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ID: 4927

CPE screening: Molecular vs Culture

a comparison

Pamela Hunter, Sarah Whitehead, Thomas Gillespie.

NHS Lanarkshire


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.


We set out to compare use of CPE screening

plates with a molecular method.


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.


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


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


Emily Goldstein, Rory Gunson, Brian Jones, John Coia.

NHS Greater

Glasgow and Clyde


Carbapenemase producing



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


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.


In this study we aim to evaluate the utility of

eight different screening methods to detect CPE in a panel of 125



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?



, Md Smith


, Rebecca Greenham


, Arun Sareen





University Hospitals NHS Trust,


University of Nottingham


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.


To assess the suitability of the teicoplanin

therapeutic drug monitoring (TDM) recommendations in relation to

audit results from a UK OPAT centre.


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.


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


, David Meads


, Jane Minton


, Judy Wright



Carolyn Czoski Murray


, Elizabeth Mitchell


, Claire Hulme



Angela Gregson


, Philip Stanley


, Maureen Twiddy




University of



Leeds Teaching Hospitals NHS Acute Trust,



Community Healthcare Trust,


Bradford Teaching Hospitals NHS

Foundation Trust


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.


This study aimed to estimate the cost-effective-

ness of these different OPAT services.


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.


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


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