-GN43) Kang C.K., S185 (P2-LB02) Kim Jeong-Han, S87 (P1-BT14) Kim SuYeon, S86 (P1-BT11) Kang Chang Kyung, S87 (P1-BT14), S152 (P2-CE03) Kim JH, S117 (P1-GN48), S139 (P1-VR17), Kim SW, S73 (O2-PT01), S78 (O4-PT02), Kang Cheol-In, S118 (P1-GP02), S119 (P1-GP03) S156 (P2-CE12), S169 (P2-HV06), S137 (P1-VR14), S159 (P2-CE20) Kang C-I, S79 (O4-PT04), S118 (P1-GP01) S181 (P2-TM05), S181 (P2-TM05) Kim SY, S100 (P1-CM30), S137 (P1-VR15) Kang HY, S146 (P2-AR03) Kim Jieun, S78 (O4-PT01), S97 (P1-CM22) Kim T, S179 (P2-TM01) Kang JS, S121 (P1-HI03) Kim Jin A, S124 (P1-HI11) Kim Taek Soo, S87(P1-BT14) Kang JY, S137 (P1-VR14), S163 (P2-CE29) Kim Jin Seok, S103 (P1-GN10), S104 (P1-GN11) Kim Tae-Sun, S160 (P2-CE21) Kang S., S112 (P1-GN31) Kim Jin Yong, S176 (P2-OT13) Kim Taeyun, S186 (P2-LB06), S186 (P2-LB07) Kang Seong Hui, S190 (P2-LB19) Kim Jong Hun, S132 (P1-MM10) Kim TH, S179 (P2-TM01) Kang Seung Ji, S117 (P1-GN47), S153 (P2-CE06) Kim Juhyeon, S80 (O4-PT06) Kim TW, S176 (P2-OT14) Kang Seung-Ji, S166 (P2-CE39) Kim Jun Hyoung, S143 (P2-AG04), S162 (P2-CE27), Kim Uh Jin, S117 (P1-GN47) Kang SH, S122 (P1-HI07) S176 (P2-OT15) Kim Uiryeong, S179 (P2-OT22) Kang Yoon Gu, S72 (O1-PT03) Kim Jung Ho, S72 (O1-PT03), S143 (P2-AG04), Kim WB, S131 (P1-MM09), S136 (P1-VR13) Kang Yu Min, S152 (P2-CE03) S162 (P2-CE27), S176 (P2-OT15) Kim WJ, S137 (P1-VR14), S163 (P2-CE29) Kang Yu Ri, S118 (P1-GP02), S119 (P1-GP03) Kim Jung Mogg, S84 (P1-BT05) Kim Woo Joo, S34 (S5-1), S136 (P1-VR12), Kant R., S172 (P2-OT04) Kim Jung Ok, S80 (O4-PT06) S139 (P1-VR16) Kant Ravi, S133 (P1-VR01) Kim JW, S117 (P1-GN46), S127 (P1-HI20) Kim YA, S174 (P2-OT09) Karki Rashmi, S93 (P1-CM12) Kim JY, S78 (O4-PT02), S117 (P1-GN48) Kim Yae-Jean, S38 (S6-1) Kartina L, S112 (P1-GN33) Kim SJ, S144 (P2-AG06) Kim Yang Ree, S169 (P2-HV05) Karunakaran R., S112 (P1-GN32) Kim Kisoon, S168 (P2-HV03), S168 (P2-HV04) Kim Yang Soo, S79 (O4-PT05) Karunarathna C, S123 (P1-HI08) Kim Kwang Gon, S115 (P1-GN40), S160 (P2-CE21) Kim YC, S177 (P2-OT17) Kazmierczak K., S154 (P2-CE08), S156 (P2-CE13), Kim Kwang-sun, S103 (P1-GN09), S174 (P2-OT08) Kim Ye Jin, S133 (P1-VR02) S157 (P2-CE14) Kim Kyoungmi, S124 (P1-HI11) Kim Yeonjae, S97 (P1-CM22), S136 (P1-VR11) Keam B., S185 (P2-LB02) Kim MC, S137 (P1-VR15), S179 (P2-TM01) Kim Yeon-Sook, S115 (P1-GN42), S136 (P1-VR11) Kee Hye Young, S115 (P1-GN40) Kim MH, S130 (P1-MM05) Kim YH, S161 (P2-CE25) Kee Hye-young, S160 (P2-CE21) Kim Mi-Hee, S78 (O4-PT01) Kim YJ, S110 (P1-GN26), S116 (P1-GN45) Kee Mee-Kyung, S167 (P2-HV01) Kim Min Ja, S132 (P1-MM10), S167 (P2-HV01) Kim YJ., S109 (P1-GN25) Kehaloon M., S149 (P2-CC06) Kim Min Jae, S79 (O4-PT05) Kim YK, S95(P1-CM18), S96 (P1-CM19), Khaemaporn Boonbumrung, S154 (P2-CE07) Kim Min Ji, S115 (P1-GN40), S160 (P2-CE21) S137 (P1-VR14) Khoo Y, S105 (P1-GN14) Kim Mi-Na, S135 (P1-VR10) Kim Yong Chan, S79 (O4-PT03), S167 (P2-HV01) Khor B, S94 (P1-CM17) Kim MJ, S86 (P1-BT12), S117 (P1-GN48), Kim Yoon jung, S111 (P1-GN30) Kicic A, S90 (P1-CM05), S93 (P1-CM13) S139 (P1-VR17), S177 (P2-OT17) Kim Yoonjung, S178 (P2-OT19) S194 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S191-S197

