The Journal of Hospital Infection - Supplement 1

Discussion and/or Conclusion(s):

Though the key factors for success

include among others the multimodal nature of the campaigns, the

political and financial support from the government, the highest

number of observed opportunities and compliance rates recorded in

2013 can also be attributed to the new online tool.

ID: 5182

Identifying preventable Gram-negative bloodstream infections

Conor Bowman, Damien Mack, Robin Smith, Susan Hopkins.

Royal Free

London NHS Foundation Trust

Background:

In England, from 2010 to 2014,

Klebsiella

and

E. coli

bloodstream infections (BSI) rose 21% and 16% across England. The UK

government ambition is to half preventable Gram-negative BSI by

2020.

Aim(s)/Objective(s):

To identify the differences between these two

pathogen BSIs to allow focused interventions to be developed.

Method(s):

All

Klebsiella

E. coli

BSI at a university teaching hospital

between 1/1/2014 and 31/12/2016 were extracted from the laboratory

information management system. Clinical data was extracted from

the patient clinical records and hospital administration system. A

hospital-acquired BSI (HABSI) was defined as onset

≥

day 3 of the

hospital admission.

Results:

In 2014

–

2015, 458

E. coli

and 172

Klebsiella

BSI were detected.

Patients with E. coli were less likely to be male (50% v 61%) and were

older (median age 72y V 64y) than those with Klebsiella BSI.

The greatest burden of HAI occurred in

E. coli

compared to

Klebsiella

(126 V 84 patients); though 48% of all

Klebsiella

were HABSI compared

to 28% of

E. coli

. The top two commonest sources of BSI were urinary

tract (

E. coli

46% V

Klebsiella

28%) and hepatobiliary (21% for both

bacteria) infections. Preventable infections were assessed as very

likely or possibly for 36% of

E. coli

and 47% of

Klebsiella

BSI,

predominantly related to devices, procedures or inappropriate initial

antibiotic therapy.

Discussion and/or Conclusion(s):

There are significant demographic

and clinical differences between

E. coli

and

Klebsiella

BSI. However

targeting device insertion and care, surgical prophylaxis and empiric

treatment guidelines could reduce these HABSI.

Topic: Tropical infections

ID: 4421

Transmission study of

Mycobactrium leprae

in household contact

using polymerase chain reaction method in leprosy endemic area

of Papua Indonesia

Hana Krismawati

, Antonius Oktavian

, Yustinus Maladan

Tri Nury Kridaningsih

National Institute of Health Research and

Development- Institute of Research and Development for Biomedicine

Papua

Background:

The new case number in Papua, easternmost part of

Indonesia Archipelago is remained stable although so many efforts of

leprosy elimination programs were carried out. It shows that the

transmission of

Mycobacterium leprae

is actively happen.

Aim(s)/Objective(s):

Aims of this study are to detect

Mycobacterium

leprae

using Polymerase Chain Reaction (PCR) in asymptomatic

household contact in order to observe the transmission of

Mycobacterium leprae

in early stage before the clinical manifestation

and to observe the risk factors of transmission.

Method(s):

This is cross sectional with descriptive design study.

Sample population were 35 symtomatic leprosy patients and 4

asymptomatic household contacts for each patient. Environment

factors that observed are periode of living with the patient, intencity

and number of person in a house. The nasal swab, skin silt and blood

samples was collected from all subjects. The DNA was extracted from

nasal and skin silt.

Results:

Thirty five leprosy patients and 107 asymptomatic

household contacts were recruited as subjects in this study. The

result show that

Mycobacterium leprae

can be detect on 100%

leprosy patients and 19,62% of household contact using PCR. Risk

factors that statistically significant associated with transmission of

Mycobacterium leprae

is the period of living together with leprosy

patients (P: 0,002).

Discussion and/or Conclusion(s): The conclusion of this study is PCR

can be used to detect

Mycobacterium leprae

in household contact

without clinical cardinal sign as well as in leprosy patients with

cardinal sign. The risk factors that influence the transmission of

Mycobacterium leprae

is the period of living together.

ID: 4828

Outpatient management of uncomplicated

P. falciparum

infection

in returning travellers: benefits & barriers of implementation in a

South-East London DGH setting

Edward Monk, Juliet Uwagwu.

Greenwich and Lewisham NHS Trust

Background:

Admission is recommended for all imported

Plasmodium falciparum

infections, despite studies in UK specialist

and district settings claiming safe selective-outpatient management.

We established admission criteria at Queen Elizabeth Hospital,

Woolwich for

P. falciparum

and present potential benefits to

outpatient management in a UK district general hospital and

barriers to implementation.

Aim(s)/Objective(s):

We aim to determine whether it is possible to

implement an ED risk-assessment protocol for outpatient manage-

ment of adult, uncomplicated

P. falciparum

infection safely. Objectives

are to determine appropriate referral, audit documentation of

outpatient/admission criteria and ascertain whether outpatient

P. falciparum

management is a rational pursuit.

Method(s):

Patient notes were gathered for adults with

P. falciparum

positive blood films between 01/08/2014 and 31/11/15 (protocol

implementation from 01/03/2015) and searched retrospectively for

documentation of criteria used to determine uncomplicated infection

and suitability for outpatient management.

Results:

During the study period, 52 adults were diagnosed with

P. falciparum

with 42.3%(22/54) eligible for outpatient management.

25.0%(13/52) had a heart rate >120 on admission, 17.3%(9/52) a

parasitaemia of >2% and 13.5%(7/52) associated AKI. Of the 13 patients

suitable for outpatient management after pathway implementation, 0

were referred to outpatient services. All had uneventful admissions.

Average admission was 2.05 days; 29 hospital-bed-days could have

been saved with appropriate outpatient referral-pathway use.

Discussion and/or Conclusion(s): Improved staff education and

referral-pathway awareness is required to assess the true feasibility

of outpatient

P. falciparum

management; in theory it could save

QEH 32 hospital-bed-days/year (approximately £12,800). Eligibility

criteria were well-documented and suitable patients made quick

recovery. High-powered, multi-centre studies are necessary to

establish statistical safety.

ID: 5019

Diarrhoea in a returning traveller from Mexico

Marco Lee, Fauzia Rizwan

Leeds Teaching Hospitals NHS Trust.

Background:

A 72 year old female, normally fit and well, returned

from a one month visit to Mexico City. She ate at local restaurants on

many occasions and developed acute onset diarrhoea. She attended

private clinics twice and was given courses of ciprofloxacin and

cephalexin. Symptoms did not improve. On arrival to UK, she had

symptoms of abdominal bloating, vomiting, and type 7 stools.

Results:

A bloodborne virus screen (HIV, HBV, HCV) was negative.

Stools were negative for Campylobacter, Salmonella, Shigella,

E. coli

0157, rotavirus, adenovirus, and

C. difficile

toxin. A stool OCP revealed

Cyclospora cayetanensis oocysts. Diarrhoea improved within 3 days of

starting oral co-trimoxazole. She was discharged to complete a 7 day

course with routine follow-up in the infectious diseases outpatient

clinic.

Abstracts of FIS/HIS 2016

–

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

–

S134

S131