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between hospitals including patient mix. This may bias the results

preventing effective benchmarking of antimicrobial prescribing

quality indicators.


To develop and implement a standardised

audit methodology using the same patient mix and speciality of staff

examining antimicrobial stewardship indicators across a region.

To achieve 90% in agreed audit standards.


Quality indicators, audit standards, data collection criteria

and patient specialties applicable to all hospitals in the region were

agreed. Trust antimicrobial pharmacists collected and analysed data

on 100 patient cases from agreed specialities between November and

December 2015.


Ranges and means are reported.

Standard1: Antimicrobial choice reasonable: (range 67

97%) mean


Standard 2: Indication documented: (range 33

97%) mean 79%

Standard 3: Stop/review date documented: (range 20

95%) mean 64%

Standard 4: 72 hour prescribing decision: (range 50

94%) mean 73%

Standard 5: Pharmacist screen: (range 57

86%) mean 72%

Standard 6: Not reasonable but screened: (range 4

36%) mean 17%

Standard 7: Consultant review; (range 73.5

100%) mean 86%.

Discussion and/or Conclusion(s):

This audit allowed a consistent

approach to data collection; patient mix and data interpretation were

comparable. There was no indicator where the region achieved 90%

and therewas awide variation inmany indicators. This data is useful to

highlight outlying and achieving Trusts encouraging best practice

sharing across the region. This audit will be repeated annually,

allowing effective comparisons to be drawn.

ID: 4758

Clinic-epidemiological profile and molecular characterization of

linezolid resistant coagulase negative staphylococci from India

Gajanand Mittal


, Vasundhra Bhandari


, Vandana Rani


, Rajni Gaind




VMMC & Safdarjung Hospital,




Reports on characterization of linezolid resistant (LR)

staphylococci are limited from India.


We investigated clicoepidemiological profile and

molecular characterization of LRCoNS.


15 blood isolates of LRCoNS were characterized for

mechanism of LR. Species identification was done by sequencing of

16S rRNA

gene. Demographic data, clinical and antibiotic history and

co-morbid conditions were recorded through chart review. Linezolid

and glycopeptides MIC was determined by microbroth dilution and E-

test respectively. PCR was performed for


gene and

domain V


of the 23S rRNA. Mutations were detected by sequencing of five copies

of 23S rRNA gene.


LR was observed in diverse species of CoNS (9

S. haemolyticus



S. cohnii

and 3

S. arlettae

). All LRCoNS were noscomially acquired.

All patients had co-morbidities without prior exposure to linezolid,

clindamycin or chloramphenicol. Mean agewas 30 years (8month


year). All isolates were susceptible to vancomycin and 10 were

teicoplanin resistant. Linezolid MIC ranged from 8

32 μg/mL and


gene was detected in all isolates. Novel mutations were detected;

G2614T (n = 10) and C2384T (n = 1) in

domain V

region of 23S rRNA.

One isolate of

S. arlettae

showed both mutations. Among three isolates

no mutation was identified. There was no correlation between

linezolid MIC and


gene, type of mutation detected, number of

mutant copies.

Discussion and/or Conclusion(s):

LR is emerging in diverse species of

CoNS without prior exposure. Multiple mechanisms contributed to

resistance and novel mutations were detected. Resistance mediated



gene is of great concern as it can be rapidly disseminated and

capable of transmitting horizontally between diverse species.

ID: 4776

Bacteriophages in prophylaxis of healthcare-associated infections

(HAIs) in a neurosurgical intensive care unit (ICU)

Andrey Aleshkin


, Eugenia Selkova


, Olga Ershova



Nikolai Volozhantsev


, Edward Svetoch


, Irina Kiseleva



Lidiya Novikova


, Svetlana Bochkareva




Gabrichevsky Moscow

Research Institute for Epidemiology and Microbiology,



Moscow Research Institute for Epidemiology and Microbiology,



Research Institute of Neurosurgery,


State Research Center for Applied

Microbiology and Biotechnology


Phages have been used to prevent and/or treat infectious

diseases of bacterial etiology for almost a century.


The purpose of this research was to establish the

effect of a single administration of bacteriophage in patients of

neurosurgical ICU on circulation of hospital pathogens.


42 patients on prolonged mechanical ventilation in an

ICU were administered a 20 mL dose (10


pfu/mL) of bacteriophage

cocktail per os, some patients had multiple administrations. A phage

cocktail combined host range was 73% of the antibiotic-resistant

strains (A.baumannii, K.pneumoniae, P.aeruginosa) isolated in the ICU.

Anti-phage IgG-antibodies were tested by enzyme-linked immuno-

sorbent assay (ELISA).


A.baumannii, K.pneumoniae, P.aeruginosa were isolated from

the samples of the patients

endotracheal aspirate (ETA), blood, urine

and feces, with a content of up to 87%. In the first episode of trials,

one day after a 3-day therapy, effective sanitation was confirmed in

62.5% of the cases. Pharmacokinetic tests have shown that per os

administered bacteriophages penetrate through the gastrointestinal

tract into blood, feces, urine, ETA. Repeated therapy did not result in a

significant eradication of pathogens. Anti-phage immunity after the

intake of preparation was tested by ELISA for presence of significant

titers of specific IgG-antibodies.

Discussion and/or Conclusion(s):

The right course of action for using

bacteriophage cocktails in ICUs will be to establish fixed contents of

phage species in the cocktail with subsequent selection of phage

strains (or mandatory alteration with new phage strains in cases of

repeated administration for the same patient), active against current

pathogens in the ICU, from an existing Phage Bank.

ID: 4784

Transition to ribotyping of

Clostridium difficile

in a university

hospital in Norway

Michaela M. Lelek


, Silje Bakken Jørgensen


, Andre Ingebretsen




Akershus University Hospital,


Oslo University Hospital


Clostridium difficile

associated diarrhoea (CDAD) causes

considerable morbidity and mortality world-wide. The emergence of

virulent clones has increased CDAD morbidity in many countries.


To assure early outbreak detection in our

hospital, we have established a local CDAD surveillance system.


CDAD is diagnosed by the hospital microbiology labora-

tory by a two-step method using LAMP-technology. All positive

samples are subsequently cultured, and

C. difficile

isolates are ribo-

typed at the national

C. difficile

reference laboratory. Infection control

staff monitors new cases weekly.


During 2014 and 2015, 195 cases of CDAD were identified. 83

acquired their CDAD more than 48 hours after being admitted to the

hospital, 68 acquired CDAD outside of the hospital, and 44 were only

treated in primary care.

Ribotypes 081, 131, 207 and NO24 occurred solely in hospitalized

patients, while 087 and 106 were found only in patients that had not

been admitted. Therewere a few others that originately only outside of

the hospital.

Discussion and/or Conclusion(s):

The departments with the highest

occurence of CDAD were the infectious diseases department and the

haematology department. There was no significant accumulation of

specific ribotypes on any ward. The distribution of ribotypes in our

Abstracts of FIS/HIS 2016

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24