Kim Youn Jeong, S169 (P2-HV05) S131 (P1-MM09), S136 (P1-VR13) Lee S-J., S108 (P1-GN21) Kim Young Ah, S44 (S7-3) Lee Dong-Gun, S167 (P2-CE41) Lee SO, S86 (P1-BT12), S137 (P1-VR15), Kim Young-Eui, S134 (P1-VR04) Lee Dong-Hyun, S91 (P1-CM08) S181 (P2-TM04) Kim Younjoo, S124 (P1-HI11) Lee DS, S174 (P2-OT09) Lee Sohee, S174 (P2-OT08) Kim YS, S86 (P1-BT12), S137 (P1-VR15), Lee EY, S179 (P2-TM01) Lee SY, S127 (P1-HI20) S181 (P2-TM04) Lee FS, S94 (P1-CM16) Lee W.J., S166 (P2-CE40) Kim Yunjung, S124 (P1-HI11) Lee Gi Yong, S146 (P2-AR02) Lee WB, S144 (P2-AG07), S179 (P2-OT23) Kim Yun-Kyung, S127 (P1-HI19) Lee Giseong, S179 (P2-OT22) Lee WJ, S88 (P1-BT16), S181 (P2-TM05) Kimberlin David, S39 (S6-2) Lee H, S159 (P2-CE20) Lee Woon Ji, S72 (O1-PT03), S143 (P2-AG04), Kiratisin P, S171 (P2-OT01) Lee H., S108 (P1-GN20), S108 (P1-GN21) S162 (P2-CE27), S176 (P2-OT15) Klinkajorn A., S109 (P1-GN24) Lee Hae Kyung, S80 (O4-PT06) Lee WR, S161 (P2-CE25) Ko JH, S134 (P1-VR06) Lee Haejeong, S114 (P1-GN39) Lee YA, S126 (P1-HI15) Ko Mei-Lan, S126 (P1-HI17) Lee Haeng Ho, S146 (P2-AR02) Lee Yangsoon, S78 (O4-PT01) Ko KS, S118 (P1-GP01), S144 (P2-AG06) Lee Han Sol, S136 (P1-VR12), S139 (P1-VR16) Lee YJ, S123 (P1-HI09) Ko Kwan Soo, S107 (P1-GN19), S114 (P1-GN38), Lee Hee Jung, S97 (P1-CM21) Lee YM, S179 (P2-TM01) S114 (P1-GN39), S115 (P1-GN41), Lee HJ, S128 (P1-HI21), S131 (P1-MM09), Lee Yongseop, S176 (P2-OT15) S115 (P1-GN42), S116 (P1-GN43), S136 (P1-VR13), S139 (P1-VR17), Lee Youn-Jeong, S35 (S5-2) S116 (P1-GN44) S156 (P2-CE12) Lee Yu Jeong, S153 (P2-CE06) Ko Sung Hun, S124 (P1-HI12) Lee HS, S137 (P1-VR14) Lee Myung-Ken, S132 (P1-VA01) Ko Y., S112 (P1-GN31) Lee Hyang Ran, S133 (P1-VR02) Leona D.F., S182 (P2-TM11) Ko Yousang, S106 (P1-GN16) Lee Hye Sun, S155 (P2-CE11) Leong CK, S72 (O1-PT04) Koh Hong, S72 (O1-PT03) Lee Hyo-Jin, S167 (P2-CE41) Leong CL, S151 (P2-CC10) Koh XP, S71 (O1-PT01) Lee J, S137 (P1-VR14), S171 (P2-HV11) Lim Daejin, S188 (P2-LB12) Koh Youngil, S87 (P1-BT14) Lee Jacob, S135 (P1-VR09) Lim Dong-Gyun, S136 (P1-VR11) Kok Li-Ching, S126 (P1-HI17) Lee JB, S88 (P1-BT16) Lim Hee-Young, S134 (P1-VR04), S134 (P1-VR05) Koo YEC, S72 (O1-PT04) Lee JG, S174 (P2-OT09) Lim JS, S137 (P1-VR15), S176 (P2-OT14) Koomanachai P., S148 (P2-CC04), S149 (P2-CC06) Lee JH, S95 (P1-CM18), S96 (P1-CM19), Lim JU, S134 (P1-VR06) Koomanachai Pornpan, S147 (P2-CC01) S174 (P2-OT09) Lim KY, S75 (O2-PT06) Ku Nam Su, S72 (O1-PT03), S143 (P2-AG04), Lee Ji Eun, S80 (O4-PT06) Lim M, S153 (P2-CE04) S162 (P2-CE27), S176 (P2-OT15) Lee Ji Yeon, S94 (P1-CM15), S159 (P2-CE19) Lim Mihyeon, S179 (P2-OT22) Ku NS, S156 (P2-CE12), S169 (P2-HV06), Lee Jin Gu, S79 (O4-PT03) Lim S, S76 (O3-PT03), S137 (P1-VR14) S181 (P2-TM05) Lee Jin, S163 (P2-CE30) Lim SK, S146 (P2-AR03), S146 (P2-AR04) Kueakulpattana N., S110 (P1-GN27), Lee Jin Seo, S106 (P1-GN16), S135 (P1-VR09), Lim Soo Yeon, S136 (P1-VR12) S111 (P1-GN29) S166 (P2-CE38) Lim W.G., S83 (P1-BT03) Kumalasari D., S177 (P2-OT18) Lee Jin Young, S186 (P2-LB06), S186 (P2-LB07), Liu Changseung, S44 (S7-3) Kumari P.N., S83 (P1-BT02) S186 (P2-LB08), S187 (P2-LB09) Liu Wei-Lun, S48 (S8-2) Kumari P Navindra, S101 (P1-GN03), Lee Jina, S110 (P1-GN28) Livermore David, S8 (O-2), S43 (S7-2) S101 (P1-GN04) Lee JM, S95 (P1-CM18), S96 (P1-CM19) Lob S., S156 (P2-CE13), S157 (P2-CE14) Kumawat M.K., S78 (O3-PT06) Lee Joo-Yeon, S134 (P1-VR04), S134 (P1-VR05) Loh J, S171 (P2-OT02), S173 (P2-OT06), Kuntaman S112 (P1-GN33) Lee JS, S137 (P1-VR14) S174 (P2-OT07) Kwa A., S74 (O2-PT04) Lee Jung Hun, S101 (P1-GN01) Loh V, S175 (P2-OT11) Kwak YG, S159 (P2-CE18), S177 (P2-OT17) Lee JY, S126 (P1-HI15) Loong L, S75 (O2-PT06) Kwan JKC, S71 (O1-PT01) Lee K., S108 (P1-GN20), S108 (P1-GN21) Low SK, S72 (O1-PT04) Kweon OM, S123 (P1-HI09), S174 (P2-OT09) Lee Keun Hwa, S133 (P1-VR02), S151 (P2-CE01) Luetkemeyer A, S170 (P2-HV09) Kweon Sun-Seog, S166 (P2-CE39) Lee KH, S135 (P1-VR08) Luis AP, S97 (P1-CM23) Kwok K, S180 (P2-TM02) Lee K-H, S76 (O3-PT03) Lukmonov Saidrakhim, S187 (P2-LB10) Kwon Da Eun, S155 (P2-CE11) Lee KJ, S127 (P1-HI20) Lum L, S127 (P1-HI18) Kwon EJ, S126 (P1-HI15) Lee KM, S94 (P1-CM16) Lum L., S74 (O2-PT04) Kwon Eun-Jeong, S133 (P1-VA03) Lee KS, S110 (P1-GN26), S159 (P2-CE18) Luu N.B.L., S145 (P2-AG08) Kwon JS, S76 (O3-PT03) Lee Kyoung Hwa, S124 (P1-HI12), S155 (P2-CE11) Lye D, S127 (P1-HI18) Kwon Ki Tae, S78 (O4-PT01), S111 (P1-GN30), Lee CE, S75 (O2-PT06) Lye D., S74 (O2-PT04) S116 (P1-GN44), S178 (P2-OT19) Lee Mi Suk, S135 (P1-VR09), S176 (P2-OT13) Lye D.C.B., S158 (P2-CE17) Kwon OM, S126 (P1-HI15) Lee MS, S78 (O4-PT02), S179 (P2-TM01), Lye David, S32 (S4-3) S159 (P2-CE20) L.P.K Benerdick, S101 (P1-GN04) Lee Naery, S133 (P1-VA03) M.N Fadzilah, S101 (P1-GN04) Lamichhane Samir, S93 (P1-CM12) Lee NY., S109 (P1-GN25) M.R Farah Roslinda, S101 (P1-GN04) Laowansiri M., S119 (P1-GP06) Lee S, S180 (P2-TM02) Ma Sang Hyuk, S91 (P1-CM07) Latupeirissa D., S113 (P1-GN34) Lee S., S112 (P1-GN31) Madhavan P, S72 (O1-PT04) Lau CL, S173 (P2-OT05) Lee Sang Hee, S101 (P1-GN01) Maggiolo F, S169 (P2-HV08) Lau EHY, S165 (P2-CE36) Lee Sang Kil, S72 (O1-PT03) Maharjan Anju, S178 (P2-OT21) Lau SCK, S71 (O1-PT01) Lee Sang-Me, S103 (P1-GN10), S104 (P1-GN11) Mahir Abdulillah M, S161 (P2-CE25) Le H.T.T., S99 (P1-CM28) Lee Sang-Oh, S79 (O4-PT05) Maizatul’ Itri CH, S121 (P1-HI05) Le P.H., S100 (P1-CM31), S140 (P1-VR19) Lee SE, S159 (P2-CE18) Makhmarasulov Abror, S187 (P2-LB10), Le S.H., S100 (P1-CM31), S140 (P1-VR19) Lee S-E, S177 (P2-OT17) S187 (P2-LB11) Le T.K.T., S99 (P1-CM28) Lee Seung Hun, S97 (P1-CM21) Maknakhon N., S145 (P2-AR01) Le T.N.M.Q., S109 (P1-GN23) Lee Seung Soon, S126 (P1-HI16) Malla Kaushal, S128 (P1-MM02) Le V.B.T, S109 (P1-GN23) Lee Seungjun, S91 (P1-CM07), S92 (P1-CM09), Malla R., S144 (P2-AG05) Lee AR, S73 (O2-PT01) S92 (P1-CM10) Manda JK, S162 (P2-CE26) Lee Byeong Soo, S124 (P1-HI12) Lee SH, S137 (P1-VR14), S156 (P2-CE12), Marlindawati MA, S88 (P1-BT15) Lee C.W, S188 (P2-LB13) S163 (P2-CE29) Martin H, S169 (P2-HV08), S170 (P2-HV09), Lee Chae Young, S164 (P2-CE31) Lee S-J, S108 (P1-GN20) S170 (P2-HV10) Lee DG, S128 (P1-HI21), S130 (P1-MM05), Lee SJ, S137 (P1-VR14), S163 (P2-CE29) Martin R, S170 (P2-HV10) Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S191-S197 S195

