31 / 150
between hospitals including patient mix. This may bias the results
preventing effective benchmarking of antimicrobial prescribing
quality indicators.
Aim(s)/Objective(s):
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.
Method(s):
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.
Results:
Ranges and means are reported.
Standard1: Antimicrobial choice reasonable: (range 67
–
97%) mean
85%
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
1
, Vasundhra Bhandari
2
, Vandana Rani
1
, Rajni Gaind
1
.
1
VMMC & Safdarjung Hospital,
2
DST-INSPIRE
Background:
Reports on characterization of linezolid resistant (LR)
staphylococci are limited from India.
Aim(s)/Objective(s):
We investigated clicoepidemiological profile and
molecular characterization of LRCoNS.
Method(s):
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
cfr
gene and
domain V
region
of the 23S rRNA. Mutations were detected by sequencing of five copies
of 23S rRNA gene.
Results:
LR was observed in diverse species of CoNS (9
S. haemolyticus
,
3
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
–
80
year). All isolates were susceptible to vancomycin and 10 were
teicoplanin resistant. Linezolid MIC ranged from 8
–
32 μg/mL and
cfr
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
cfr
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
by
cfr
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
1
, Eugenia Selkova
2
, Olga Ershova
3
,
Nikolai Volozhantsev
4
, Edward Svetoch
4
, Irina Kiseleva
2
,
Lidiya Novikova
2
, Svetlana Bochkareva
2
.
1
Gabrichevsky Moscow
Research Institute for Epidemiology and Microbiology,
2
Gabrichevsky
Moscow Research Institute for Epidemiology and Microbiology,
3
Burdenko
Research Institute of Neurosurgery,
4
State Research Center for Applied
Microbiology and Biotechnology
Background:
Phages have been used to prevent and/or treat infectious
diseases of bacterial etiology for almost a century.
Aim(s)/Objective(s):
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.
Method(s):
42 patients on prolonged mechanical ventilation in an
ICU were administered a 20 mL dose (10
8
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).
Results:
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
1
, Silje Bakken Jørgensen
1
, Andre Ingebretsen
2
.
1
Akershus University Hospital,
2
Oslo University Hospital
Background:
Clostridium difficile
associated diarrhoea (CDAD) causes
considerable morbidity and mortality world-wide. The emergence of
virulent clones has increased CDAD morbidity in many countries.
Aim(s)/Objective(s):
To assure early outbreak detection in our
hospital, we have established a local CDAD surveillance system.
Method(s):
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.
Results:
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
–
S134
S26