The Journal of Hospital Infection - Supplement 1

Annual number of cases varied from nine in 2012 to 24 in 2014.

C. albicans

was the predominant species (51%) followed by

C. glabrata

(21%) and

C. parapsilosis

(16%). The proportion of non-

albicans

species

did not vary over time. Caspofungin or 5-flucytosine resistance was

not detected. Fluconazole non-susceptibility was uncommon among

non-

glabrata

species (n = 5) and not associated with length of stay.

Azole consumption, but not other antifungals, increased over the

5-year period. Crude mortality rate was 28%.

Discussion and/or Conclusion(s):

Local surveillance of invasive

candidiasis is crucial to monitor changes in trends in antifungal

resistance. Fluconazole resistance remains at a low level, however as a

significant proportion of our isolates are

C. glabrata

empiric echino-

candin therapy should be considered particularly in critically unwell

patients pending susceptibility data.

ID: 4953

The changing epidemiology of methicillin-resistant

Staphyloccocus aureus (SARM) over a 15 years period

Ana Hornero, Sara Grillo, Juan Manuel Verge, Purificación Martos,

Jordi Camara, Mª Angeles Dominguez, Jordi Carratala, Miquel Pujol.

Bellvitge University Hospital

Background:

The first cases of MRSA at Bellvitge University Hospital

were detected in the early nineties. Cases were of nosocomial origin,

caused by a dominant clone (Iberian clone), which produced out-

breaks, especially in intensive care units, and serious infections

associated with invasive devices. The implementation of an intensive

control program resulted initially in a significant decrease in new

MRSA cases, but an upward trend was observed during last years

explained partially by clone replacement and changes in the clinical

epidemiology of MRSA.

Aim(s)/Objective(s):

To determine the current clinical epidemiology

of MRSA cases over a period of 15 years in a tertiary care hospital.

Method(s):

Prospective surveillance of MRSA cases reported daily

by the Microbiology Service: Collection of systematic information,

regarding acquisition and sample source. Implementation of a control

program based in active surveillance, contact precautions and

decolonisation.

Results:

From 2000 to 2015, 6.714 MRSA cases were identified. Most

significant changes regarding clinical epidemiology between periods

were as follows: Rate of cases detected by active surveillance cultures

(35% vs 63%); nosocomial acquisition (69% vs 13% of cases), incidence

rate of nosocomial MRSA clinical samples (0.42 vs 0.16/1,000 patients-

day), and incidence rate of nosocomial bacteraemia (0.12 vs 0.02 /1,000

patients-day).

Discussion and/or Conclusion(s):

A significant reduction of nosoco-

mial MRSA transmission and nosocomial MRSA bacteraemia cases

were observed throughout the study period. A surveillance program of

MRSA including implementation of a multifaceted infection control

program was essential to reduce nosocomial rates in our center.

ID: 4957

E. coli blood stream infections: differences in epidemiology across

different sites within a large teaching hospital Trust

Damien Mack, Husam El-Mugamar, Judy Jaques, Yvonne Carter,

Diane Rogers, Sunil Jose, Robin Smith.

Royal Free London NHS

Foundation Trust

Background:

The incidence of

E. coli

blood stream infection (BSI) in

England increased by 15.6% from 2010 to 2014. 30-day all-cause

mortality was 15.9% in 2014/15. In May 2016 the Government

announced plans to halve the number of healthcare associated BSI

such as

E. coli

in England by 2020.

Aim(s)/Objective(s):

Here we show differences in the epidemiology of

E. coli

BSI over four years across a large hospital Trust consisting of the

Royal Free Hospital (RFH) tertiary referral site, and Barnet and Chase

Farm Hospitals (BCF) district general hospital sites.

Method(s):

Trust infection control data was analysed using Stata 13.