Masri S.N., S84 (P1-BT04) Nguyen T.T.H., S109 (P1-GN23), S160 (P2-CE24) Park Kang Gyun, S80 (O4-PT06) Masri SN, S128 (P1-MM01) Nguyen Ba Thang, S147 (P2-CC02) Park KH, S137 (P1-VR14), S179 (P2-TM01) Mauleti IY., S113 (P1-GN34) Nizomova Firuza, S187 (P2-LB10), S187 (P2-LB11) Park Kwang Seung, S101 (P1-GN01) McNicholl I, S169 (P2-HV08) Nkenyi R, S132 (P1-VA01) Park Kyung-Hwa, S13 (S1-4), S117 (P1-GN47), Md Dali NA, S182 (P2-TM09) Nkuba A, S162 (P2-CE26) S166 (P2-CE39) Mekasha Sindew, S77 (O3-PT05), S89 (P1-CM02) Noh Ji Yun, S139 (P1-VR16) Park Moo Suk, S79 (O4-PT03) Mekmullica J., S185 (P2-LB04) Noh JY, S137 (P1-VR14), S163(P2-CE29) Park S.D., S120 (P1-GP08) Min Sun-Joon, S80 (O4-PT06) Noordin A, S74 (O2-PT02) Park Sang-Hun, S103 (P1-GN10), S104 (P1-GN11) Mishra S.K., S130 (P1-MM07), S131 (P1-MM08) Nor Amdan Nur Asyura, S130 (P1-MM06) Park Sang-Won, S152 (P2-CE03) Mishra Shyam Kumar, S158 (P2-CE16) Park SC, S146 (P2-AR04) Mishra Shyam, S93 (P1-CM12) Oh Dong Hyun, S79 (O4-PT03) Park Se Yoon, S78 (O4-PT01), S176 (P2-OT13) Moedjito I, S112 (P1-GN33) Oh Jihyu, S166 (P2-CE38) Park SH, S128 (P1-HI21), S131 (P1-MM09), Mohamed-Isa N.Z., S120 (P1-GP09) Oh M.-d., S185 (P2-LB02) S136 (P1-VR13) Mohammad J, S72 (O1-PT04) Oh Myoung-don, S7 (O-1), S87 (P1-BT14), Park SM, S95 (P1-CM18), S96 (P1-CM19) Mohammedowy M, S161 (P2-CE25) S152 (P2-CE03) Park So Yeon, S106 (P1-GN16), S166 (P2-CE38) Mohd Ali Mohammad Ridhuan, S130 (P1-MM06) Oh S, S79 (O4-PT04) Park So Young, S133 (P1-VA03) Mohd Khari F.I., S112 (P1-GN32) Oh SC, S95 (P1-CM18), S96 (P1-CM19) Park SQ, S161 (P2-CE25) Mohd Tap Ratna, S130 (P1-MM06) Oh Seok, S147 (P2-CC03) Park Sun Hee, S167 (P2-CE41) Mohd Yusof N, S74 (O2-PT02) Oh Suhyun, S133 (P1-VR02), S151 (P2-CE01) Park Suyeon, S114 (P1-GN39) Mohd Zain Zaini, S101 (P1-GN03), Oh Tae hoon, S117 (P1-GN47) Park SY, S76 (O3-PT03), S159 (P2-CE18), S101 (P1-GN04), S152 (P2-CE02) Oh Won Sup, S152 (P2-CE03) S161 (P2-CE25), S177 (P2-OT17), Mohd-Zain Z., S83 (P1-BT02) Oh YH, S175 (P2-OT10) S179 (P2-TM01) Mohmad A, S105 (P1-GN14) Oh Young-Hee, S103 (P1-GN10), S104 (P1-GN11) Park W.B., S185 (P2-LB02) Molina JM, S169 (P2-HV08) Oktovina M.N., S113 (P1-GN34) Park Wan Beom, S87 (P1-BT14), S136 (P1-VR11), Molly K, S121 (P1-HI05) Omar N, S128 (P1-MM01) S152 (P2-CE03) Monk PN, S90 (P1-CM05), S93 (P1-CM13) Ominami Yusuke, S98 (P1-CM25), S98 (P1-CM26) Park Woo-Jung, S134 (P1-VR05) Moon C, S78 (O4-PT02), S121 (P1-HI03), Ong C., S89 (P1-CM01) Park Y, S159 (P2-CE18) S159 (P2-CE20) Ong X., S74 (O2-PT04) Park Yeon-Joon, S80 (O4-PT06) Moon Chisook, S176 (P2-OT13) Ooi CK, S76 (O3-PT01), S171 (P2-OT02), Park YJ, S100 (P1-CM30) Moon DC, S146 (P2-AR03), S146 (P2-AR04) S173 (P2-OT06), S174 (P2-OT07) Park Yoon Seon, S135 (P1-VR09) Moon KL, S85 (P1-BT08), S150 (P2-CC09) Osongu JO, S162 (P2-CE26) Park YS, S159 (P2-CE18), S177 (P2-OT17) Moon S.M., S185 (P2-LB02) Ouirungroj T., S73 (O1-PT05), S125 (P1-HI13) Passey D, S122 (P1-HI06) Moon Song Mi, S152 (P2-CE03) Ow Dave Siak-Wei, S96 (P1-CM20) Patabendige G, S151 (P2-CC11) Motyl M., S156 (P2-CE13), S157 (P2-CE14) Patel Robin, S52 (S9-1), S57 (P3-1) Mouli Annamalai Chandra, S152 (P2-CE02) P. Gi-Deok, S132 (P1-VA01) paudel P., S144 (P2-AG05) Mughni Abdul, S189 (P2-LB16) P. Pauline Angelyna, S121 (P1-HI05) Pavelyev A., S132 (P1-VA02) Muhamad