The Journal of Hospital Infection - Supplement 1

Method(s):

During December 2015 three patients on the ward tested

positive on the same day for RSV with one case discharged home,

one asymptomatic case remaining on the ward and the final case

nursed with infection control precautions in place due to the presence

of symptoms. An outbreak was declared and theward closed to admis-

sions/transfers when a fourth patient case was confirmed. Infection

control precautions included patient and staff screening, isolation/

cohorting of cases, exclusion of symptomatic staff and personal protec-

tive equipment (including surgical face masks). Over the course of the

outbreak the situationwas assessed by an outbreak control team using

the hospital infection incident assessment tool (HIIAT).

Results:

A total of 8 patients and 2 staff tested positive during the

outbreak. Four patient cases required treatment with Ribavarin and

immunoglobulin. The ward remained closed for a total of 8 days,

reopeningwhen theoutbreakwas declaredover. Asymptomatic patient

carriers were detected and possibly contributed to ongoing cross

transmission.

Discussion and/or Conclusion(s):

A review undertaken has provided

recommendations including, isolation of a patient when symptoms

first detected, exploration of near patient testing and development of

an early alert to highlight increased incidence in the community

setting. In high risk patient groups asymptomatic carriage is an

important consideration.

ID: 4853

A Tale of Three Cities

–

Lessons from three outbreaks of

Pneumocystis jirovecii

Lindsay Chesterton

, Richard Puleston

, Tim Boswell

Efitia Yiannakis

, Philip Monk

, Katherine Packham

Derby Teaching

Hospitals NHS Foundation Trust,

Public Health England, Field

Epidemiology Service East Midlands,

Nottingham University Hospitals

NHS Trust,

Worcestershire Acute Hospitals NHS Trust,

Public Health

England, East Midlands,

Public Health England

Background:

Pneumocystis jirovecii

is a serious opportunistic fungal

infection of immunosuppressed patients. Its incidence is increasing

in England. Previously associated with HIV/Aids it is increasingly

recognised in patients immunosuppressed due to cancer/transplant

treatment.

Aim(s)/Objective(s):

We describe the learning from investigating 3

outbreaks in one region, including diagnostic approaches, the avail-

ability, utility and interpretation of genotyping, the role of environ-

mental sampling and control measures. We also describe the current

national surveillance for fungal infections, including

Pneumocystis

jirovecii

Method(s):

Each incident was identified through clinical recognition

and hospital based surveillance. Outbreaks were declared and control

teams formed. Descriptive epidemiology and analytical case-control

studies were undertaken. Genotyping was undertaken in 2 incidents.

Limited environmental investigations were undertaken for one and

detailed, repeated environmental sampling undertaken in another.

PCR combined with clinical and radiological findings was used for

diagnosis.

Results:

Three outbreaks were identified (2012

–

2015) across three

different teaching hospitals in one region (2 renal units and 1 across

multiple specialities). 25, 88 and 12 patients were identified in the

respective outbreaks. Genotyping was available for 2, showing

clonality in the isolates obtained. Environmental deposition was

identified in one incident (surfaces and air handling systems).

Discussion and/or Conclusion(s):

Pneumocystis jirovecii

outbreaks

are difficult to investigate, not least because of the lack of systematic

national surveillance. Culture is not currently possible, the diversity

of genotypes in localities and nationally is underdeveloped and

the ecology and epidemiology incompletely understood. Our

investigations have advanced our understanding of these complex

incidents which carry a substantial morbidity and mortality for

affected patients.

ID: 4857

Genetic variation in

Mycobacterium tuberculosis

isolates from a

London outbreak associated with drug resistance

Giovanni Satta

, Adam Witney

, Robert Shorten

Magdalena Karlikowska

, Marc Lipman

, Timothy McHugh

Imperial

College Healthcare NHS Trust

–

University College London,

Institute of

Infection and Immunity, St George

’

s, University of London,

University

College London, Centre for Clinical Microbiology and Public Health

Laboratory Manchester, Manchester Royal Infirmary, Manchester,

University College London, Centre for Clinical Microbiology,

Division of

Medicine, Royal Free London NHS Foundation Trust, London and UCL

Respiratory, University College London

Background:

The largest outbreak of isoniazid-resistant (INH-R)

Mycobacterium tuberculosis

in Western Europe is centred in North

London, with over 400 cases diagnosed since 1995.

Aim(s)/Objective(s):

In the current study we evaluated the genetic

variation in a subset of outbreak clinical samples with the hypothesis

that these isolates have unique biological characteristics that serve to

prolong the outbreak.

Method(s):

Fitness assays, mutation rate and whole genome sequen-

cing were performed to test for selective advantage and compensatory

mutations.

Results:

The fitness and the mutation rate of the resistant isolates

were not different from either the reference strain

H37Rv

, the other

susceptible isolates in the lineage or unrelated isoniazid susceptible

and resistant samples.

Deletions

–

Comparative analysis for the detection of deletions

demonstrated extensive deletions in 16 genes compared with the

control strains used.

SNPs

–

A total of 563 SNPs were identified with 33 virulence genes

affected by at least one SNP.

Insertions

–

Comparative analysis did not reveal the presence of any

insertion.

Discussion and/or Conclusion(s):

This detailed analysis of the genetic

variation of these INH-R samples suggests that this outbreak consists

of successful, closely-related, circulating strains with heterogeneous

resistance profiles and little or no associated fitness cost or impact

on their mutation rate. Specific deletions and SNPs may be a

peculiar feature of these isolates, which can potentially explain their

persistence for years.

ID: 4862

Pneumocystis jirovecii

detection in the hospital environment aids

outbreak investigation

Lindsay Chesterton

, Justine Halliwell

, Rebecca Turner

Deborah Gnanarajah

, Milind Khare

, Malcolm Guiver

, Cath Noakes

Louise Fletcher

, Michael Gormley

, Richard Puleston

, Maarten Taal

Derby Teaching Hospitals NHS Foundation Trust,

Public Health England,

University of Leeds,

Heriot-Watt University,

University of Nottingham

Background:

Pneumocystis jirovecii

(PJ), a human specific fungal

pathogen causing pneumonia and significant mortality amongst

immunocompromised patients remains poorly understood. Despite

research, the life cycle, reservoir and the source of transmission are not

yet fully elucidated.

Aim(s)/Objective(s):

Between 2012 and 2015, 85 patients with

positive PJ polymerase chain reaction (PJPCR) were identified in a

single centre newly built hospital (completed in 2008) which led to

further analysis of the healthcare environment.

Method(s):

Samples from patients in whom Pneumocystis jiroveci

pneumonia (PJP) was suspected were analysed with PJPCR in a single

Public Health England (PHE) laboratory. Cycle times were provided

and genotyped wherever possible. Cases were stratified according to

clinical/microbiology and imaging data.

Environmental sampling was undertaken within the hospital ventila-

tion and air handling unit (intake and extract filters), the surfaces and

room air (impingers) within the hospital.

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S106