The Journal of Hospital Infection - Supplement 1 - November 2016

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admitted from care homes; 24 of the patients with urosepsis had been
seen by their GP. Five of these patients had received an antibiotic to
which their isolatewas sensitive; 5 had received an antibiotic towhich
their isolate was resistant; only two of the admissions followed a
urinary catheter change; in 7, an alternative diagnosis had been made
and urosepsis not considered; in the remainder, there was no
information available.
Discussion and/or Conclusion(s): Prevention of admissions due to
E coli bacteraemia should focus on the elderly and on measures to
prevent urosepsis. However only 24 (44%) of the patients with
urosepsis had seen their GP before admission and only in 5 of these
might there have been an opportunity to prevent admission if the
correct antibiotic was used. The study does reinforce that it is
important to match antibiotic formularies to local sensitivities.
ID: 4786
When flu goes bad: an audit of the management of influenza
infections on an intensive care unit 2014 –2016
Tehmina Bharucha, Jennifer Hart, Ons Ben Ismail, Beatrice Cockbain,
Paul Griffiths, Tanzina Haque, Tabitha Mahungu, Dianne Irish. Royal
Free Hospital
Background: Influenza infections lead to an estimated 250,000–
500,000 deaths annually worldwide. Our ability to predict and avert
complications depends on rigorous epidemiological analyses of severe
cases.
Aim(s)/Objective(s): To characterise influenza infections on ITU in a
large teaching hospital over two consecutive flu seasons.
Method(s): Retrospective audit of influenza infections admitted to
ITU 2014 –2016.
Results: We identified 29 cases; 14 (November 2014-April 2015) and
15 (October 2015—March 2016). Median age 61 years (IQR53–71); 41%
were female, and 93% had risk factors for complications. 38% had
received the seasonal flu vaccination. In 2014–2015 60% had Influenza
A (6 H3; 3 not-typed), and 40% Influenza B (one patient had both). In
2015– 16, 93% were Influenza A (11 H1; 1 H3; 2 not-typed) and 7%
Influenza B.
Median time to sampling from admission was 4 days (IQR2–6). Length
of inpatient stay was 11 days (6–16), and length of ITU admission
17 days (IQR10 –28). Repeat respiratory sampling was performed
at day 5 in 51%, with 52% remaining positive, and day 10 in 65%,
with 21% remaining positive. All patients received Oseltamivir,
median duration 6 days (IQR5–9) with 13 (45%) receiving a prolonged
course or escalation to Zanamivir (Nebulised/Intravenous) due to
ongoing symptoms. An Oseltamivir resistant mutation (E119V) was
detected in 1 of 3 patients tested. 5/29 (17%) patients died during the
illness.
Discussion and/or Conclusion(s): Results suggest an urgent need to
improve vaccination uptake. Equally, they highlight the importance of
increased clinical suspicion and speed of diagnostic sampling, as well
as repeat sampling to demonstrate response to antivirals and timely
instigation of resistance testing.
ID: 4803
Hepatitis E virus in the transplant patient population
Ian Reekie1, Tehmina Bharucha1, Thomas Fox1, Douglas Thorburn1,
Mark Harber1, Samreen Ijaz2, Richard Tedder2, Tabitha Mahungu 1,
Tanzina Haque 1, Paul Griffiths1, Mallika Sekhar1, Dianne Irish1. 1Royal
Free Hospital, 2Public Health England
Background: Hepatitis E virus (HEV) is a common cause of acute
viral hepatitis worldwide. Traditionally associated with a self-limiting
illness, infection can become chronic in immunosuppressed popula-
tions with associated significant morbidity and mortality. At present
there are no clear guidelines for testing and monitoring for HEV in
transplant recipients.
Aim(s)/Objective(s): To determine the point prevalence of viraemic
HEV infection in solid organ transplant (SOT) and haematopoietic
stem cell transplant (HSCT) recipients undergoing transplantation
between January 2013 and December 2015.
Method(s): Stored extracts of whole blood from patients under-
going SOT (liver and/or kidney) or HSCT were tested using a
commercial real-time reverse-transcriptase polymerase chain reaction
kit for HEV RNA. Samples were tested at baseline, 30, 60 and 90 days
post-transplant.
Results: 259 HSCT, 262 Liver and 349 kidney transplant patients were
included with 2452 samples meeting the inclusion criteria. Prevalence
of HEV viraemia in HSCT patients was 0.65% at baseline, 0.85% at 30
days, 0.96% at 60 days and 1.08% at 90 days and in liver transplant
patients was 0.43% at baseline, 0.43% at 30 days, 1.06% at 60 days and
0.72% at 90 days. None of the kidney transplant patients had HEV
viraemia.
Discussion and/or Conclusion(s): Prevalence of viraemic HEV
infection in SOT and HSCT patients is low at baseline and remains
low throughout the early post transplant phase. Prospective studies
are necessary to inform monitoring guidelines in this population.
ID: 4811
Investigation of unbalanced influenza subtype data reveals a wave
of H1N1 from outside of Singapore
Timothy Barkham1, Sebastian Maurer-Stroh2, Janice Leong1,
Masafumi Inoue3. 1Tan Tock Seng Hospital, 2Bioinformatics Institute,
Agency for Science, Technology and Research, 3Experimental Therapeutics
Centre, Agency for Science, Technology and Research
Background: Some samples with a positive Influenza A matrix result
presented without an H1N1 or H3N2 subtype in our routine one
tube multiplex. None were associated with travel or especially severe
disease so H5N1 or other more virulent subtypes were not suspected.
Aim(s)/Objective(s): We investigated to determine the ‘unknown ’
subtypes as part of pandemic planning.
Method(s): Samples reported to be Influenza A without subtype
by the clinical laboratory between May 1st and August 14th 2015
were further interrogated with singleplex assays. Haemagglutinin
sequences were compared with online sequences collected in 2015
(GISAID).
Results: Of 925 Influenza reports, 66 were reported as Influenza A
with subtype undetermined. These cases first appeared on May 4th,
reached a peak at 5 cases per run in mid June and then faded away
with the last one on August 14th. In 38 of these 66 the ct was
considered so weak that a mismatch between matrix and subtype
could be expected. Of the remaining 28 one was H3N2 but 27 were
identified as H1N1 with mutations affecting both primers and the
probe but still within the pdm09-lineage; 16 clustered with
A/Bangladesh/4001/2015 A /H1N1.
Discussion and/or Conclusion(s): Investigation of unbalanced
results enabled us to witness a wave of imported influenza which
may be connected with the numerous immigrant Bangladeshi
workers in Singapore. It is a reminder of the normal movement of
influenza and its potential for unseen global travel. The mutations are
expected to interferewith theWHO recommended primers/probe; one
mutation is in the probe and two in the reverse primer region.
ID: 4821
Perinatal antibiotic consumption in Małopolska in the years
2012–2013
Anna Różańska, Jadwiga Wojkowska-Mach, Agniszka Pac,
Małgorzata Bulanda. Jagiellonian University Medical College
Background: According to official data, infections after delivery in
Poland are rare.
Aim(s)/Objective(s): The objective of this study was the assessment of
perinatal antibiotic consumption as a method to verify some official
data on infections in an obstetric patient population.
Method(s): For the evaluation of perinatal antibiotic consumption,
data on the antibiotics purchased in outpatient care were used
(years 2012–2013). The analysis took into consideration antibiotic
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S120