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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


Tehmina Bharucha, Jennifer Hart, Ons Ben Ismail, Beatrice Cockbain,

Paul Griffiths, Tanzina Haque, Tabitha Mahungu, Dianne Irish.


Free Hospital


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



To characterise influenza infections on ITU in a

large teaching hospital over two consecutive flu seasons.


Retrospective audit of influenza infections admitted to

ITU 2014



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


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


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 Reekie


, Tehmina Bharucha


, Thomas Fox


, Douglas Thorburn



Mark Harber


, Samreen Ijaz


, Richard Tedder


, Tabitha Mahungu



Tanzina Haque


, Paul Griffiths


, Mallika Sekhar


, Dianne Irish





Free Hospital,


Public Health England


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.


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.


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



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


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 Barkham


, Sebastian Maurer-Stroh


, Janice Leong



Masafumi Inoue




Tan Tock Seng Hospital,


Bioinformatics Institute,

Agency for Science, Technology and Research,


Experimental Therapeutics

Centre, Agency for Science, Technology and Research


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.


We investigated to determine the


subtypes as part of pandemic planning.


Samples reported to be Influenza A without subtype

by the clinical laboratory between May 1


and August 14th 2015

were further interrogated with singleplex assays. Haemagglutinin

sequences were compared with online sequences collected in 2015



Of 925 Influenza reports, 66 were reported as Influenza A

with subtype undetermined. These cases first appeared on May 4



reached a peak at 5 cases per run in mid June and then faded away

with the last one on August 14


. 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 Ma


opolska in the years



Anna Różańska, Jadwiga Wojkowska-Mach, Agniszka Pac,



gorzata Bulanda.

Jagiellonian University Medical College


According to official data, infections after delivery in

Poland are rare.


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.


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