Safety and efficacy of outpatient parenteral antimicrobial therapy
(OPAT) for infective endocarditis: a retrospective analysis
, Oliver Koch
, Claire Mackintosh
NHS Lothian, University of Edinburgh,
Infective endocarditis (IE) is known for both its
diagnostic difficulties and continued association with high mortality
and severe complications despite improvements in management. IE
is treated with antibiotics and, according to the European Society of
Cardiology guidelines, some cases may be amenable to Outpatient
Parenteral Antimicrobial therapy (OPAT). However, there is currently
little literature available on the use of OPAT for IE.
This study aims to determine the safety and
efficacy of OPAT in treating IE.
All 43 IE patients (50 episodes) referred to the NHS Lothian
OPAT clinic were reviewed, the gathered data analysed and Duke
criteria fulfilment noted where possible.
The mean patient age was 58 years, 27/43 were male and
41/43 were accepted to OPAT. Streptococci spp. were the infective
organism in 23/50 episodes, with 9/50 and 4/50 for Staphylococcus
spp. and Enterococcus spp. respectively. 11/50 episodes were pros-
thetic valve IE. 21/43 patients had a relevant co-morbidity. Adverse
events were recorded for 8/50 episodes, of which 5 were drug-related
and resolved with treatment change. 4 patients required elective valve
replacement surgery following OPAT discharge. Of the 48 episodes
completed over 3 months ago, there were 3 deaths, including both
patients not accepted to OPAT, and one death due to unrelated causes.
Discussion and/or Conclusion(s):
Therefore, in a selected group, it is
possible to successfully treat IE using OPAT and thus reduce the
number of inpatient days associated with this condition. This could
potentially allowmore cost-effective use of resources as well as reduce
risks associated with prolonged hospitalisation.
Food for thought: An unusual cause of mycotic aneurysm
, Emma O
, James Dunbar
South Tees NHS Foundation Trust
Non-typhoidal salmonella, NTS, infection commonly
causes gastroenteritis after ingesting contaminated food. Bacteraemia
is unusual and is associated with immunosuppression. The incidence
of NTS bacteraemia increased with the HIV epidemic but as potent
immunosuppressant medications become more widely used these
patients will also be at risk.
We present a case of recurrent NTS bacteraemia
with a mycotic aortic aneurysm in a patient taking methotrexate.
Case report: A 69-year-old man presented with fever and
right flank pain, one month after starting methotrexate for Wegener
granulomatosis. Other co morbidities included angina, atrial fibrilla-
tion and chronic kidney disease.
Blood cultures grew Salmonella enteritidis. It transpired he been
treated 4 months earlier for a bacteraemiawith the same organism. CT
showed a dissecting aneurysm of the abdominal aorta extending to the
right common iliac artery, which was too large for surgical interven-
tion. A plan was made for lifelong antibiotic suppression.
His treatment was complicated by pancytopenia with
ceftriaxone and seizures whilst on ciprofloxacin. He changed to
trimethoprim and amoxicillin but repeat CT scan at 4 weeks showed
progression of the dissection. He continued treatment but died 6
Discussion and/or Conclusion(s):
NTS bacteraemia should prompt
investigation for immunosuppression as well as a search for an
Mycotic aneurysms with NTS have a high mortality. Surgical repair
with an extended course of appropriate antibiotics is recommended.
Patients may need lifelong suppressive treatment, which may be
difficult to tolerate. Even with surgical resection of some infected
material antibiotic suppression may still fail.
Management of meningitis at a large teaching hospital: a clinical
India Wheeler, Libuse Ratcliffe, Kate Vaudrey, Sylviane Defres.
Liverpool University Hospital
Bacterial meningitis and meningococcal sepsis are
rare but important conditions associated with serious morbidity
and mortality. Early recognition and treatment is essential to
minimize deleterious effects. Management relies on appropriate use
of neuroimaging, lumbar punctures (LPs) and prompt antibiotic
therapy to avoid delayed treatment as exemplified in recent
To investigate the management of meningitis in
adults (>18 years) since the publication of updated UK joint specialist
A retrospective audit of electronic and paper case notes
from January 2015- June 2016 against current guidelines.
We reviewed 15 records; 73.3% (11) of patients entered
through A&E, 11 (73.3%) were female with mean age of 40.3 years (SD:
17.65). Of those reviewed; 8 (53.3%) were likely bacterial meningitis: 4
(27%) pneumococcal, 1 (6.6%) HSV 1, 1 (6.6%) pharyngitis and 1 (6.6%)
Immediate LP was contraindicated in 26.7% (4) of cases. Immediate LP
was carried out in 20% (2) of thosewith no contraindication. No LP was
performed within 1 hour.
Antibiotics were administered at a median time of 274 minutes after
arrival to hospital (IQR: 123
571 minutes). Only 7.1% (1) of patients
had a LP before antibiotics.
Discussion and/or Conclusion(s):
The results from this audit reveal
delays in the initial management of suspected meningitis; this could
be in part due to route of admission to hospital. It appears that the new
guidelines have not had an impact but this may be due to lack of
awareness in hospital departments. This issue could be addressed
nationally through wider awareness campaigns.
Adenovirus minigene vectors and novel vaccination strategies
, Burkhard Ludewig
, Paul Klenerman
Hospitals NHS Foundation Trust,
Kantonsspital St. Gallen, Institute of
NDM, University of Oxford
T cell memory inflation is a striking immunological
response, first reported in murine cytomegalovirus (MCMV) infection
and subsequently in human CMV (HCMV). It describes certain
T cell responses that gradually increase over
time and are maintained as functional effector memory populations in
blood and tissues. These populations are of potential relevance to
vaccine design. However, only a limited set of epitopes exhibit such
responses, and thus directing these remains an issue.
We have developed a simple and tractable
adenoviral model to define the critical rules governing epitope-
specific memory inflation, which in parallel informs us further on
adenoviral vaccine T cell responses. We tested whether minimal
epitope-insert adenoviral vectors (called
provide effective, targeted vaccine responses against a range of
Vectors containing the Gp33 epitope (minigene) and full
Gp protein, from Lymphocytic Choriomeningitis Virus (LCMV), were
developed and tested in vivo.
Abstracts of FIS/HIS 2016
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24