The Journal of Hospital Infection - Supplement 1 - November 2016

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Results: 33 Acute NHS Trusts piloted the surveillance tool; 12 were
teaching hospitals. All had collected patient level audit/quality
improvement data relating to national AMS guidance in the previous
year; these datawere most commonly collected on a monthly (39%) or
quarterly (27%) basis. A high proportion of wards were typically
surveyed at least once over the past year (51–100%). Antibiotic courses
were reviewed with formal documentation at 48 –72 hours after
initiation of therapy by 36% of Trusts.
Discussion and/or Conclusion(s): Following publication of an AMR
CQUIN (Commissioning for Quality and Innovation) by NHS England
which includes empiric review of antibiotic prescriptions as one of the
indicators and comments from respondents of the pilot, the AMS
surveillance tool was simplified to focus on the key elements required
by both the national AMS toolkit SSTF and the AMR CQUIN. A sample
data collection audit tool was designed to accompany the surveillance
tool and both circulated to Trusts to support their submission for the
CQUIN.
Topic: Clinical cases
ID: 4711
Beans for breakfast darling?
Alison Burgess1, Begona Bovill2, Elizabeth Johnson3, Megan Jenkins 2.
1PHE, Southmead Hospital, Bristol, 2Southmead Hospital, Bristol,
3National Mycology Reference Laboratory
A thirty-four year old teacher with a history of mild asthma presented
with a twoweekhistoryof fever, arthralgia andprogressive shortness of
breath since returning froma school-trip to Guyana. The tripwas based
within the rainforest and included accommodation near a bat colony.
He had taken proguanil hydrochloride with atovaquone as malaria
prophylaxis. A pansystolic murmur was noted but examination was
otherwise unremarkable. He had a swinging pyrexia to 38.9°C. Initial
investigations revealed normal white cell count, CRP 81 mg/L, ALT
raised at 117 U/L. Admission chest radiograph had widespread nodular
opacification and a subsequent CT thorax demonstrated multiple
pulmonary nodules. Echocardiogram showed mild tricuspid regurgi-
tation only. Sputumwas sent urgently for standard and mycobacterial
culture.
ID: 4807
Fusobacterium nucleatum and Parvimonas micra polymicrobial
infection in a patient with spondylodiscitis
Leanne Cleaver, Damien Mack, Shara Palanivel, Simon Warren. NHS
A 45 year old Caucasian female was referred to the Royal National
Orthopaedic Hospital, Stanmore for an eight week history of back pain
after lifting a bag onto a luggage rack, which was not responding to
physiotherapy and analgesia.
The patient reported no fevers, sweats, or weight loss in this time. She
also recalled no urinary symptoms, had never had any other back pain
or injury, no epidural anaesthetic, and no other significant illnesses.
The patient has an intrauterine device (copper coil) which has been in
situ since 2009.
The patient had undergone surgery to remove varicose veins in the
leg as a teen for Klippel Trenaunay Syndrome. She sustained a trauma
to the right hand in early 2015, which she did not receive antibiotics
for and had not received antibiotics prior to the current complaint.
Some years previously the patient had had a dental cavity filling and
some subsequent dental hygienist procedures and had good oral
health.
The patient was born and raised in Australia and moved to the United
Kingdom 20 years previously, where she currently resided in London
working in finance. Recent travel history included visiting Manila in
2014. Other than the aforementioned, the patient was healthyandwell.
Upon referral, the patient underwent X-ray and magnetic resonance
imaging (MRI) of the spine which showed acute supporative osteo-
myelitis of the twelfth thoracic vertebra and the first lumbar vertebra.
The patient then had a computed tomography (CT)-guided vertebral
biopsy; one sample was sent to the microbiology department at the
Royal Free Hospital, London.
ID: 4896
Hypoglycaemia and a disseminated infectious disease… time to
think!
Alberto San Francisco, Bethany Davies, Gillian Jones, Catherine Sargent.
Brighton and Sussex University Hospitals NHS Trust
76 year-old female, retired opera singer, with background history of
Hypertension, Atrial Fibrillation, Asthma and Right total Knee
replacement presented to the orthopaedics team in December 2015
with 6-month history of intermittent swelling and pain on her right
knee, weight loss, anorexia and intermittent sweats.
Initial X-rays raised suspicion for inflammation in the distal femur
close to the prosthetic material. Further Nuclear medicine scans
revealed increased radionuclide uptake in the distal right femur and an
incidental finding of a large soft tissue abscess in the right thigh. MRI
confirmed a 20 cm thick walled cystic mass in the right proximal thigh.
She was admitted in March 2016 for surgical washout and debride-
ment of the thigh abscess. CT CAP showed evidence of disseminated
disease with milliary pulmonary nodules. Pus cultures from the
abscess identified the causative microorganism. HIV test was negative.
She was started on 2 different intravenous antibiotics with symptom-
atic improvement and reduction of inflammatory markers. However,
on day 10 of treatment she developed recurrent episodes of severe
hypoglycaemia, recurring despite intravenous dextrose and glucagon
injections. She subsequently developed severe hyponatremia follow-
ing aggressive resuscitation with iv. dextrose and required ICU
admission for 6 days.
The Endocrinology team reviewed the case and advised that one of the
antibiotics was likely to be the cause of the hypoglycaemic episodes.
The patient was switched to a different intravenous antibiotic and no
further hypoglycaemic episodes were recorded.
What was the underlying diagnosis, and whichwas the offending drug?
ID: 4918
A fatal case of pyogenic liver abscess complicated by two traits of
one pathogen
Kerry Roulston1, Tehmina Bharucha Bharucha1, Katie Hopkins2,
Jane Turton2, Damien Mack1. 1Royal Free London NHS Foundation Trust,
2Antimicrobial Resistance and Healthcare Associated Infections Reference
Unit, Public Health England
A 63 year old lady of Bangladeshi origin presented with a four day
history of fever, rigors and right upper quadrant pain. She had a recent
diagnosis of metastatic pancreatic cancer with biliary stent insertion
three weeks earlier. On admission the patient was septic (temperature
38°C, heart rate 125, blood pressure 106/44, respiratory rate 25) with a
white cell count of 28 (neutrophils 25) and a c-reactive protein of 318.
Piperacillin-tazobactam was started for presumed biliary sepsis and
blood cultures taken on admission grew a fully susceptible Escherichia
coli. A computed tomography scan revealed a large multi-septate liver
abscess, a drain was inserted and E. coli was isolated. The patient
deteriorated and died seven days after admission.
A second organism associated with this condition was also isolated
from the liver aspirate and a rectal screening swab which posed a
significant challenge in the management of this patient. The
emergence of such organisms presents a new and significant threat
to global public health.
ID: 4955
A very chronic infection
Chloe Walsh, Jane Minton. Leeds Teaching Hospitals NHS Trust
A 49 year old woman was referred to Infectious Diseases with pyrexia
of unknown origin (PUO). Past medical history includes systemic
lupus erythematosus with multi-organ involvement and long term
prednisolone use. She was admitted with fever without localising
Abstracts of FIS/HIS 2016 – Oral Presentations / Journal of Hospital Infection 94S1 (2016) S11–S21 S15