AN, S85 (P1-BT10) Pachayappan K., S129 (P1-MM03) Pawar A., S172 (P2-OT04) Muhamad Rabuan Isa NA, S85 (P1-BT10) Pai H, S71 (O1-PT02), S178 (P2-OT20) Peck KR, S79 (O4-PT04), S118 (P1-GP01) Muhamad Rizal N, S94 (P1-CM17) Pai Hyunjoo, S66 (S11-3), S78 (O4-PT01), Peck Kyong Ran, S107 (P1-GN19), S118 (P1-GP02), Muhummudaree N., S107 (P1-GN18) S97 (P1-CM22) S119 (P1-GP03) Muhummudaree Netchanok, S107 (P1-GN17) Paik Hyo Chae, S79 (O4-PT03) Peck KR, S134 (P1-VR06) Mujahidah M, S177 (P2-OT18) Palanisamy Navindra Kumari, S152 (P2-CE02) Perera V, S105 (P1-GN15) Mun SJ, S121 (P1-HI03) Palanisamy NK, S72 (O1-PT04) Periyasamy P, S94 (P1-CM17) Mun Sujin, S179 (P2-OT22) Parajuli A., S144 (P2-AG05) Periyasamy Petrick, S173 (P2-OT05) Mustakim S, S105 (P1-GN14) Parajuli K., S130 (P1-MM07), S131 (P1-MM08) Pham B.T., S145 (P2-AG08) Myung Go Eun, S97 (P1-CM21) Parasakthi N., S101 (P1-GN03) Pham D.T., S140 (P1-VR18) Myung-Ken L, S162 (P2-CE26) Park AK, S113 (P1-GN35), S113 (P1-GN36), Pham H.T., S99 (P1-CM28), S140 (P1-VR18), S114 (P1-GN37), S164 (P2-CE33), S145 (P2-AG08) Na Hae-Young, S166 (P2-CE39) S165 (P2-CE35) Pham P.T.T., S140 (P1-VR18) Na In-Young, S116 (P1-GN44) Park C, S127 (P1-HI20), S130 (P1-MM05), Pham S.T., S99 (P1-CM28), S100 (P1-CM31), Na SH, S146 (P2-AR03) S131 (P1-MM09), S136 (P1-VR13) 140 (P1-VR18), S140 (P1-VR19), Nahusenay Honelegn, S77 (O3-PT05) Park Chul Min, S168 (P2-HV03) S145 (P2-AG08) Narissara Yuchui, S154 (P2-CE07) Park D, S135 (P1-VR08) Pham V.H., S99 (P1-CM28), S100 (P1-CM31), Naskar Atanu, S174 (P2-OT08) Park Dae Won, S127 (P1-HI19), S167 (P2-HV01) S140 (P1-VR18), S140 (P1-VR19), Nathan S, S94 (P1-CM17) Park Duck woong, S115 (P1-GN40), S145 (P2-AG08) Navarro KC, S97 (P1-CM23) S160 (P2-CE21) Pham Thi Ngoc Quyen, S147 (P2-CC02) Nega Desalegn, S77 (O3-PT05), S89 (P1-CM02) Park E., S108 (P1-GN20) Phan D.Q., S140 (P1-VR18) Neoh H, S74 (O2-PT02), S94 (P1-CM17) Park ES, S123 (P1-HI09), S126 (P1-HI15), Piontkowsky D, S169 (P2-HV08) Neupane Sunita, S172 (P2-OT03) S174 (P2-OT09) Plabutong N., S129 (P1-MM04) Ng E, S94 (P1-CM16) Park G., S112 (P1-GN31) Poh CL, S76 (O3-PT02) Ng RX, S75 (O2-PT06) Park Hye jung, S160 (P2-CE21) Pongsamart W., S119 (P1-GP05) Ng Q., S77 (O3-PT04) Park J, S113 (P1-GN35), S113 (P1-GN36), Pongsuttiyakorn S, S171 (P2-OT01) Nguyen D.D., S99 (P1-CM28) S114 (P1-GN37), S164 (P2-CE33), Ponnampanavalar S, S75 (O2-PT06) Nguyen L.N.D., S140 (P1-VR18) S165 (P2-CE35) Poolperm P., S145 (P2-AR01) Nguyen L.Q.A, S160 (P2-CE24) Park J., S132 (P1-VA02) Poudel Sushanta, S128 (P1-MM02) Nguyen N.H.B, S109 (P1-GN23) Park JH, S179 (P2-TM01), S181 (P2-TM04) Poudyal Anup, S84 (P1-BT06) Nguyen N.M.H, S160 (P2-CE24) Park Ji Young, S187 (P2-LB09) Prabhu V., S132 (P1-VA02) Nguyen S.H.T., S140 (P1-VR18) Park Joo-Hyun, S103 (P1-GN10), S104 (P1-GN11) Prabowo Rafik, S188 (P2-LB14) Nguyen T.V., S99 (P1-CM28) Park Jungwook, S179 (P2-OT22) Puangprasart U., S119 (P1-GP05) Nguyen T.A., S100 (P1-CM31), S140 (P1-VR19) Park Jun-Sun, S136 (P1-VR11) Pulido F, S169 (P2-HV08) Nguyen T.H.T., S99 (P1-CM28) Park JY, S131 (P1-MM09), S136 (P1-VR13) Puspitadewi Elisabeth Sukma, S189 (P2-LB16) Nguyen T., S140 (P1-VR18) Park K., S90 (P1-CM04) Puspitasari D, S112 (P1-GN33) S196 Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S191-S197

