The Journal of Hospital Infection - Supplement 1

ID: 5156

Safety and efficacy of outpatient parenteral antimicrobial therapy

(OPAT) for infective endocarditis: a retrospective analysis

Judith Oguguo

, Oliver Koch

, Claire Mackintosh

University of

Edinburgh,

NHS Lothian, University of Edinburgh,

NHS Lothian

Background:

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.

Aim(s)/Objective(s):

This study aims to determine the safety and

efficacy of OPAT in treating IE.

Method(s):

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.

Results:

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.

ID: 5174

Food for thought: An unusual cause of mycotic aneurysm

Helena Bond

, Emma O

’

Cofaigh

, James Dunbar

Friarage hospital,

South Tees NHS Foundation Trust

Background:

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.

Aim(s)/Objective(s):

We present a case of recurrent NTS bacteraemia

with a mycotic aortic aneurysm in a patient taking methotrexate.

Method(s):

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.

Results:

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

weeks later.

Discussion and/or Conclusion(s):

NTS bacteraemia should prompt

investigation for immunosuppression as well as a search for an

underlying source.

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.

ID: 5178

Management of meningitis at a large teaching hospital: a clinical

audit

India Wheeler, Libuse Ratcliffe, Kate Vaudrey, Sylviane Defres.

Royal

Liverpool University Hospital

Background:

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

guidelines.

Aim(s)/Objective(s):

To investigate the management of meningitis in

adults (>18 years) since the publication of updated UK joint specialist

societies guidelines.

Method(s):

A retrospective audit of electronic and paper case notes

from January 2015- June 2016 against current guidelines.

Results:

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%)

migraine.

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.

Topic: Immunisation

ID: 4684

Adenovirus minigene vectors and novel vaccination strategies

Julia Colston

, Burkhard Ludewig

, Paul Klenerman

Oxford University

Hospitals NHS Foundation Trust,

Kantonsspital St. Gallen, Institute of

Immunobiology,

NDM, University of Oxford

Background:

CD8

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

epitope-specific CD8

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.

Aim(s)/Objective(s):

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

“

minigene vectors

”

), can

provide effective, targeted vaccine responses against a range of

epitopes.

Method(s):

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

–

S134

S101