122 / 210
S114
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
Ecology:
Escherichia coli
(
E. coli
) was the most common bacteria
(75%)
32% of
E. coli
were sensitive to most ATB
40% of
E. coli
were resistant to ampicillin and sensitive to
amoxicillin–clavulanic acid
28% of
E. coli
were resistant to quinolone
28% of
E. coli
were resistant to sulfa drug
0% of
E. coli
were resistant to nitrofurantoin.
A standard operating procedure (SOP) was performed according to
this ecology
Conclusion:
Information gathered from this study was helpful in
establishing SOP on a nursing home for GP to know when and
which antibiotics should be used.
P-310
Human lymphadenitis due to Corynebacterium
pseudotuberculosis: a case report
N. Denewet
1
, R. Demeester
2
, D. Famere
2
, J. Kengni Tameze
2
,
S. Higuet
2
1
CHU Charleroi, ULB, Uccle, Belgium;
2
CHU Charleroi, ULB, Lodelinsart,
Belgium
Objectives:
We report the case of a 82-year-old man who presented
a 15-day history of a single painful axillary adenitis, without fever,
weight loss or sweats.
Methods:
Physical examination of our patient was normal,
without hepatosplenomegaly or other adenitis. We noted a
dry cough. Initial laboratory evaluation was normal, serology
was negative for Brucella or Bartonella, imaging by computed
tomography (CT) showed patterns of pulmonary fibrosis,
micronodular anthracosilicosis, and a large (34mm) left axillary
lymphadenopathy.
Results:
The lymph node was excised and bacterial cultures allowed
to identify C. pseudotuberculosis. Histopathology examination
showed an adenitis (dimension 2.5
×
1.5
×
1.5 cm) containing
necrotic, granulomatous and abscess material. PCR was negative for
Bartonella, Mycobacterium tuberculosis or atypical Mycobacteria.
The patient was treated with amoxicillin antibiotherapy. Medical
history review of the patient confirmed he had been skinning a
sheep four months ago.
Conclusions:
C. pseudotuberculosis is a nonmotile, gram-positive
small bacillus that grows both aerobically and anaerobically. Most
of the cases of human lymphadenitis due to C. pseudotuberculosis
have been reported in Australia, usually in those who have
been occupationally exposed to sheep. Axillary lymphadenitis
predominates, presumably because the hands and arms are
frequently the site of primary infection. Histopathology features
of human lymph nodes infected by C. pseudotuberculosis are
variable and are characterized by necrotizing and suppurative
granulomatous lympadenitis. Cases of suppurative lymphadenitis
might be treated by incision and drainage, along with
antibiotherapy. C. pseudotuberculosis is susceptible to penicillin
and other antibiotics that are active against gram-positive bacteria
or have broad-spectrum activity.
P-311
Ramsay Hunt Syndrome
–
a case report
J.P. Figueiredo Gomes
1
, H. Temido
2
, D. Donaire
3
, M. Petrova
1
,
B. Barbosa
1
, M. Teixeira Ver´ıssimo
1
, A. Carvalho
1
1
CHUC, Coimbra, Portugal;
2
Centro Hospitalar e Universit´ario de
Coimbra, Coimbra, Portugal;
3
CHUC, Coimbra
Introduction:
Ramsay Hunt Syndrome is a rare condition caused
by the Varicela-Zoster Virus (VZV), which is characterized by facial
palsy with associated erythematovesicular rash of the pinna or
mouth. This syndrome is the second most common aetiology for
non-traumatic peripheral facial palsy, and is diagnosed based on
the patient’s clinical history and physical examination.
Case report:
The case we describe refers to a 70 years old white man
that presents at the hospital with oral pain, left unilateral otalgia
and facial asymmetry; all of which had started 3 days prior to
presenting to hospital. He had essential hypertension, dyslipidemia
and was overweight (BMI = 28.125 kg/m
2
). He was medicated with
a combination of lisinopril 20mg and amlodipine 5mg, once a day.
The physical examination revealed left palsy with palpebral ptosis
and Bell’s sign, and vesicular rash on soft and hard left palates.
There was no sign of disease in the ear. It was presumed that
was Ramsay Hunt Syndrome and the patient was medicated with
deflazacorte 60mg and acyclovir 500mg once a day, for 7 days.
One month later, he was reassessed in consultation and he still
presented with facial palsy, having recovered from the remaining
symptomatology. The serologic evaluation shown elevated titles of
VZV antibodies [IgG 3308 (positive
>
165); IgM
>
2.3 (positive
>
1.1)].
Conclusion:
Ramsay Hunt Syndrome is a benign aetiology of facial
palsy, but it has a poor prognosis in the elderly, especially if the
treatment is delayed or the patient has elevated arterial blood
pressure.
P-312
Antimicrobial therapy assessment in four health centers from
2010 to 2014
M. Hernandez
1
, L. Puerta
1
, A. Augusti
2
, B. Llagostera
1
, C. Plana
3
,
C. Mestres
1
1
Grup Mutuam, Barcelona, Spain;
2
Grup Mutuam, Girona, Spain;
3
Grup Mutuam, Tarragona, Spain
Objectives:
Assess antimicrobials use in subacute-longterm care
during the last five years, depending on the different types of
patients.
Identify differences in:
•
Group of antimicrobials used
•
Length of treatment
•
Administration route
Material and Methods:
•
Evaluation period: 2010–2014.
•
Beds of the centers included: G ¨uell 165, Girona 97, Vilaseca 25
and Diagonal 17.
•
Data obtained from the management program and prescription
application.
•
DDD/100 stays were calculated according to antimicrobial group
ATC-classification, antimicrobial, typology of patient and length
of treatment.
Results:
Mean age 80.4 years (62.4% women). The percentage of
patients/year with antimicrobial treatment has ranged between
33% and 40%; 47% and 54%; 10% and 28%; 54% and 69% per center.
The DDD/100 stays have remained constant in Girona (12.81), and
Diagonal (18.02) but have increased in G ¨uell, from 26 in 2010 to
52.1 in 2014, and Vilaseca, from 3.8 to 8.4.
Mean length of treatment 10.5 days. Parenteral route in Girona and
G ¨uell is stepping out.
Antimicrobial most used was penicillin/beta-lactamase inhibitors
(amoxicillin/clavulanic) in all centers. Also stand out quinolones
and fosfomycin. In recent years the use of fourth generation
cephalosporins, metronidazole and monobactam has increased.
Conclusions:
Incidence of antimicrobial treatments remains high.
Antimicrobial use follows the Antimicrobial Treatments Guideline
of Group Mutuam im relation to the most prevalent infections
(urinary and respiratory). Decrease of treatment days related to
fosfomycin high use. Complexity of patients referred to geriatric
hospitals is increasing, shown by the increasing use of intravenous
route and antimicrobials for multiresistant bacteria.