Putra A.E., S182 (P2-TM11) Seong H, S162 (P2-CE26), S181 (P2-TM05) Song Joon Young, S139 (P1-VR16), S167 (P2-HV01) Putra IW, S112 (P1-GN33) Seong Hye, S72 (O1-PT03), S143 (P2-AG04), Song JY, S137 (P1-VR14) S162 (P2-CE27), S176 (P2-OT15) Song Kyoung-Ho, S152 (P2-CE03) Quek C.Y.J., S99 (P1-CM28) Seong Jiseon, S124 (P1-HI11) Song Miryoung, S188 (P2-LB12) Setyani AB., S163 (P2-CE28), S164 (P2-CE34) Song Yeong-Jun, S166 (P2-CE39) R Sheila Ivy, S121 (P1-HI05) Shaari S.A., S120 (P1-GP09) Song YG, S156 (P2-CE12), S181 (P2-TM05) Rachayon M, S185 (P2-LB03) Shafi H, S179 (P2-OT23) Song Young Goo, S124 (P1-HI12), S155 (P2-CE11), Rafsanjani Intan S., S188 (P2-LB14) Shaharuddin N, S173 (P2-OT05) S176 (P2-OT15) Rahim SM, S128 (P1-MM01) Shakya Rajina, S87 (P1-BT13) Srinivasan Arjun, S30 (S4-1) Raja Abd Rahman R, S74 (O2-PT02) Shakya Hada Manju, S102 (P1-GN06) Sripirom N., S185 (P2-LB04) Raja Azwa RIS, S75 (O2-PT06) Sherkhonov Bakhrom, S187 (P2-LB10), Srisakul S., S108 (P1-GN22) Rajasuriar Reena, S69 (S12-2) S187 (P2-LB11) Stibich M, S122 (P1-HI06) Ramanathan B, S76 (O3-PT02) Shi HJ, S171 (P2-HV11) Stick SM, S90 (P1-CM05), S93 (P1-CM13) Ramli R, S94 (P1-CM17) Shi HyeJin, S106 (P1-GN16) Stone G., S154 (P2-CE08), S154 (P2-CE09), Ramli SR, S182 (P2-TM09) Shim TS, S181 (P2-TM04) S155 (P2-CE10) Ranasinghe T, S74 (O2-PT03), S151 (P2-CC11) Shin Bo Ra, S133 (P1-VR02) Subedi Subas, S172 (P2-OT03) Raoult Didier, S16 (S2-2), S98 (P1-CM25), Shin Dong-Yeop, S87 (P1-BT14) Suh Jin Woong, S132 (P1-MM10) S98 (P1-CM26) Shin E, S113 (P1-GN35), S113 (P1-GN36), Suh Y.H., S108 (P1-GN20), S108 (P1-GN21) Rattaumpawan P., S75 (O2-PT05) S114 (P1-GN37), S164 (P2-CE33), Suhaila Tuan, S101 (P1-GN04) Razonable CD, S97 (P1-CM23) S165 (P2-CE35) Suk Ki Tae, S126 (P1-HI16) Reda Hailemariam, S77 (O3-PT05) Shin HI, S159 (P2-CE18) Sulastri D., S183 (P2-TM12) Regmi M., S144 (P2-AG05) Shin H-I, S177 (P2-OT17) Sundram M, S175 (P2-OT11) Rengel KO, S149 (P2-CC05) Shin HS, S174 (P2-OT09) Sung H, S181 (P2-TM04) Reyes F.A., S99 (P1-CM29) Shin Hyoung-Shik, S136 (P1-VR11) Sung Heungsup, S54 (S9-3), S135 (P1-VR10) Rhee Ji-Young, S136 (P1-VR11), S189 (P2-LB18) Shin J.H., S108 (P1-GN20) Sung HS, S86 (P1-BT12) Rhee YM, S169 (P2-HV06) Shin Jeong Hwan, S44 (S7-3) Sung Sul A, S127 (P1-HI19) Rho M, S71 (O1-PT02), S178 (P2-OT20) Shin Ji Hyun, S115 (P1-GN40), S160 (P2-CE21) Supapueng O, S171 (P2-OT01) Ricohermoso J., S99 (P1-CM29) Shin Jong Hee, S44 (S7-3), S47 (S8-1), Sutharson A, S74 (O2-PT03) Riley Thomas, S64 (S11-1) S153 (P2-CE06) Sutrisnaningsih E.S., S177 (P2-OT18) Rimbadi Muhammad I., S188 (P2-LB14) Shin Kyeong Seob, S44 (S7-3) Syed Omar SF, S75 (O2-PT06) Rivera W, S102 (P1-GN08) Shin S.Y., S141 (P2-AG02) Tamang Basanta, S84 (P1-BT06), S102 (P1-GN06) Rockstroh J, S170 (P2-HV09) Shin Min-Ho, S166 (P2-CE39) Roman A.D., S99 (P1-CM29) Shin So Youn, S124 (P1-HI10) Tan Hwee Tong, S96 (P1-CM20) Roslan N., S175 (P2-OT12) Shin Sung Un, S117 (P1-GN47), S166 (P2-CE39) Tan J, S127 (P1-HI18) Rosli MA, S173 (P2-OT05) Shin SY, S177 (P2-OT17) Tan J., S74 (O2-PT04), S175 (P2-OT12) Rubion