102 / 150
December 2015. Clinic documentation, MDT outcome and imaging
were reviewed.
Results:
49 patients treated. Vancomycin 1 g in stimulan in 7 patients
and 42 with vancomycin and gentamicin 240mg. 38/49 forefoot, 9/49
hindfoot and 2/49 midfoot.
A multitude of organisms were identified including staphylococcus
aureus, citrobacter, pseudomonas, haemolytic streptococcus, e. coli
and enterococcus.
All patients were discussed at MDT. Patients received augmentin and
the antibiotics were changed based on microbiology results.
86% (42/49) had no further surgery within 6 months. 14% (7/49)
patients went on to have further surgery linked to their initial
procedure.
Follow up 6 months
–
24 months.
Discussion and/or Conclusion(s):
In our experience, antibiotic loaded
stimulan provides safe and effective local delivery of high concen-
tration antibiotics in the presence of osteomyelitis reducing the need
for more extensive surgery in a compliant patient.
ID: 4765
A randomised controlled trial to compare medical grade honey
with mupirocin for MRSA decolonisation
Toney Thomas
1
, Georgina Gethin
2
, Deirdre Hughes-Fitzgerald
3
,
Hilary Humphreys
4
.
1
Beaumont Hospital /RCSI,
2
NUI Galway,
3
RCSI,
4
RCSI/Beaumont Hospital
Background:
Mupirocin is an important component in MRSA control
specifically for nasal decolonisation but resistance limits its use.
Medical grade honey (MGH) is used for the treatment of burns and
infected wounds. The antimicrobial activity of natural honey may
offer potential in MRSA eradication. We report the results of a RCT on
nasal MRSA decolonisation.
Aim(s)/Objective(s):
To compare the efficacy of MGH to mupirocin 2%
to eradicate nasal MRSA.
Method(s):
MRSA colonised patients were recruited and MGH 30% or
mupirocin 2% was applied intra-nasally. Up to two courses of either
treatment, TDS for five days, was administered. Three consecutive
negative MRSA screening results confirmed successful decolonisation.
Results:
The mean age was 73.2 y and 36% female. Of the 100 study
participants 93% were previously known MRSA, 89% had a history of
attempted decolonisation with 34% receiving two or >courses of nasal
mupirocin, 43% had concomitant MDRO colonisation and 68% non-
nasal site MRSA. In total 57% (57) were isolated either in a single room
or were cohorted with contact precautions. Of the 86 participants who
completed the study protocol, 36% (18) in the intervention group and
50% (25) in the control groupwere decolonised (P = 0.196, c
2
= 1.675) in
an ITT analysis. The success rate for MGH and mupirocin was 43% and
57% respectively, according to the PP analysis. Fourteen participants
were lost on follow up, withdrawn or deviated from the allocated
protocol.
Discussion and/or Conclusion(s):
The first of its type RCTo results
confirm the potential of MGH. However, further work is required to
replicate the findings and optimise the concentration of MGH.
ID: 4843
Observational study on Klebsiella pneumoniae bacteraemia at
University Malaya Medical Center
Shaharudeen Kamaludeen
1
, Helmi Sulaiman
2
, Nadia Atiya
2
,
Adeeba Kamarulzaman
3
.
1
University Malaya Medical Centre,
2
University
Malaya Medical Center,
3
University Medical Center
Background:
Klebsiella pneumoniae is a common gram negative
bacteria causing infection and it is associated with high mortality. The
incidence of Klebsiella pneumoniae bacteraemia (KPB) is increasing in
trend and although many regional studies have been conducted on
KPB, the data in Malaysia is limited.
Method(s):
This is a retrospective study from May 2014 to April 2015,
that analysed 127 patients with KPB, to identify the demographic
factors, risk factors and outcomes associated with this infection. Cases
were identified from the microbiology laboratory database. Organism
identification and antimicrobial susceptibility testing were performed
using VITEK 2 automated system.
Results:
KPB occurred predominantly in the elderly age group in both
community onset (CO) and nosocomial-onset (NO) infections; 62.5
and 64 years old respectively and diabetes predominates in both
the groups (CO, 63.9%; NO, 43.6%). NO-KPB showed significantly
higher ICU admission rates, and longer hospital and ICU stays. The
commonest identifiable site of infection was pneumonia (CO 22.2%;
NO 38.2%). The rate of liver abscess in CO and NO-KPB was 8.3%
and 3.6% respectively. Antibiotics exposure up to one month prior to
current infection (p < 0.001), and presence of foreign body (p < 0.001)
were associated with a resistant phenotype (ESBL/CRE). APACHE II
score (OR 1.168, 95%CI 1.045
–
1.306; p = 0.006) and time to appropriate
antibiotic therapy (OR 0.549, 95%CI 0.347
–
0.868; p = 0.01) were
associated with 30 days mortality.
Discussion and/or Conclusion(s):
Severity of illness and time to
appropriate antibiotics were associated with mortality. Identifying
microorganism and sensitivity at a shorter time interval and
streamlining antibiotics according to sensitivity results may reduce
mortality.
ID: 4873
Evaluation of a pharmacist review of patients with Clostridium
difficile infection
Danielle Stacey.
Dudley Group NHS Foundation Trust
Background:
A specialist pharmacist was seconded to support the
management of Clostridium difficile infection (CDI).
Aim(s)/Objective(s):
Measures for improvement were time to reso-
lution (TTR) of diarrhoea, 30 day mortality, length of stay (LOS)
and adherence to antimicrobial and proton-pump inhibitor (PPI)
guidelines.
Method(s):
The pharmacist reviewed CDI patients, aiming to improve
outcomes. Outcomes were compared with similar cases in the
previous year.
Results:
•
42/56 (75%) patients were reviewed by pharmacist
•
83% (35/42) required some intervention
•
TTRof diarrhoeawas 1.4 days shorter in the intervention group (5.9
vs 4.5 days)
•
LOS was 27.9 days in the pre-intervention group and 35 days in the
intervention group. It was noted that both groups had discharges
delayed for reasons other than CDI
•
For patients with recurrent CDI, TTR of diarrhoea was reduced by
6.6 days and length of stay decreased by 8.4 days
•
30 day mortality reduced from 20% to 7%, although significance of
this is unclear
•
Appropriate antimicrobial therapy within 72 hours increased from
88% to 100%.
•
PPI review documentation increased from 58% to 100%.
Discussion and/or Conclusion(s):
Appropriate antibiotic prescribing
and PPI review demonstrate the quality benefits to patients, as well
as improvement in TTR of diarrhoea. There are also organisational
benefits: duration of isolation precautions can be reduced. As well as
considerable reduction in TTR of symptoms in patients with recurrent
CDI, earlier dischargewas expedited, saving and estimated 56 bed days
over 3 months.
Overall, the evaluation supports the value of pharmacist management
of CDI and led to permanent recruitment of the post.
ID: 4881
On board the best practice express
– “
Diarrhoea roadshow
”
Manjula Natarajan
1
, Sonia Mellor
2
, Dawn Westmoreland
2
,
Jennie Lovell
3
, Martha Bird
3
.
1
Kettering General Hospital Foundation
Trust,
2
KGH FT,
3
KGHFT
Background:
KGH had a trajectory of 26 trust-attributed cases of C.
difficile infection (CDI) for 2015/16. By 7 months, we had 20 cases. Root
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S97