is an emerging pathogen in the
NICU setting. Recent outbreaks have been reported in the literature
clone NRCS-A, characterised by vancomycin
resistance or heteroresistance. In a recent French study
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.
We describe an outbreak of
in a Scottish
neonatal intensive care unit.
3 patients with
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
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):
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.
Antibodies to Ebola in international responders to the West Africa
, Catherine McGowan
, Steve Dicks
, Richard Tedder
, Judith Glynn
London School of
Hygiene and Tropical Medicine,
Public Health England
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.
Since asymptomatic EVD has been described, we
tested international returnees for EVD antibodies.
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.
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.
Community outbreak of invasive group A streptococcal infection
amongst patients receiving care from the same district nursing
, Hamid Mahgoub
, Margaret Lewin
, Vicki Chalker
, Juliana Coelho
, Theresa Lamagri
PHE East of England,
Health Protection Team
PHE East of
PHE Respiratory and Vaccine Preventable Bacteria Reference
Norfolk and Norwich University Hospital Trust,
In early September 2016, three cases of invasive Group A
streptococcal (iGAS) infection were identified who shared the same
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.
Identify and eliminate a potential source of exposure
Identify any further linked cases
Prevent ongoing transmission
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
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.
Pneumocystis pneumonia cluster outbreak at a Scottish Renal
, Paul J. Phelan
, Dáire T. O
, Ian Laurenson
Pneumocystis Pneumonia (PCP) caused by Pneumocys-
tis jirovecii is a potentially fatal opportunistic infection. Cluster
outbreaks of PCP amongst renal transplant recipients have been
We aimed to describe a cluster of PCP diagnosed
in nine renal transplant recipients from our centre between November
2014 and January 2016.
A retrospective analysis of cases was carried out. We
matched these cases with two case linked controls.
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
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