Results:

We found that from 2012/13 to 2015/16 cases of

E. coli

BSI

fell by 0.21% from 481 to 469 per year however the case rate rose

from 118 to 145 per 100,000 occupied bed days. The average age

of cases was lower at RFH than at BCF: 67 versus 70 years for pre-48

hour cases and 61 versus 75 years for post-48 hours cases (both

p < 0.001). There was a decreasing trend in the proportion of post-48

hour cases at BCF (9.8% to 5.1%, p = 0.004) and a non-significant

increasing trend at RFH (12.1% to 16.6%, p = 0.088). On multi-variate

analysis, compared to BCF, cases at RFH were more often associated

with augmented care (OR = 5.25,95%CI:3.53

–

7.80,p < 0.001), non-A&E/

medical/geriatric specialties (OR = 2.47,95%CI:1.96

–

3.11,p < 0.001),

non-emergency admission (OR = 1.78,95%CI:1.78

–

2.69,p = 0.006), and

post-48 hour onset (OR = 1.54,95%CI:1.07

–

2.24,p = 0.021).

Discussion and/or Conclusion(s):

Analysis of

E. coli

BSI by Trust site

revealed differences in epidemiology that will be important con-

siderations in planning measures to reduce cases.

ID: 4966

E. coli blood stream infections: changes in healthcare associations

over five years at a large teaching hospital

Damien Mack, Yvonne Carter, Sunil Jose, Robin Smith.

Royal Free

London NHS Foundation Trust

Background:

The incidence of

E. coli

blood stream infection (BSI) in

England increased by 15.6% from 2010 to 2014; 30-day all-cause

mortality was 15.9% in 2014/15. In May 2016 the Government

announced plans to halve the number of healthcare associated BSI

such as

E. coli

in England by 2020.

Aim(s)/Objective(s):

Here we show changes in the healthcare

associations of

E. coli

BSI over five years at the Royal Free Hospital, a

large teaching hospital in London.

Method(s):

Analysis of Trust data using Stata 13.

Results:

From 2011/12

–

2015/16

E. coli

BSI cases varied between 214

and 246 per year, however the proportion that were likely to be or

possibly healthcare associated infections (HCAI) fell 30% from 53% to

37% (chi-squared test for trend: p < 0.001). On multivariate analysis,

compared to

“

community

”

cases with no contact with the hospital

in the previous three months, the proportion of HCAI cases was

significantly higher in cases diagnosed on day 0-1 of admission but

with previous contact with the hospital within three months

(OR = 10.38, 95%CI:6.86

–

15.71), and in cases diagnosed on day 2 of

admission onwards (OR = 15.94, 95%CI:7.42

–

34.24). For the 488

(43%) HCAI cases, the following year-on-year trends were seen:

decreasing association with vascular access device use (p = 0.02),

and increasing associations with other invasive device use (p <

0.002), catheter use (p = 0.006), surgery or other invasive procedures

(p < 0.001).

Discussion and/or Conclusion(s):

Factors associated with

E. coli

BSI

HCAI are changing. Further investigation by root cause analysis will be

required to determine what proportion of

E. coli

BSI HCAI may be

preventable.

ID: 4973

Performance of the Research-Use-Only Xpert MRSA NxG on a nasal

swab collection

Martin Rottman

, Christine Lawrence

, Hayfa Mansour

Faten El Sayed

, Anne-Laure Roux

, Jean-Louis Herrmann

Jean-Louis Gaillard

Groupe Hospitalier Universitaire Paris Ile de France

Ouest (AP-HP) UMR Université de Versailles St Quentin

–

INSERM U1173,

Groupe Hospitalier Universitaire Paris Ile de France Ouest (AP-HP),

Groupe Hospitalier Universitaire Paris Ile de France Ouest (AP-HP) UMR

Université de Versailles St Quentin

–

INSERM U1173

Background:

The shifting genetic background of methicillin resistant

Staphylococcus aureus

(MRSA) requires the regular update of the PCR

based rapid detection assays. The Research-Use-Only Xpert MRSA NxG

is a new Cepheid assay designed to be highly effective at detecting

current MRSA isolates in nasal swabs without requiring cold room

storage and with a long shelf life.

Abstracts of FIS/HIS 2016

–

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

–

S134

S125