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December 2015. Clinic documentation, MDT outcome and imaging

were reviewed.


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


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


, Georgina Gethin


, Deirdre Hughes-Fitzgerald



Hilary Humphreys




Beaumont Hospital /RCSI,


NUI Galway,




RCSI/Beaumont Hospital


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.


To compare the efficacy of MGH to mupirocin 2%

to eradicate nasal MRSA.


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.


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


= 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


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


, Helmi Sulaiman


, Nadia Atiya



Adeeba Kamarulzaman




University Malaya Medical Centre,



Malaya Medical Center,


University Medical Center


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.


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.


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


ID: 4873

Evaluation of a pharmacist review of patients with Clostridium

difficile infection

Danielle Stacey.

Dudley Group NHS Foundation Trust


A specialist pharmacist was seconded to support the

management of Clostridium difficile infection (CDI).


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)



The pharmacist reviewed CDI patients, aiming to improve

outcomes. Outcomes were compared with similar cases in the

previous year.


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


, Sonia Mellor


, Dawn Westmoreland



Jennie Lovell


, Martha Bird




Kettering General Hospital Foundation







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