21 / 150
symptoms, which responded to piperacillin/tazobactam. Fever
recurred on stopping antibiotics. Examination revealed a dull right
lung base; imaging confirmed consolidation, but suggested that
changes were chronic.
Her respiratory problems date back to 1990 when she had
“
pleurisy
”
.
Imaging reveals pleural thickening and consolidation of the right lung
since at least 2004. In 2010 she had empyema. Symptoms improved
following thoracoplasty and washout of the pleural cavity. In 2012, she
presented with bacteraemia, and has since had multiple admissions
with pneumonia and bacteraemia; likely secondary to the same
chronic infection. She is currently receiving prolonged antibiotics, as
surgical management is too high risk.
Such prolonged bacterial infection is rarely described. In PUO it is
essential not to dismiss any clues when assessing patients and to be
aware that chronic infection can establish when source control is not
adequately achieved.
ID: 4998
Mysterious mycosis from Maidenhead
Michael Butler
1
, David Denning
2
, Jane Democratis
3
.
1
Frimley Health
Foundation Trust,
2
Professor of Infectious Diseases in Global Health,
University Hospital of South Manchester,
3
Consultant Physician Infectious
Diseases, Frimley Health NHS Foundation Trust
We report a 49 year old British-Asian female with a 40 year history of
unilateral recurrent cellulitis and chronic lymphoedema referred for
consideration of prophylactic antibiotics. Removal of dressings
identified no cellulitic changes but rather an invasive fungating
lesion, with MRI revealing underlying osteomyelitis.
The chronic lymphoedema had developed in the left leg at the age of
fifteen, the skin on which began to break down, and she developed a
fungal infection, with recurrent secondary bacterial cellulitis. Follow-
ing failed attempts by the vascular team to save the rapidly deterio-
rating leg, she required an above knee amputation to save her life.
She was lost to follow up before a diagnostic work up was complete.
The patient is of Pakistani ethnicity, born in the UK, with no significant
travel history. Apart from suffering from onychomycosis from the age
of three, she is otherwise fit and well, showing no signs of any other
immunocompromise, nor any recurrent mucosal candidiasis.
After two years of good health, the patient re-presented to the clinic
with accelerated oedematous changes and new onset of fungal
infection in her remaining right leg. A race began to make a diagnosis,
curb the infection and save the remaining leg.
ID: 5012
What is optimal antimicrobial therapy for PVL MSSA infection?
Daniel Pan, Gavin Barlow, Kate Adams.
Hull and East Yorkshire NHS Trust
A 15-year-old healthy boy accidentally fell over whilst playing football,
subsequently scraping his left leg. A few days later he presented to
hospital with fever and severe progressive back and leg pain.
Admission blood tests showed a C-reactive protein (CRP) of 82 mg/L
and normal range white cell count. Magnetic resonance imaging
suggested pyomyositis of the left obturator, adductor and pubo-
coccygeal muscles. Subsequent blood tests showed leukopenia,
thrombocytopenia, CRP of >380 mg/L and an elevated creatine
kinase of 399 U/L. Thoracic CT showed extensive bilateral consolida-
tion with cavitation.
Topic: Clinical microbiology
ID: 4718
Comparison of inpatient Clostridiumdifficile rates in cystic fibrosis
and respiratory patients at a Large Centre
Liana Hewson.
University of Manchester
Background:
Previous research has identified a high carriage rate of
C. difficile in Cystic Fibrosis (CF) patients. On the inpatient unit of
Manchester adult CF Centre (MACFC) it is common to detect antigen
positive, toxin negative C. difficile in stool samples. There is lack of
clarity as to how best to treat these patients, particularly around
isolation for infection control as this greatly impacts on treatment of
respiratory disease.
Aim(s)/Objective(s):
The aim is to investigate the rate of antigen
positive, toxin negative C. difficile in CF patients and develop
guidelines for the management of such patients.
Method(s):
From 2011 to 2014 C. difficile testing for presence of
glutamate dehydrogenase (GDH) antigen and toxin A and B in the
stools of CF patients with diarrhoea was compared with testing of
stools of general respiratory patients with diarrhoea.
Results:
The mean rates of antigen positive, toxin negative C. difficile
were 36.5% (95% CI 29.5
–
43.9%) on the CF unit and 9.2% (95% CI 7.1
–
11.7%) on other respiratory wards. For each year studied, results of
testing in the two populations are significantly different.
Discussion and/or Conclusion(s):
The rates of antigen positive, toxin
negative C. difficile are significantly higher in CF patients than in
general respiratory patients.
We have instituted PCR testing of stool samples to establish potential
for the C. difficile identified to produce toxin. If PCR testing is negative,
with a clear non-infective cause of diarrhoea we are developing
guidelines whereby patients do not need isolation, allowing patients
to engage with necessary exercise and physiotherapy.
ID: 4805
A randomised control trial and results of sequence typing of
sequential MRSA isolates
Toney Thomas
1
, Deirdre Hughes Fitzgerald
2
, Georgina Gethin
3
,
Hilary Humphreys
4
.
1
Beaumont Hospital/RCSI,
2
RCSI,
3
NUI Galway,
4
RCSI/Beaumont Hospital
Background:
Eradicating MRSA from the nose is important in preven-
ting MRSA infection. Mupirocin resistance restricts the use of repeated
courses. A randomised control trial was conducted to determine if
medical grade honey is an appropriate alternative to mupirocin.
Aim(s)/Objective(s):
To compare sequential isolates, i.e. historical
(original first isolate from that patient), on recruitment and on study
completion using
spa
typing.
Method(s):
Isolates were
spa
typed. DNA sequencing was performed
by GATC Biotech, Germany and
spa
type assigned.
Results:
To date, 100 patients have completed the study, resulting in
209 isolates. The mean age was 73.2 y and 36% female. Most (93%)
were previously known MRSA, duration 0
–
15 y. Of the 209 isolates,
66 were historic, of which 41 were nasal and the remainder were
clinical isolates. There were 143 nasal isolates; 100 on enrolment and
43 at study end. A
spa
type was assigned for 205 isolates, predominant
spa
-types were t032, t515, t127 and t4559. Two new
spa
types were
identified and assigned t15373 and t15959 by the SeqNet curator. Of
the 66 patients, 45 (68%) had an indistinguishable
spa
type on both
occasions. Among persistent MRSA carriers (n = 46/100), 42 had an
indistinguishable
spa
type on recruitment and at the end of study.
Discussion and/or Conclusion(s):
Genetic diveristy of MRSA colonis-
ing strains necessitates surveillance and molecular analysis to identify
new and resistant strains. Identification of an indistinguishable
spa
type among two thirds of persistent MRSA carriers supports the
widely held view that most persistent carriers are colonised with the
same strain, rather than with new strains.
ID: 4859
A 6 month evaluation of a frozen faecal microbiota transplant
service for the treatment of chronic Clostridium difficile infection
Kelly Bicknell
1
, Andrew Flatt
2
, Carole Fogg
3
.
1
Portsmouth Hospitals NHS
Trust,
2
Portsmouth Hospitals NHS Trust,
3
University of Portsmouth
Background:
In July 2015, the Wessex Faecal Microbiota Bank was
funded to provide frozen faecal microbiota transplant (FMT) service
to patients with recurrent Clostridium difficile infection (CDI). FMTs
have a reported cure rate of 94%, but barriers towidespread use include
Abstracts of FIS/HIS 2016
–
Oral Presentations / Journal of Hospital Infection 94S1 (2016) S11
–
S21
S16