Carbapenemase-producing organisms in NHS Lothian
reliable detection and confirmation
, Kate Templeton
, Fiona Hamilton
, Clark Russell
University of Edinburgh
Carbapenemase-producing Organisms pose an increas-
ing clinical threat globally. Increasing resistance to carbapenems
(often considered the last line in antibiotics in the treatment of
gram-negative infections) has led to the requirement for rapid and
robust methods for the analysis of carbapenemase activity in these
From September 2014, NHS Lothian has been
performing in-house multiplex real-time PCR for OXA-48, VIM, NDM,
KPC and IMP carbapenemase-producing organisms alongside Rapidec
Carba NP testing and detection of growth on ChromID CARBA SMART
media. The sensitivity and specificity of these assays were assessed
over a 24 month period.
This review detailed the investigation of 81 isolates from
the period September 2014 to Aug 2016 including 38 carbapenamase-
positive isolates and 43 carbapenemase-negative isolates.
The sensitivity and specificity of the in-house PCR to detect
the OXA-48, VIM, NDM, KPC and IMP (
) targets was assessed to
be 100% and 100%. The chromogenic screening agar ChromID CARBA
SMART had a sensitivity of 97.3% and a specificity of 95.3% for detection
of carbapenemase-producing organisms. The Rapidec Carba NP had a
sensitivity of 97.3% and a specificity of 97.6%. Two OXA-23 producing
isolates and two IMI-producing isolates were all positive by Rapidec
Carba NP and characterised by ARMRL Colindale.
Discussion and/or Conclusion(s):
The overall compilation of
Carbapenemase-producing Organisms over the 24 month period in
NHS Lothianwas NDM (21%), OXA-48 (29%), VIM (24%), IMP (11%), KPC
(5%), OXA-23 (5%) AND IMI (5%). A robust, reliable and rapid workflow
for laboratory detection of Carbapenemase-producing organisms has
been validated for use in NHS Lothian.
Surveillance of antifungal resistance patterns in oral
Noha Seoudi, Wala Belhaj.
Oral microbiology investigation forms an important
role in managing orofacial infections and patient care. Recently, the
Public Health England (PHE) updated their oral mucosal standards for
microbiology investigations (SMI).
infection is one of the most
frequent oral infections that require proper diagnosis, for optimum
management especially with the increased immunocompromised
population and the reported emergence of antifungal resistance.
Therefore, this study analysed the antifungal resistance in oral
To analyse the antifungal resistance pattern in
infection reported by one of the oral microbiology
laboratory in a dental hospital in the UK.
Data from oral microbiology laboratory reports was
collected electronically retrospectively in a two-year period (2014
2015). Subsequently, Oral
reports were studied and the
sensitivity patterns were analysed.
In the period between the 1st of January 2014 to the 31st
of December 2015, a total of 2051 oral mucosal swabs received, only
29% (594/2051) of these swabs grew yeasts, 95.6%(568/594) of
the yeast isolates were identified to species level. Susceptibility
tests were performed for 9.5% (54/568) of the reported
was reported 100% sensitive to Ambizome, Itraconazole,
Nystatin, Caspofungin and voriconazole, and 95% to Fluconazole and
Echinocandin. Resistance was reported only in non-albicans
Candida glabrata, Candida krusei
Discussion and/or Conclusion(s):
This study highlights that
isolated from oral infection remains very sensitive to the commonly
used antifungal agents. However, sensitivity testing is still justified
in cases of failure of treatment, immunocompromised patients and
infection with non-albicans
Investigating new cases of Enteroccoci conferring Optr-A mediated
linezolid resistance from Scotland
, Anne Marie Karcher
, Michael Lockhart
, Ben Parcell
National Services Scotland
Presently less than one percent of Gram positive
organisms have Linezolid resistance. This resistance can result from
mutations in chromosomal genes. Since 2012 there has been a Scottish
national alert flagging newly identified plasmid mediated trans-
ferable mechanisms via the cfr gene and recently the Optr-A gene. The
Optr-A gene encodes an ABC transporter which confers resistance to
oxazolidinones and phenicols.
We have identified three separate Optr-A mediated Linezolid resistant
isolates from urine samples in NHS Grampian
from 2014 to 2016. It is extremely rare to identify this resistance
To describe these three cases and investigate risk
factors for acquiring these infections and identify potential links
To review lab system records, and Vitek 2 sensitivities and
typing for comparison; to collate clinical information and establish
whether the patients were managed for acute episodes of urinary
infection; and to identify epidemiological risk factors for acquiring
these isolates including past medical histories, hospital admissions,
links to farming, and travel histories including to Ireland.
The results from the lab system search and the case histories
from GP interviews will be described.
Discussion and/or Conclusion(s):
Plasmid mediated mechanisms
are of considerable public health importance due their potential to
transfer and confer resistance to other strains and species.
Topic: Antimicrobial stewardship
The role of point of care tests in antibiotic stewardship for
urinary tract infections in a resource limited setting on the
Lauren Chalmers, Rose McGready, François Nosten, Jessica Cross,
Cindy S. Chu, Aung Pyae Phyo, Margreet Trip, Clare Ling,
Verena Carrara, Wanitda Watthanaworawit, Lily Keereecharoen,
Shoklo Malaria Research Unit (SMRU),
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical
Medicine, Mahidol University, Thailand
Published literature from resource-limited settings is
infrequent, although urinary tract infections (UTI) are a common cause
of outpatient presentation and antibiotic use. Point-of-care test (POCT)
interpretation relates to antibiotic use and antibiotic resistance.
We aimed to assess the diagnostic accuracy of
POCT and their role in UTI antibiotic stewardship.
One-year retrospective analysis in three clinics on the
Thailand-Myanmar border of non-pregnant adults presenting with
urinary symptoms. POCT (urine dipstick and microscopy) were com-
pared to culture with significant growth classified as pure growth of a
single organism >10(5) CFU/mL.
In 247 patients, 82.6% female, the most common symptoms
were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency
(53.7%). After excluding contaminated samples, UTI was diagnosed
in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture,
and >80% of these were
(20.9% produced extended-
-lactamase (ESBL)). Positive urine dipstick (leucocyte
1 and/or nitrate positive) compared against positive micro-
scopy (white blood cell >10/HPF, bacteria
1/HPF, epithelial cells
<5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity
Abstracts of FIS/HIS 2016
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24