9th International Conference on Emerging Infectious Diseases August 27-28, 2018 Hilton Zurich Airport, Zurich, Switzerland

Elsie Uduak Onwunhafua is a Fellow in College of Veterinary Surgeons, Nigeria. Her academic career in the veterinary profession started 25 years ago in the Ahmadu Bello University, Zaria, Nigeria where she obtained the Degree of Doctor of Veterinary Medicine; Master’s and Doctor of Philosophy in Veterinary Public Health and Preventive Medicine. At present she is an Equine Surgeon and Equitation Tutor at the Nigerian Defence Academy. She has many publications to her credit in reputable journals and is the Author of a book titled “Molecular Identification of Yeasts Associated with Bovine Mastitis”.

The Lassa fever season has lasted longer and generated more cases and deaths than expected in Nigeria since last year. A cross sectional study was designed to assess knowledge, attitude and practice of shop owners of four community markets in a military barrack in Kaduna State, Nigeria towards Lassa fever virus. Structured questionnaires were prepared and administered to 200 respondents by face to face interview. The questionnaire sought information on demographic characteristics of the respondents, Lassa fever awareness, knowledge, attitude and practice towards Lassa fever virus. Associations between demographic variables and categorized knowledge, attitude or practice scores were assessed using χ2 analysis. The mean knowledge score of respondents was 11.5 out of 16 items scored, 5.6 out of 9 for attitude and 5.2 out of 7 in the practice of the respondents towards Lassa fever virus. Among the 200 respondents, 128 (64%) knew that Lassa fever virus is a highly infectious viral disease and 153 (76.5%) knew it is found in rats. Also, 190 (95%) said they will go to the hospital if they have symptoms while, all of them agreed it is good to wash hands often. Respondents who had tertiary education were 0.2 times more likely to have good knowledge (OR=0.23, 95% CI on OR=0.13-0.54) than those with less education. Positive attitude towards Lassa fever virus improved with increase in the level of education, as respondents with no formal education were more likely to have negative attitude (OR=2.04, 95% CI on OR=0.66-6.33). Respondents in community market four (CM-4) were 2.45 times more likely to have good practice than respondents in other community markets. The findings in this study show that the respondents have a good knowledge, positive attitude and practice towards Lassa fever virus nonetheless, awareness programs should continue; proper medical care should be provided for the sick and protective gears should be available to health care workers. Prevention of Lassa fever largely relies on community engagement and promoting hygienic conditions to discourage rodents in the surroundings.

David Blihar accepted his BS in the fields of Human Biology and Chemistry from the University of Wisconsin – Green Bay (UWGB). He is currently a second term medical student at Saint George University – Grenada. He is also a member of the Medical Student Research Institute (MSRI) where he currently works under Dr. Kotelnikova researching case studies of rarely reported microbiological pathogens and associated virulence factors. He has actively been involved in private education with UWGB and Tutor Doctor since 2012 and 2015, respectively, and sat on various safety and training councils within ThedaCare and HSHS hospital systems.

A 31-year-old female was admitted via the emergency department on October 26, 2017 with sudden onset of abdominal pain, fever, chills, and malaise. She had a history of laparoscopic cholecystectomy in 2008 and post operatively developed a bile leak requiring biliary stents. Three years later, she developed hepatic cysts which were surgically extirpated in 2011 and 2012. She remained asymptomatic with occasional mild right upper quadrant pain without fevers until the current presentation. Importantly, she had no history of any previously reported risk factors for R. planticola infection, a rarely reported pathogen of gastrointestinal origin, including solid organ, hematologic malignancy, chemotherapy, transplantation neutropenia, cirrhosis, seafood ingestion, nor proton pump inhibitor use. Physical examination revealed she was afebrile, anicteric, had slight diffuse abdominal tenderness on palpation, and showed signs of moderate distress with abdominal pain. Computer tomography and magnetic resonance cholangiopancreatography (MRCP) showed dilated right intrahepatic biliary ducts with evidence of a surgically absent gall bladder. Biliary sepsis and bacteremia due to intrahepatic duct stricture were suspected and piperacillin/ tazobactam therapy was started. Blood cultures reported positive and the isolate was reported as R. planticola on the third hospital day. The isolate was resistant to ampicillin and piperacillin. Therapy was changed to ceftriaxone 2 grams parenterally. She quickly improved clinically and was discharged on home therapy with referral for subsequent evaluation and treatment of the intrahepatic duct strictures.

