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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



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


, David Denning


, Jane Democratis




Frimley Health

Foundation Trust,


Professor of Infectious Diseases in Global Health,

University Hospital of South Manchester,


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


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.


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.


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.


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


, Deirdre Hughes Fitzgerald


, Georgina Gethin



Hilary Humphreys




Beaumont Hospital/RCSI,




NUI Galway,


RCSI/Beaumont Hospital


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.


To compare sequential isolates, i.e. historical

(original first isolate from that patient), on recruitment and on study

completion using




Isolates were


typed. DNA sequencing was performed

by GATC Biotech, Germany and


type assigned.


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


type was assigned for 205 isolates, predominant


-types were t032, t515, t127 and t4559. Two new


types were

identified and assigned t15373 and t15959 by the SeqNet curator. Of

the 66 patients, 45 (68%) had an indistinguishable


type on both

occasions. Among persistent MRSA carriers (n = 46/100), 42 had an



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


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


, Andrew Flatt


, Carole Fogg




Portsmouth Hospitals NHS



Portsmouth Hospitals NHS Trust,


University of Portsmouth


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