L.E., S99 (P1-CM29) Shin Y.B., S90 (P1-CM04) Tan M, S127 (P1-HI18) Rybak Michael, S3 (K-2), S12 (S1-3) Shin YoungHyun, S168 (P2-HV03), S168 (P2-HV04) Tan SH, S179 (P2-OT23) Ryou Jungsang, S134 (P1-VR04) Shrestha K., S121 (P1-HI01) Tan SY, S144 (P2-AG07), S179 (P2-OT23) Ryu BH, S85 (P1-BT08), S150 (P2-CC09) Shrestha Kalpana Kumari, S102 (P1-GN05), Tan T, S74 (O2-PT02), S94 (P1-CM17) Ryu Byung-Han, S92 (P1-CM09) S102 (P1-GN06) Tang W, S175 (P2-OT11) Ryu S, S165 (P2-CE36) Shrestha P.C., S121 (P1-HI01) Tangkoskul T., S145 (P2-AR01) Ryu Seong-yeol, S78 (O4-PT01), S94 (P1-CM15), Shrestha Pukar Chandra, S102 (P1-GN05), Tasew Geremew, S77 (O3-PT05), S89 (P1-CM02) S159 (P2-CE19) S102 (P1-GN06) Tay S.T., S112 (P1-GN32) Shrestha R., S121 (P1-HI01) Tee K., S77 (O3-PT04) S Siti Fazilah, S121 (P1-HI05) Shrestha Rajeshwori, S102 (P1-GN05) Teeratakulpisarn N., S111 (P1-GN29) Saenjum C., S73 (O1-PT05), S125 (P1-HI13), Shrestha Sabina, S102 (P1-GN05), S102 (P1-GN06) Teka Hiwot, S77 (O3-PT05) S125 (P1-HI14) Simpao L., S180 (P2-TM03) Tesfaye Gezahagn, S77 (O3-PT05) Sahm D., S154 (P2-CE08), S154 (P2-CE09), Singh Taru, S91 (P1-CM06) Thamlikitkul V., S75 (O2-PT05), S145 (P2-AR01), S155 (P2-CE10), S156 (P2-CE13), Singkham-in Uthaibhorn, S107 (P1-GN17) S171 (P2-OT01) S157 (P2-CE14) Sirijatuphat R, S171 (P2-OT01) Thammahong A, S185 (P2-LB03) Salud V.M., S99 (P1-CM29) Sirijatuphat R., S75 (O2-PT05) Thammahong A., S119 (P1-GP06), Saluja D., S172 (P2-OT04) Sirilun S., S73 (O1-PT05), S125 (P1-HI14) S129 (P1-MM04) Salvaña E, S150 (P2-CC08) Slavin Monica, S5 (K-4), S50 (S8-4) Thangjui S., S185 (P2-LB04) Salvin K, S150 (P2-CC07) Smith Davey, S4 (K-3), S68 (S12-1) Tharavichitkul P., S125 (P1-HI13) Sapkota A., S130 (P1-MM07) So Hyejin, S110 (P1-GN28) Thongkam A, S185 (P2-LB03) Sapkota A., S131 (P1-MM08) Soh Sang Moon, S97 (P1-CM21) Thongthaisin A, S185 (P2-LB03) Sapri H, S74 (O2-PT02) Sohail A, S75(O2-PT06) Thursky K, S75 (O2-PT06) Sari D., S177 (P2-OT18) Sohn Jang Wook, S132 (P1-MM10) Tin G, S76 (O3-PT01) Sari IM., S183 (P2-TM12) Sohn JW, S117 (P1-GN48), S139 (P1-VR17) Titichoatrattana S., S185 (P2-LB04) Saw S, S94 (P1-CM17) Sohn Yong-Hak, S78 (O4-PT01) Tong T.Y.K., S83 (P1-BT03) Sax PE, S170 (P2-HV09) Sohn Yu Jin, S176 (P2-OT15) Tong Y., S77 (O3-PT04) Seah J, S179 (P2-OT23) Somani J, S127 (P1-HI18) Tonga C, S132 (P1-VA01) Seenama C., S145 (P2-AR01) Somani J., S74 (O2-PT04) Tran D.K., S100 (P1-CM31), S140 (P1-VR19) Seo Jinjong, S179 (P2-OT22) Son Hyo-Ju, S79 (O4-PT05) Tran N.B.V, S160 (P2-CE24) Seo Jungyu, S115 (P1-GN41), S115 (P1-GN42) Son K., S132 (P1-VA02) Tran N.H.T., S100 (P1-CM31), S140 (P1-VR19) Seo M, S71 (O1-PT02), S178 (P2-OT20) Son Y.K, S188 (P2-LB13) Tran N.V., S99 (P1-CM28) Seo Mi hee, S115 (P1-GN40) Song HJ, S146 (P2-AR04) Tribhuddarat C., S119 (P1-GP05), S125 (P1-HI13) Seo Mihee, S160 (P2-CE21) Song Jae-Hoon, S25 (P1-1) Trinh T.T.L., S109 (P1-GN23) Seo Min-ji, S127 (P1-HI19) Song JE, S159 (P2-CE18), S177 (P2-OT17), Truong Q.M, S160 (P2-CE24) Seo Mi-Ran, S97 (P1-CM22) S181 (P2-TM05) Seo YB, S137 (P1-VR14) Song J-H, S118 (P1-GP01) Uh Young, S44 (S7-3) Seok Hyeri, S127 (P1-HI19) Song Joon Seon, S79 (O4-PT05) Uirungroj P., S73 (O1-PT05), S125 (P1-HI13), Abstracts of the ICIC & ISAAR 2019 / Infection & Chemotherapy 2019 Sep;51 (Suppl 1):S191-S197 S197