Zinat Mohebbi completed her PhD in Nursing from Shiraz University of Medical Sciences (SUMS) in Iran. She is the Faculty Member of SUMS and has the history of teaching for over 20 years. She published more than 50 papers in several journals and has been seving as an Editorial Board Member of International Journal of Community Based Nursing and Midwifery.

Surgical site infection (SSI), as one of the most common nosocomial infections, detrimentally influences the outcome of surgical treatment. SSIs are a common cause of nosocomial infection, accounting for 38% of nosocomial infections. A SSI is an infection that occurs after surgery in the part of the body where the surgery took place. Overall risk of SSI is 2–5% out of more than 30 million patients undergoing surgical procedures each year. The Centers for Disease Control and Prevention (CDC) estimates that 22% of all health care associated infections are SSIs. In Iran, such infection comprises 17.4% compared with the 14% quoted in literature. Median SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor related and transplant surgeries. In a study performed in Ethiopia, prevalence rate of post-surgical wound infections was reported to be 75% and 82% of these infections were multi drug resistant. In another study in Canada, 9% of the patients undergoing cesarean section (CS) experienced post surgical infections and the main cause of infectious complications (Ics) was reported to be under use of antibiotics. One study was done with purpose of assessment of the prevalence of post operation orthopedic wound infection in the orthopedic surgical ward of Motahari Hospital in Iran. Prevalence of orthopedic infection was 8.8%. Chi-square test showed significant correlation between SSI and days of hospitalization. In another study in Iran the rate of SSI of clean contaminated wounds was 53%. The most common gram positive microorganism was Staphylococcus aureus (22%) and among gram negative: Escherichia coli (26%), Klebsiella sp., (26%) and Pseudomonas sp., (25%). Significant correlation between the type of surgery and SSI was found, it was not seen with the sex and surgical procedure. Data from the United Kingdom quantify the impact of being overweight or obese on the risk of infection in knee and hip replacement, with elevation in SSI rates from 0.4% to 1%. These infections are associated with substantial morbidity and mortality, prolonged hospital stay and increased patient cost. Patients with SSI also utilized more healthcare resources, including out patient and emergency department visits, radiology and home health aids. They were also re-admitted more frequently. Approximately 8000 patient deaths are associated with these infections. However, healthcare costs for a patient with SSI are on average, approximately twice the amount of costs for a patient without a SSI. A CDC estimate from 2001 suggests that approximately 290,000 SSIs occur annually in the United States, resulting in $1 billion to $10 billion in direct and indirect medical costs. In addition, there were too few studies available to map economic consequences of SSI accurately. The studies were performed in hospitals in Europe (UK, Turkey, Spain, Switzerland and France), the USA, Asia (Taiwan and Thailand) and New Zealand. There was considerable variation between study methods in several respects. In various studies antibiotic prophylaxis reduce the SSI.

Apichai Srijan is a Senior Microbiologist at the Armed Forces Research Institute of Medical Sciences. He has his expertise in enteric diseases and antimicrobial resistance studies for more than 30 years. As an independent investigator, he develops the new research proposals, submit the proposals/protocols, get the research funding and progress the report and publish findings. As a Senior Microbiological Consultant, he provides microbiology support to research studies in the department; provide training to new technicians and/or visitors; refresh laboratory practices to other technicians and provide training and field laboratory setup. As a Field Coordinator, he is responsible for POC supply request, specimen receiving and transferring with sites etc. He is also responsible for preparation of manuscript and generating publication.

