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ID: 4865

Antimicrobial management of E. coli bacteraemia

Mariha Hamid


, Paul Wade


, William Newsholme





s College




s and St Thomas

NHS Foundation Trust


Inappropriate antimicrobial use is a significant risk

factor in the spread of antimicrobial resistance (AMR); this, coupled

with a recent increase in the rate of E. coli bacteraemia and associated

antibiotic resistance, reinforces the need to monitor adherence to

clinical antibiotic guidelines.


To explore the cases of E. coli bacteraemia in


s and St Thomas

NHS Foundation Trust reported between March

and September 2015, in order to determine whether Trust guidelines

were followed with regards to empirical antibiotic therapy, and

whether antibiotic sensitivity patterns were used to adjust antibiotic



The patient sample was obtained from the Public Health

England surveillance programme data. Data on prescribing and

antibiotic sensitivity patterns were obtained from Trust electronic

systems and compared to Trust antimicrobial guidelines.


The analysis included 89 patients. Overall, 63% of cases

adhered to guidelines. 31% of patients required an antibiotic

adjustment based on sensitivity patterns, and appropriate alternatives

were given in 75% of these cases. Co-amoxiclav was frequently used as

monotherapy for cases where empiric guidance recommended dual

antimicrobials (such as gentamicin e.g. in severe sepsis). The majority

of patients who did not receive an appropriate antibiotic adjustment

had been given co-amoxiclav despite reported resistance.

Discussion and/or Conclusion(s):

Routinely documenting the

acknowledgment of blood culture results may prompt clinicians to

identify resistance patterns and adjust subsequent management

decisions, reducing the number of patients who are continued on

inappropriate antibiotics. This will be important for adherence to the

72-hour review component of the new AMR Commissioning for

Quality and Innovation guidance.

ID: 4894

Acquired colistin resistance found in 2% of human

enterobacteriaceae in Singapore

Pooja Rao, Jen Mee Long, Wen Ying Tang, Timothy Barkham.

Tan Tock

Seng Hospital


Colistin has increased in importance over the last decade

as multi drug resistant Gram negative bacteria have become more

numerous and more difficult to treat. The report of acquired colistin

resistance due to MCR-1, carried on a plasmid, heralds an era of

therapeutic poverty and stimulated a search for colistin resistance in

many countries to define the extent of MCR-1 in their populations.

Having acquired a positive control for MCR-1 in May 2016, we found

MCR-1 in three out of four enterobacteriaceae that had been flagged as

colistin resistant on the Vitek system in mid-June 2016.


The aim was to define the possible extent of

colistin resistance in our population.


We extracted colistin MIC data from the Vitek suscepti-

bility testing system for a sixmonth period fromDec 2015 toMay 2016.

Data for organisms naturally resistant to colistin were discarded.

Colistin resistance was defined as an MIC >2 mg/L.


Datawere available for 3887 enterobacteriaceae. 78 (2%) were

colistin resistant with MICs as follows. MIC < 0.5 mg/L, 3768; 1 mg/L,

22; 2 mg/L, 19; 4 mg/L, 17; 8 mg/L, 34;

16 mg/L, 27.

Discussion and/or Conclusion(s):

Polymyxin is used instead of

colistin in Singapore, and polymyxin MICs are measured with an E

test, when clinically indicated, and interpreted with CLSI breakpoints.

Colistin results, although on our Vitek system, did not flow through to

the laboratory information system and constituted important but

hidden data. Many of these colistin resistant bacteria are not multi

drug resistant. Further work will define what proportion carry MCR-1

and how widespread this is in the community.

ID: 4961

Relationship between resistance in coliform bacteraemia and

antimicrobial exposure

Jennifer Wood


, Peter Davey


, Bruce Guthrie



Virginia Hernandez-Santiago


, Charis Marwick




University of Dundee,


University of Dundee,


University of Dundee/NHS Tayside


Antimicrobial resistance (AMR) is a serious public

health threat, with emerging resistance among coliforms particularly

concerning. Antimicrobial use contributes to this but associations

between individual past exposure and risk of AMR infection are not

well understood.


The aim is to quantify associations between

antimicrobial resistance in coliform bacteraemia on admission to

hospital (positive blood culture on day 0

2) and antimicrobial

exposure in the prior 12 months, in a case-control study using linked

routine data enhanced by case-note review. Cases are those with

resistant infections and controls those with susceptible infections.


The study includes all NHS Tayside residents admitted

with coliform bacteraemia (first episode if >1) from Jan 2011 to Dec

2015. Patient-level data on hospital admissions, microbiology results,

GRO deaths, and prescriptions dispensed from community pharmacies

are anonymously linked by the Health Informatics Centre (HIC).

Hospital inpatient prescribing data are not captured electronically

so extracted by case-note review, then anonymised and linked.

Logistic regression (univariate then multivariate) will generate odds

ratios for the likelihood of resistant versus susceptible (e.g. to co-

amoxiclav) bacteraemia associated with prior exposure (e.g. any

exposure/cumulative exposure/most recent exposure to beta-lactam/

beta-lactamase inhibitor combinations). Potential confounders in

multivariate analyses are: age, gender, comorbidity, deprivation, care

home residence, previous hospital admissions.


There are 372 eligible bacteraemia episodes, 204 (54.8%) with

admissions in the previous year. The complete dataset is almost

assembled foranalysis and the resultswill be available for presentation.

Discussion and/or Conclusion(s):

Findings will help to inform

prescribing policy, enabling tailored therapy for at risk individuals.

ID: 4963

A new scoring system to predict the risk of multiresistant

pathogens in pneumonia and sepsis validated using

big data


Michael Wilke


, Nadine Tränkner


, Kerstin Worf


, Silvia Wilke



Wolfgang Heinlein


, Klaus-Friedrich Bodmann





Dr. Wilke GmbH,


Klinikum Barnim, Werner-Forßmann Krankenhaus


Hospital-acquired pneumonia and sepsis pose a major

challenge in intensive care medicine. A key factor for the survival of

patients is the early administration of adequate initial antibiotic

therapy, which covers the causative pathogens, especially if there are

pathogens with multiple resistances (MDR). The correct assessment

of the risk for MDR presence is a key strategy in antimicrobial

stewardship. Multiple risk factors are described in the literature, hence

few studies exist that did a systematic validation of those factors by

using large data collections.


The aim of this study is to develop and validate

a risk scoring system that is able to predict the presence of MRE in

these disease entities.


A systematic literature research based on the PICO-

principle was used to identify the risk factors for hospital-acquired

pneumonia and sepsis described in the literature. A number of risk

factors could be identified. The risk factors were

if possible

described by the use of routine data (OPS, ICD, etc.) that are easily

available and will be validated on a large amount of patient cases (55

hospitals with 3.7 Million hospitalizations over 5 years). Using the

valid risk factors a score will be developed using multivariate

regression models and Receiver-operator Curves (ROC) to allow a

better risk stratification in the initial phase of the therapy.

Abstracts of FIS/HIS 2016

Oral Presentations / Journal of Hospital Infection 94S1 (2016) S11