S125 (P1-HI14) Wong L, S127 (P1-HI18) Yoo J.I., S120 (P1-GP08) Uirungroj T., S125 (P1-HI14) Wong L., S74 (O2-PT04), S175 (P2-OT12) Yoo Jae Il, S163 (P2-CE30), S164 (P2-CE31) Umur N, S105 (P1-GN14), S151 (P2-CC10) Wong PL, S75 (O2-PT06) Yoo Jeong Rae, S133 (P1-VR02), S151 (P2-CE01), Umur N., S129 (P1-MM03) Wong Eng Hwa, S101 (P1-GN03) S178 (P2-OT19) Unemo M., S108 (P1-GN21) Woo DH, S174 (P2-OT09) Yoo JH, S128 (P1-HI21), S130 (P1-MM05), Upadhyay E., S144 (P2-AG05) Woo JH, S86 (P1-BT12), S137 (P1-VR15), S131 (P1-MM09), S136 (P1-VR13) Upreti H., S144 (P2-AG05) S181 (P2-TM04) Yoo Jin-Hong, S22 (S3-3), S167 (P2-CE41) Ushijima H., S100 (P1-CM31), S140 (P1-VR19) Woo Jinhee, S133 (P1-VA03) Yoo Myeongsu, S167 (P2-HV01) Woo Jun Hee, S79 (O4-PT05) Yoo Reenar, S110 (P1-GN28) Valmoria K, S150 (P2-CC08) Woo Patrick, S49 (S8-3) Yoon Cheol-Hee, S168 (P2-HV03), S168 (P2-HV04) Vandekerckhove L, S169 (P2-HV08) Woyessa Adugna, S77 (O3-PT05), S89 (P1-CM02) Yoon Eun-Jeong, S44 (S7-3) Vellasamy KM, S85 (P1-BT10) Yoon In-Kyu, S15 (S2-1) Vidanagama D, S151 (P2-CC11) Yagi Tetsuya, S31 (S4-2) Yoon J.W., S166 (P2-CE40) Yang H.S, S188 (P2-LB13) Yoon JW, S88 (P1-BT16) Waitayangkoon P, S185 (P2-LB03) Yang S, S170 (P2-HV10) Yoon SS, S146 (P2-AR03), S146 (P2-AR04) Wang Hui, S53 (S9-2) Yang Soo-Jin, S146 (P2-AR02) Yoon Sung-Soo, S87 (P1-BT14) Wang HY, S170 (P2-HV09) Yang Su Jeong, S178 (P2-OT21) Yoon W, S137 (P1-VR15) Wangchinda W., S75 (O2-PT05) Yang Chih-Man, S126 (P1-HI17) Yoon YK, S78 (O4-PT02), S117 (P1-GN48), Wangchinda Walaiporn, S147 (P2-CC01) Yang S, S169 (P2-HV08) S139 (P1-VR17), S159 (P2-CE20) Wannigama DL, S90 (P1-CM05), S93 (P1-CM13) Yasdanpanah Y, S170 (P2-HV09) Yoon Young Kyung, S132 (P1-MM10) Wariyapola D, S150 (P2-CC07) Yeo J, S127 (P1-HI18) Yoon YS., S109 (P1-GN25) Weerasinghe Y, S123 (P1-HI08) Yeo J., S74 (O2-PT04), S175 (P2-OT12) Young K., S156 (P2-CE13), S157 (P2-CE14) Wei L, S170 (P2-HV10) Yeom Joon Sup, S18 (S2-4), S72 (O1-PT03), Yu IA, S123 (P1-HI09), S174 (P2-OT09) Wei V, S180 (P2-TM02) S143 (P2-AG04), S156 (P2-CE12), S159 (P2- Yu Yo han, S117 (P1-GN47) White K, S170 (P2-HV10) CE18), S162 (P2-CE26), S162 (P2-CE27), Yun Na-Ra, S90 (P1-CM03) Wi YM, S135 (P1-VR08), S182 (P2-TM10) S169 (P2-HV06), S176 (P2-OT15), Yun SC, S137 (P1-VR15) Widanagamage R, S123 (P1-HI08) S177 (P2-OT17), S181 (P2-TM05) Yun Seok-Min, S134 (P1-VR04) Wie Seong-Heon, S78 (O4-PT01) Yi HJ, S175 (P2-OT10) Wie SH, S130 (P1-MM05), S137 (P1-VR14) Yi S.Y., S90 (P1-CM04) Z.A. Nor Zanariah, S88 (P1-BT15) Wijesinghe W.A.B.N., S73 (O1-PT06) Yi Y, S128 (P1-HI21), S131 (P1-MM09), Zaidah M, S121 (P1-HI05) Willkom M, S170 (P2-HV10) S136 (P1-VR13) Zainal M, S151(P2-CC10) Won Eun Jeong, S153 (P2-CE06) Yi Yunmi, S167 (P2-CE41) Zaipul Anuar Nurul Fathiyah, S152 (P2-CE02) Won J, S171 (P2-HV11) Yim Jae-Joon, S28 (P2-1) Zaipul-Anuar N.F., S83 (P1-BT02) Wong C, S179 (P2-OT23) Yong Dongeun, S55 (S9-4), S72 (O1-PT03), Zamri HF, S182 (P2-TM09) Wong EH, S72 (O1-PT04) S126 (P1-HI16) Zewdie Ayele, S77 (O3-PT05) Wong K, S94 (P1-CM17) Yong PE Ow, S179 (P2-OT23)