36 / 150
ID: 4927
CPE screening: Molecular vs Culture
–
a comparison
Pamela Hunter, Sarah Whitehead, Thomas Gillespie.
NHS Lanarkshire
Background:
Carbapenemase producing Enterobacteraciae (CPE) are
endemic in some healthcare facilities worldwide. There is a risk these
could become endemic in Scottish hospitals. Consequently, Scottish
government has mandated CPE screening of patients who have been in
hospitals in rUK and worldwide.
Aim(s)/Objective(s):
We set out to compare use of CPE screening
plates with a molecular method.
Method(s):
We carried out a 3 month pilot involving 4 wards at
Monklands District General Hospital. For 6 weeks samples from
patients requiring CPE screening were tested using CPE screening
plates (Chromogenic UTI agar (Thermo Fisher) with a 10 microgram
ertapenem disc, and for the subsequent 6 weeks, Cepheid GeneXpert
®
was used for PCR.
Results:
Conventional culture requires patients to be isolated for a
minimum of 6 days, whereas molecular methods could give a negative
result within hours. A comparison of turn round time for the two
methods; cost, ease of patient and laboratory staff use and effect on
infection control/patient placement is presented.
Discussion and/or Conclusion(s):
CPE propose a significant risk to
patients in hospitals worldwide. It is important to prevent CPE
’
s
becoming endemic in Scottish healthcare facilities and screening
identified groups of patients, allowing those who are colonised to be
isolated may help prevent spread. However, it is essential that
methods for screening must be cost effective and acceptable to both
patients and staff. Although individually more expensive, a rapid test
has the potential to release staff resource and allow patients to be
discharged from isolation facilities up to 6 days earlier.
ID: 4946
Carbapenemase producing Enterobacteriaceae
–
the trouble with
screening
Emily Goldstein, Rory Gunson, Brian Jones, John Coia.
NHS Greater
Glasgow and Clyde
Background:
Carbapenemase producing
Enterobacteriaceae
(CPE)
are considered a significant public health threat, with prevalence
increasing dramatically in the UK over the past decade. In 2004
there were only two CPE isolated, in comparison to 2014 in which
>1600 CPE were detected in the UK, therefore interventions are
urgently required to reduce transmission of these highly resistant
organisms.
Active surveillance of CPE, allowing for early detection and implication
of effective infection control procedures, is of paramount importance
in healthcare settings. However, a variety of screening methods are
being employed by different laboratories.
Aim(s)/Objective(s):
In this study we aim to evaluate the utility of
eight different screening methods to detect CPE in a panel of 125
Enterobacteriaceae
isolates.
The following methods were investigated: multiplex real-time PCR,
modified Hodge test, Rapidec Carba NP, two chromogenic agars
(CarbaSmart and SuperCarba), MacConkey agar with a 10 μL merope-
nem disc, MIC by both Vitek and Etest.
Discussion and/or Conclusion(s):
The ideal screening method should
provide rapid, highly sensitive results in addition to being non-labour
intensive and cost-effective. Each method poses its own advantages
and challenges, and only PCR resulted in a sensitivity and specificity
of 100%.
ID: 4964
Is weekly therapeutic drug-level monitoring of Teicoplanin
necessary in the OPAT setting?
TimHills
1
, Md Smith
2
, Rebecca Greenham
2
, Arun Sareen
2
.
1
Nottingham
University Hospitals NHS Trust,
2
University of Nottingham
Background:
Teicoplanin is a once a day antibiotic often given to
treat serious Gram positive infection. In 2013 an amendment to the
dosing and monitoring advice contained in the Summary of Product
Characteristics for Teicoplanin advised taking trough blood levels at
least once a weekly.
Aim(s)/Objective(s):
To assess the suitability of the teicoplanin
therapeutic drug monitoring (TDM) recommendations in relation to
audit results from a UK OPAT centre.
Method(s):
Data from patients who received teicoplanin as part of the
OPAT service was collected retrospectively July 2012 to February 2016
including dose, weight, serum creatinine, age, TDM data and levels,
adverse events and clinical outcome.
Results:
29 patient-episodes had an initial steady-state trough level
between 20 and 45.5 mg/L, had no changes to their on-going dosing
regimen and received at least one follow-up teicoplanin levels at
least 7 days after the initial level. The mean time between levels was
22 days (range 7
–
46). 28 of the 29 patient-episodes (97%) had follow-
up levels between 20 and 60 mg/L with one having a trough level of
68 mg/L. This patient
’
s calculated creatinine clearance (Cockcroft-
Gault) reduced from 53.6 to 38.5 mL/min between the two levels.
None of the 29 patient-episodes experienced adverse drug reactions.
Overall, the mean trough level increased from 29.7 to 37.8 mg/L
between the two levels.
Discussion and/or Conclusion(s):
Results of our audit call into
question the need for weekly TDM of teicoplanin for OPAT patients
with stable renal function.
ID: 4982
Cost-effectiveness of outpatient intravenous antibiotic service
using a Discrete Event simulation approach
Armando Vargas-Palacios
1
, David Meads
1
, Jane Minton
2
, Judy Wright
1
,
Carolyn Czoski Murray
1
, Elizabeth Mitchell
1
, Claire Hulme
1
,
Angela Gregson
3
, Philip Stanley
4
, Maureen Twiddy
1
.
1
University of
Leeds,
2
Leeds Teaching Hospitals NHS Acute Trust,
3
Leeds
Community Healthcare Trust,
4
Bradford Teaching Hospitals NHS
Foundation Trust
Background:
Many patients who have an infection will require intra-
venous antimicrobial treatment. Some will be suitable for receiving
their antibiotics in the community through OPAT (outpatient paren-
teral antimicrobial therapy) services. These services include: admin-
istration of the intravenous antimicrobial treatment in a hospital
out-patient clinic; at home by general or specialist nurse; or patient
self-administered following training. In the UK there is uncertainty
regarding which service represents the best value for money.
Aim(s)/Objective(s):
This study aimed to estimate the cost-effective-
ness of these different OPAT services.
Method(s):
A cost effectiveness decision analytic model was devel-
oped using a discrete event simulation technique. The model estima-
ted costs and outcomes using quality adjusted life years (QALYs). OPAT
services were simulated including nurses and consultation room
capacity for a given population at risk.
Results:
For short term infection, hospital outpatient administra-
tion was the most expensive service and provided negligible
QALY gains compared to services provided by nurses visiting at
home. Administration at home by a specialist nurse was estimated
to be the most cost-effective service. For long term infections,
whilst patient self-administration was the cheapest option, specialist
nurse administration offered the most QALY gain resulting in a
combination of the two services being the most cost-effective
configuration.
Discussion and/or Conclusion(s):
Nurse administration and patient
self-administration of intravenous antimicrobial treatment were the
most cost-effective strategies. However a lack of service capacity will
result in treatment delays, greater health risks and increased costs
which eventually impact on service cost-effectiveness.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S31