The Journal of Hospital Infection - Supplement 1

Background:

Staphylococcus capitis

is an emerging pathogen in the

NICU setting. Recent outbreaks have been reported in the literature

including the

S. capitis

clone NRCS-A, characterised by vancomycin

resistance or heteroresistance. In a recent French study

S.capitis

late

onset sepsis was found to be a risk factor for severe morbidity. With

advances in laboratory methods and use of MALDI-TOF identification

of Coagulase negative staphylococci (CNS) to species level is being

performed more frequently.

Aim(s)/Objective(s):

We describe an outbreak of

S. capitis

in a Scottish

neonatal intensive care unit.

Method(s):

3 patients with

S capitis

bacteraemia were identified

over a 16 day period. Blood culture isolates were identified using

MALDI-TOF. During subsequent investigations a further case was

detected taking the total number to 4 cases in 1 month. Two of the

patients were treated for infection; the other two were considered

contaminants.

Results:

Pulsed field gel electrophoresis (PFGE) of the blood culture

isolates revealed the same pulsotype. Infection control measures

implemented included increased environmental cleaning, education

and a review of staff skin health in the unit. Environmental screening

was undertaken but was negative with no source identified.

Discussion and/or Conclusion(s):

S capitis

is an emerging pathogen

in neonates. No source was found in our outbreak which was brought

under control by implementation of infection control measures. Use

of MALDI-TOF was pivotal in identifying this outbreak. Laboratories

should give consideration to identifying CNS from neonatal units to

species level to enable early outbreak detection.

ID: 5177

Antibodies to Ebola in international responders to the West Africa

Ebola epidemic

Catherine Houlihan

, Catherine McGowan

, Steve Dicks

David Mabey

, Richard Tedder

, Judith Glynn

UCL,

London School of

Hygiene and Tropical Medicine,

Public Health England

Background:

The 2014/5 Ebola (EVD) epidemic in West Africa (WA)

resulted in a large international humanitarian response. Health

care workers (HCWs) from WA were disproportionately affected, and

a few international HCWs were infected.

Aim(s)/Objective(s):

Since asymptomatic EVD has been described, we

tested international returnees for EVD antibodies.

Method(s):

An online consent and survey link were distributed

using a snowball technique. Eligibility criteria included having

travelled to WA during the epidemic and never having tested

positive for Ebola virus or received a filovirus vaccine. Oral fluid

collection devices were posted and returned using standard mail.

Samples were tested using an IgG capture ELISA. Non-exposed UK

controls were tested.

Results:

268 individuals responded and submitted a sample; 152

(56.7%) were women. The majority (253, 94.4%) travelled to Sierra

Leone. Roles included, but were not limited to; laboratory (95, 35.4%),

clinical (124, 42.3%), epidemiologist/research (37, 13.8%), community

engagement/burial (19, 7.1%) and water/sanitation/engineer (14, 5.2%).

A total of 233 (86.9%) returnees spent time in Personal Protective

Equipment (PPE), of whom 22 (9.4%) had concerns about exposure

during removal, and 54 (20.1%) described possible significant EVD

exposure. 57 (21.3%) described a febrile/diarrhoeal illness in WA or

within 1 month of return. Of the 268 returnees, two had reactive

results on IgG capture assay. Neither was reactive on a competitive

ELISA using plasma.

Discussion and/or Conclusion(s):

A high proportion of international

responders reported potential exposure to EVD, and reported a

febrile illness during the incubation period for Ebola. Improvements

in training and procedures, and consistency in PPE equipment and

removal may mitigate this.

ID: 5171

Community outbreak of invasive group A streptococcal infection

amongst patients receiving care from the same district nursing

team, August

–

September 2016

David Edwards

, Hamid Mahgoub

, Margaret Lewin

, Vicki Chalker

Ngozi Elumogo

, Juliana Coelho

, Theresa Lamagri

Health Protection

Team

–

PHE East of England,

Health Protection Team

–

PHE East of

England,

PHE Respiratory and Vaccine Preventable Bacteria Reference

Unit,

Norfolk and Norwich University Hospital Trust,

PHE National

Infection Service

Background:

In early September 2016, three cases of invasive Group A

streptococcal (iGAS) infection were identified who shared the same

rare

emm

type (

emm

ST9). These cases were investigated by the East of

England Health Protection Team (HPT) to identify common links and

oversee the implementation of control measures.

Aim(s)/Objective(s):

Identify and eliminate a potential source of exposure

Identify any further linked cases

Prevent ongoing transmission

Method(s):

An incident management team (IMT) was convened. This

discussed case epidemiology, possible mechanisms for transmission

and further investigations. The HPT agreed actions with the commu-

nity health healthcare trust infection control team (ICT) to prevent

further transmission.

Results:

Initial investigations identified that the cases were resident

geographically close to each other (3 miles) and received wound care

for bilateral leg ulcers from the same community nursing team. The

community healthcare service provider infection control team (ICT)

assessed the nursing team and preliminary findings identified

two nurses who had visited all three cases during their incubation

period, one of whomwas symptomatic with tonsillopharyngitis. These

staff were screened and antibiotic chemoprophylaxis arranged. A piece

of equipment (bandage scissors) was also used between patients,

subsequently taken out of use.

Discussion and/or Conclusion(s):

This outbreak highlights the

susceptibility of patients receiving wound care. Whilst prevention of

transmission from asymptomatic carriage is not always possible, the

importance of exclusion or temporary redeployment of healthcare

staff with symptomatic infections should be highlighted.

ID: 5159

Pneumocystis pneumonia cluster outbreak at a Scottish Renal

Transplant Centre

Andrew McClarey

, Paul J. Phelan

, Dáire T. O

’

Shea

, Ian Laurenson

Lorna Henderson

Doctor,

NHS Lothian

Background:

Pneumocystis Pneumonia (PCP) caused by Pneumocys-

tis jirovecii is a potentially fatal opportunistic infection. Cluster

outbreaks of PCP amongst renal transplant recipients have been

documented worldwide.

Aim(s)/Objective(s):

We aimed to describe a cluster of PCP diagnosed

in nine renal transplant recipients from our centre between November

2014 and January 2016.

Method(s):

A retrospective analysis of cases was carried out. We

matched these cases with two case linked controls.

Results:

Of the nine patients affected, the median age at presentation

was 65 years (range 24

–

77 years). Median time to disease onset

was 5.8 years post-transplant (range 0.5

–

10.4 years). At diagnosis,

all patients had a functioning graft with a mean eGFR of 29.3 mL/min

(range 15

–

41 mL/min), significantly lower than controls (70.0 mL/min

−

23.5) (p = 0.0007). There was no significant difference in immu-

nosuppression regimens. All patients were lymphopenic at diagnosis

(mean 0.2 × 10

/L), significantly lower than our control population at

corresponding time of diagnosis (mean 0.9 × 10

/L) (p = 0.028). Four

patients required mechanical ventilation and two required dialysis.

Four patients died within three months of presentation.

Abstracts of FIS/HIS 2016

–

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

–

S134

S110