Multidrug resistant (MDR) gram-negative ESKAPE pathogens are one of the biggest threats to global public health and infections due to MDR strains resulting in a significant healthcare burden. We collected 150 clinical isolates of MDR gram negative ESKAPE pathogens at Queen Sirikit Naval Hospital in Thailand from October 2016 - May 2017, performed isolate whole genome sequencing (WGS), and determined epidemiology by in silico multi-locus sequence typing (MLST) techniques. All 32 (100%) of identified A. baumannii isolates were extremely drug resistant (XDR) and harbored atleast one carbapenemase gene (31/32 carried blaOXA-23, 1/32 carried blaNDM-1). MLST analysis showed 24/32 (75%) A. baumannii were assigned to ST-2, a prominent global strain. A total of 43 XDR K. pneumoniae isolates were identified with 43/43 (100%) of the isolates harboring CTX-M ESBL gene variants (blaCTX-M-15 (93%),-27, or -55). The carbapenemase genes blaNDM-1 and blaOXA-48 variants were found in 30/43 (69.8%), with 29/43 (67%) carrying both. Moreover, two K. pneumoniae isolates carried the transferable colistin resistance gene mcr-1. MLST analysis showed 31/43 (72.1%) K. pneumoniae isolates belong to ST-16. A total of 84 drug resistant E. coli isolates were identified with 79/84 (94%) carrying at least one extended spectrum β-lactamase (ESBL) gene (blaCTX-M-14,-15, -27, -55, or blaVER-5). The carbapenemases blaNDM-4 and blaKPC-2 were each detected in a single E. coli isolate. MSLT analysis of the 84 E. coli isolates separated them into 22 different ST groups with three primary STS: 33/84 (40%) ST-131, 10/84 (12%) ST-1193 and 8/84 (9.5%) ST-648. The identification and characterization of these pathogens demonstrates the spread of gram-negative ESKAPE pathogens at Queen Sirikit Naval Hospital. These findings serve to highlight the urgent need for continued surveillance and intervention measures of XDR bacterial pathogens, especially A. baumannii ST-2 and K. pneumoniae ST-16 in Thailand and Southeast Asia.

Sirigade Ruekit is a Medical Research Technologist at the Armed Forces Research Institute of Medical Sciences. She is interested in multidrug resistance genes and molecular typing in enteric pathogens. For molecular typing, she performs and evaluate capsular typing of Campylobacter jejuni isolates by multiplex PCR and real-time PCR assays. For multidrug resistance studies, she perform and evaluate PCR and real-time PCR for extended spectrum of beta-lactamase resistance genes, carbapenemase genes, methicillin resistant gene and vancomycin resistance genes among enteric bacteria. She also performs DNA sequencing and analysis of DNA sequences to detect resistant gene mutation. For molecular training, she provides training to new technicians and/or visitors, update molecular technique to other technicians and provide training for co-laboratory. She is also responsible for preparing manuscript and generate publication.

Aim: ESKAPE pathogens, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp., (and E. coli in this study) are multidrug-resistant (MDR) bacteria with increasing challenges for healthcare institutions worldwide and recognized as one of the greatest threats to humans. This study report the prevalence of ESKAPE pathogens and molecular characterization of the resistant genes in these organisms. Methods: 429 ESKAPE bacteria were isolated from clinical samples as part of active surveillance study in Queen Sirikit Naval Hospital, Chonburi, Thailand. Resistant strains reported through BD Phoenix System based on CLSI guidelines. Molecular characterizations of resistant genes were performed by PCR and Real-time PCR assays. Results: Prevalence of MDR - E. faecium, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, Enterobacter spp., and E. coli were 1.2%, 4.0%, 24.9%, 22.6%, 4.7%, 42.4%, respectively. Percentage of vancomycin resistance Enterococcus (VRE) and methicillin resistance S. aureus (MRSA) were 83.3% and 76.5%, respectively. Carbapenem, ESBL, and colistin resistance in gram negative (GN)-ESKAPE pathogens were detected in 46.7%, 93.4%, and 3.0% respectively. The resistant genes detected in ESKAPE pathogens were as follows; vanA 100% in VRE; mecA 100% in MRSA isolates. Carbapenem resistance in A. baumannii, K. pneumoniae, P. aeruginosa, Enterobacter and E. coli isolates were 49.5%, 35.3%, 7.9%, and 7.4%, respectively. Carbapenem resistant genes in GN-ESKAPE bacteria were; blaNDM 36.8%, blaOXA-48 family 27.4%, blaVIM 1.1% and blaKPC 0.5%, respectively. ESBL genes detected in this study were; blaSHV, blaOXA, blaCTX-M, blaDHA, blaCMY, blaPER and blaVER. Among 12 colistin resistant isolates, mcr-1 gene was detected in five E. coli and three K. pneumoniae isolates. Conclusion: The continuous surveillance should be performed periodically in order to evaluate the prevalence of MDRESKAPE pathogens. The importance of this study is to prevent hospital-acquired infections, as well as greater antibiotic prescribing control in the hospital.