30 / 150
Results:
Aspirate cultures were positive in 57% of the patient. The
mean number of isolates per sampling was 1.0 from fine-needle
aspirates, compared to 1.6 from wound swabs. The correlation of
isolates from aspirates and swabs was 60%. Two aspirates did not yield
significant growth but yielded heavy and moderate growth from
wound swabs. In one wound swab additional organism (
Pseudomonas
sp) was isolated from the same wound and one wound swab yielded
scanty coliform growth but nil growth from aspirate. In two closed,
inflamed cellulitic areawith nil growth from aspiratewound swab was
not taken.
Discussion and/or Conclusion(s):
The FNA microbiopsy technique in
this study used only a small amount of tissue for sampling, which
was not painful for patients. It was possible to obtain aspirate from
closed cellulitic tissue where simple swab was not possible. The
aspirate results yielded less pathogens and fewer organisms compared
to wound swabs reflecting more accurately the state of the wound
infection and response to antimicrobial treatment.
ID: 4695
Trends and variations in antimicrobial susceptibility testing
between laboratories in North West England: implications for
interpretation of surveillance data
Vicky Watts, Paul Cleary, Andrew Dodgson.
Public Health England
Background:
Surveillance of multidrug-resistant organisms (MROs) of
public health significance using routine laboratory data is complicated
by variations in practice between reporting sources.
Aim(s)/Objective(s):
We examined trends and variation in antibiotic
susceptibility testing (AST) of Enterobacteriaceae between laborator-
ies in North West England between 2010 and 2016.
Method(s):
Retrospective analysis of routine diagnostic laboratory
data.
Results:
We analysed AST data from 21 laboratories for 12,021
Enterobacteriaceae isolates.
Testing of
Klebsiella pneumoniae
for meropenem susceptibility
increased between 2010 and 2012 (85
–
98%), remained stable until
2014 and declined in 2016 (92%); testing was generally high but
varied between laboratories in 2015/16 (median: 95%, IQR: 84
–
98%,
min: 49%). Findings were similar for
Enterobacter
spp and for
ertapenem resistance testing. Testing of
E. coli
varied considerably
between laboratories in 2015/16 (median: 21%, IQR: 12
–
36%, max:
100%, min: 4%). A high proportion of
K. pneumoniae
were tested for
susceptibility to a third generation cephalosporin in 2015/16 but this
was variable between laboratories (ceftazidime: median:86%, IQR:62
–
97%; cefpodoxime: median:64%, IQR:39
–
99%). Findings were similar
for
Enterobacter
and
E. coli
. Testing of
K. pneumoniae
and
Enterobacter
for colistin susceptibility declined between 2010 and 2016 (8
–
3%; 17
–
10%) and remained low for
E. coli
(<2%). There was a marked decline in
AST for trimethoprim, nitrofurantoin and fosfomycin (
K. pneumoniae
and
Enterobacter
) and ciprofloxacin (
E. coli
) from 2014.
Discussion and/or Conclusion(s):
We identified variation in AST
between laboratories and over time, complicating interpretation of
routine surveillance data. We recommend routine collection and
reporting of laboratory practice to aid interpretation of surveillance
data.
ID: 4706
Impact of hospital-wide use of antiseptic bath/wipes on incidence
of MDROs
Moi Lin Ling
1
, Ismawati Mohammad Amin
2
, Molly How
2
,
Yong Ming Tee
2
, Kwee Yuen Tan
2
.
1
Singapore General Hospital Pte Ltd,
2
Singapore General Hospital
Background:
Studies suggest that daily bathing of patients with
chlorhexidine may prevent hospital-acquired bloodstream infections
and the acquisition of multidrug-resistant organisms (MDROs). In
Singapore, the common MDROs seen in hospitals are MRSA, VRE, CRE
and multiresistant
Acinetobacter baumannii
(MR-ACBA).
Aim(s)/Objective(s):
We implemented hospital-wide use of antiseptic
bath/wipes in 2013 as an additional initiative to the existing MDRO
bundle used. The latter comprising active surveillance for MDROs,
Contact Precautions, hand hygiene and environmental hygiene, was
implemented hospitalwide from 2009.
Method(s):
Healthcare-associated MR-ACBAwas significantly reduced
from0.26 to 0.12 per 1,000 patient days following the hospitalwide use
of antiseptic bath. In contrast, no reduction was seen in the incidence
of healthcare-associated MRSA, VRE or CRE.
Results:
Healthcare-associated MR-ACBA was significantly reduced
from0.26 to 0.12 per 1,000 patient days following the hospitalwide use
of antiseptic bath. In contrast, no reduction was seen in the incidence
of healthcare-associated MRSA, VRE or CRE.
Discussion and/or Conclusion(s):
The use of antiseptic bath is an
important component of the MDRO bundle to help reduce the MDRO
bioburden amongst skin colonisers. However, its long term use will
need to be assessed with respect to possible resistance development.
ID: 4721
Resistance to disinfectants and antiseptics
–
a risk?
Bernhard Meyer
1
, Ellie Wishart
2
.
1
Ecolab Deutschland GmbH,
2
Ecolab
United Kingdom
Background:
While the problem of antibiotic resistance is well under-
stood within the infection prevention community, there remains some
confusion about a potential risk of resistance against disinfectants and
antiseptics (biocidal substances).
Aim(s)/Objective(s):
Assess available literature and knowledge on
application of biocidal substances to identify the risk of relevant
microbial resistance to these substances and the potential risk of
promoting antibiotic resistance.
Method(s):
Review and evaluation of available literature.
Results:
Whereas antibiotic resistance can be defined as an increased
minimum inhibitory concentration, resistance to biocidal substances
must be defined as failing defined log reduction according to
accepted standards as outlined in EN 14885 at concentrations and
contact times, which deliver kill of standard test organisms. Also,
genetically determined resistance must be distinguished from pheno-
typic adaptation, which is found e.g. in biofilms. Using these
definitions, the development of relevant resistance to biocidal
substances has not been observed in more than 50 years of routine
use. Notably, antibiotic resistancewas found even before broad clinical
use of these substances. Given the broad and unspecific mode of action
of biocides, it is unlikely that this will happen. Correct use of biocidal
substances like avoiding sublethal exposure of microbes under
conditions supporting microbial growth and selection further reduce
this risk. It was also demonstrated that correct use of biocidal
substances does not promote antibiotic resistance.
Discussion and/or Conclusion(s):
It is concluded that correct use of
biocidal substances may provide opportunities to reduce the risk of
spread of antibiotic resistance.
ID: 4728
Development and implementation of a standardised antimicrobial
stewardship audit to improve benchmarking across a region
Naomi Fleming
1
, Bolla Balwinder
2
, Tim Hills
3
, Monica Marriott
4
,
Julia Lacey
5
, Suraiya Chandratillake
6
, Anna Braithwaite
7
,
Corrine Ashton
8
, Claire Salt
9
, Suewen Leo
2
, Annette Clarkson
3
,
Aneeka Chavda
4
.
1
Kettering General Hospital,
2
United Lincolnshire
Hospitals NHS Trust,
3
Nottingham University Hospital,
4
Sherwood Forest
Hospital NHS Foundation Trust,
5
Derby Teaching Hospitals NHS
Foundation Trust,
6
Milton Keynes Hospital NHS Foundation Trust,
7
Chesterfield Royal Hospital NHS Foundation Trust,
8
Leicester University
Hospital,
9
Northampton General Hospital
Background:
Trusts are encouraged to benchmark antimicrobial
quality assurance measures to provide an additional context to
consumption data.
1
The regional antimicrobial pharmacists
group share data but this does not take into account differences
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S25