Table of Contents Table of Contents
Previous Page  20 / 150 Next Page
Show Menu
Previous Page 20 / 150 Next Page
Page Background


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


Topic: Clinical cases

ID: 4711

Beans for breakfast darling?

Alison Burgess


, Begona Bovill


, Elizabeth Johnson


, Megan Jenkins




PHE, Southmead Hospital, Bristol,


Southmead Hospital, Bristol,


National 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


ID: 4807

Fusobacterium nucleatum and Parvimonas micra polymicrobial

infection in a patient with spondylodiscitis

Leanne Cleaver, Damien Mack, Shara Palanivel, Simon Warren.


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


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


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 Roulston


, Tehmina Bharucha Bharucha


, Katie Hopkins



Jane Turton


, Damien Mack




Royal Free London NHS Foundation Trust,


Antimicrobial 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



. 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