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Discussion and/or Conclusion(s):

Following the health board


reorganisation, the infection consults remain an important service in

the new hospital and continue to support NHSGGC

s antimicrobial

stewardship agenda.

ID: 4700

Does 16S PCR really contribute to antimicrobial stewardship?

Sinead O

Donnell, Karen Burns, Fidelma Fitzpatrick, Lillian Rajan,

Mairead Skally, Edmond Smyth, Hilary Humphreys.

Beaumont Hospital,

Dublin 9, Ireland


16S rRNA PCR (16S PCR) is utilised in clinical micro-

biology to identify organisms from culture negative clinical specimens,

with the potential to optimise empiric antimicrobial management.

Selected critical specimens were referred to a UK laboratory for 16S

PCR on a case-by-case basis and after review of local culture results.


We investigated if 16s PCR influenced antimicrobial

management over a one year period (2015), by conducting a retro-

spective review of specimens sent for 16S PCR. Specimen type, result

turnaround time (TAT) and the clinical impact of a positive result were



Seventy-eight specimens were sent from 60 patients, with an

average TATof five days (range 1

11). A large proportion (35, 45%) were

from neurosurgical patients and included; CSF (17), bone flap (5) and

intracranial material (13).

Overall, positive results were received on 33 specimens (42%) from 28

patients (46%). Of those, treatment information was available for 24

(86%), with de-escalation to a narrower spectrum agent upon receipt

of positive 16S PCR possible for five (20%).

Of 32 patients, from whom 45 specimens were sent, with DNA not

detected, treatment information was available in 21 (66%), with two

patients having antimicrobials discontinued upon receipt of the

negative result.

Discussion and/or Conclusion(s):

16S rRNA PCR has a role in anti-

microbial stewardship for complex infection requiring lengthy treat-

ment courses, whereby providing evidence of presence of microbial

DNA may support de-escalation decisions or absence of microbial DNA

may support decisions to discontinue empiric treatment in selected


ID: 4701

Younger generation views

community pharmacists delivering the

5-year antimicrobial resistance strategy

Gill Hawksworth


, Phil Howard


, Jake Mills


, Bahareh Yazdani



Sophie Devine


, Emily Clifford




University of Huddersfield,



Teaching Hospitals NHS Trust, Leeds


This study determined University students


understanding of antimicrobial resistance and issues related to the

work of community pharmacists implementing the NHS England

5-year antimicrobial resistance strategy.


To determine students views on having the

reason for their infection on a prescription, the importance of hand-

washing, their knowledge on antimicrobial resistance, importance of

adherence, use of left over medicines and to what extent they trust

health care professionals when advising on antibiotic use.


This study received ethical approval. Questionnaires were

handed out to University of Huddersfield students at a stand pro-

moting awareness of antimicrobial resistance on Antibiotic awareness

day November 2015.


From 90 questionnaires, 54.4% (n = 49) students missed

and/or stopped before the antibiotic course ended, 72.2% (n = 65)

correctly identified antibiotics solely effective against bacterial

infections and a chi-squared test determined healthcare/applied

science students were more likely to correctly identify this showing

a statistically significant result (p = 0.038) with a small effect

(Phi = 0.219). For cold/flu symptoms only 66.7% (n = 67) students saw

a pharmacist before GP however 61.1% (n = 55) support the cause

of infection on their prescription with 21 of these feeling

uncomfortable for personal conditions such as chlamydia, HIV and

thrush. Handwashing was important for 70.9% (n = 61) who used good

hand washing technique.

Discussion and/or Conclusion(s):


knowledge on anti-

microbial resistance needs improving, many students were not

taking their antibiotics correctly. Community pharmacists could

increasing compliance of antibiotic use with further counselling,

signposting to informative websites, and provision of leaflets on hand

washing technique. However many students are unwilling to see a

pharmacist before a GP.

ID: 4707

Impact of pharmacy-led stewardship rounds at a London Teaching


Laura Whitney, Ghadeer Muqbill, Matthew Laundy.

St George


University Hospitals NHS Foundation Trust


In 2013

14 we were required to reduce hospital-

acquired Clostridium difficile infection (CDI) by 27%. The year began

with 12 cases in 6 weeks; significantly above trajectory. Root cause

analyses (RCAs) were completed alongside review of ward-based

antibiotic prescribing. These identified scope to optimise prescribing,

particularly treatment review.


Intervention was required to reduce HA-CDI

through improved stewardship by:

Raising stewardship on the pharmacy agenda

Providing additional junior pharmacist supervision and external

scrutiny of prescribing

Increasing documented antimicrobial reviews

Improving documentation relating to stewardship by pharmacists


In May 2013 education on stewardship and the recent

RCAs was provided to pharmacists. Senior pharmacists were tasked to

perform monthly ward stewardship visits, supported by further

education and referral of complex cases to the stewardship MDT.

Activity is reviewed, collated and discussed at pharmacy directorate


This approach is supported by a comprehensive stewardship strategy

within the Trust.


This intervention significantly increased the number of

stewardship encounters (149 patients reviewed monthly by pharmacy

and 123 by the MDT). Pharmacist-led rounds had a lower intervention

rate (31%vs46%) and made different intervention types, most com-

monly improving prescription documentation, and dose adjustment,

with similar rates of IV to PO switch (6%vs8%).

CDI rates were significantly reduced (by 53% in 2013/14) and have

remained under trajectory.

Documented clinical review has increased from 77% to 90%.

Discussion and/or Conclusion(s):

The rounds have positively

contributed to stewardship within the Trust. Work in 2016/17

will focus on understanding clinical variation in these stewardship

rounds both in the number of patients reviewed and the intervention


ID: 4725

Does electronic prescribing facilitate antimicrobial stewardship

Laura Whitney, Matthew Laundy.

St George

s University Hospitals NHS

Foundation Trust


The slow implementation of electronic prescribing and

medicines administration (EPMA) has been identified as a barrier to

stewardship in the UK.


To identify how electronic prescribing has

facilitated stewardship at a large London teaching hospital.


EPMA was introduced sequentially in our Trust; first in

paediatrics, then cardiology and neurosciences using the Cerner

system (Kansas, US). A delay in further role out has lead to EPMA

being used alongside paper medical records for 2 years, which offers

us a unique opportunity to analyse the effects of implementation on

stewardship metrics and activities.

Abstracts of FIS/HIS 2016

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