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Southampton General Hospital. In doing so, we hope to reduce

inappropriate use of broad-spectrum antibiotics.


Over one week, all twenty oncology inpatients who had

received at least 72 hours of antibiotics were identified (excluding

haematological cancer patients and those receiving stem cell trans-

plant). We audited antibiotic choice and duration, investigations to

identify infection source and severity, compliance with local guide-

lines, and outcomes of antibiotic reviews. The results were dissemi-

nated, and good practice guidelines were produced and incorporated

into the Trust

s application-based antibiotic policy.


Tazocin was used in 55% of patients, with no clear

justification in 46% of these. Nearly 70% of patients received long

antibiotic courses (>7 days), and no changes were made in 70% of

antibiotic reviews. There was inadequate use of documentation,

cultures to guide antibiotic prescribing, and of tools to assess

infection risk (e.g. MASCC score not used in any patient with febrile

neutropenia) or severity (e.g. blood lactate measured in only 36% of


Discussion and/or Conclusion(s):

Inappropriate broad-spectrum

antibiotic use was associated with inadequate assessment of infection

risk, source and severity. By educating and empowering clinicians to

improve these domains, we hope to reduce inappropriate antibiotic

use (re-audit pending at the time of writing).

ID: 5122

Evaluating behaviour change as part of Antimicrobial Stewardship

interventions; a review of UK state-of-the-art conferences

Adam Tsao


, Ann Tivey


, Timothy M. Rawson


, Esmita Charani



Mark Gilchrist


, Luke Moore


, Alison Holmes




Imperial College School

of Medicine,


Imperial College London,


Imperial College Healthcare NHS



To improve the quality of antimicrobial stewardship

(AMS) interventions the application of behavioural sciences suppor-

ted by multidisciplinary collaboration has been recommended. We

analysed major UK scientific research conferences to investigate the

level of AMS behaviour change intervention reporting.


Leading UK 2015 scientific conference abstracts for 30

clinical specialties were identified and interrogated by four research-

ers. All AMS and/or antimicrobial resistance (AMR) abstracts were

identified using validated search criteria. Abstracts were then

independently reviewed by three researchers with reported behav-

ioural interventions categorised using the behaviour change wheel

framework described by Michie and colleagues.


Overall, conferences ran for 110 days with >57,000 delegates.

311/12,313 (2.5%) AMS-AMR abstracts (oral and poster) were identi-

fied. 118/311 (40%) were presented at the UK

s infectious diseases/

microbiology conference. 56/311 (18%) AMS-AMR abstracts described

behaviour change interventions. The commonest abstract reporting

behaviour change interventions were quality improvement projects

[44/56 (79%)]. In total 71 unique behaviour change functions were

identified. Policy categories;


(16/71) and

service provi-


(11/71) were the most frequently reported. Intervention





(7/71), and


(9/71) were also common. Intervention categories




and policy categories




were not

reported in any identified abstracts.

Discussion and/or Conclusion(s):

Despite the benefits of behaviour

change interventions on antimicrobial prescribing, very few AMS-

AMR studies at UK state-of-the-art conferences report implementing

them in 2015. AMS interventions must focus on promoting behaviour

change towards antimicrobial prescribing. Greater emphasis must be

placed on non-infection specialties to engage them with the issue of

behaviour change towards antimicrobial use.

ID: 5132

An audit of appropriate sampling for culture prior to starting

intravenous antibiotics in acute admissions at St. James


Hospital, Leeds

Amy Baggott, Miles Denton.

Leeds Teaching Hospitals Trust


Frequently the opportunity for obtaining critical micro-

biological specimens appears to be missed prior to starting intraven-

ous antibiotics in acute admissions to hospital.


By gaining an accurate picture of current practice,

a strategy to improve practice might then be developed.


100 patients on intravenous antibiotics were reviewed

on the medical and surgical admissions wards at St. James University

Hospital in a series of

spot checks

over a period of three weeks.

Data was then analysed to primarily see how many patients had blood

cultures obtained prior to intravenous antibiotics being commenced.

Secondary analyses were carried out to identify if any demographic or

diagnostic features or adverse treatment outcomes were associated

with samples not being taken.


Only 52 patients had blood cultures taken prior to the first

dose of antibiotics.

25 patients had no cultures taken at all.

Being apyrexial on admission was associated with a failure to take

cultures, as was presenting with biliary sepsis and also being admitted

to the surgical ward.

25% of blood cultures taken before antibiotics were positive compared

to 13% of blood cultures taken after antibiotics.

Length of stay was increased for those who had cultures taken after

antibiotics had been given, relative to those who had cultures taken


Four patients died, none of whom had cultures taken before


Discussion and/or Conclusion(s):

Current practice falls far short of

the standard. This audit helps identify areas to focus interventions and

education on. It also demonstrates the negative impact on patient

outcome that failure to sample appropriately causes.

ID: 5134

Foundation doctor-led audit and education as an effective

intervention to promote antimicrobial stewardship at Royal Bolton


C. Subudhi, Aideen Carroll, Jonathan Evans, Emma Clare Hughes,

Rhian Proffitt, Alex Smith, Andrew Steele, Samim Patel.

Royal Bolton

Hospital, Bolton NHS Foundation Trust


In view of rapidly emerging antibiotic-resistant bacteria,

there is a growing need for antibiotic stewardship programmes.

It is important that interventions to improve stewardship target

foundation doctors, as they comprise a significant proportion of

antibiotic prescribers.


This study aims to evaluate improvements in the

quality of antibiotic prescribing following foundation doctor-led

educational interventions at Royal Bolton Hospital.


At Royal Bolton Hospital, quarterly audits are carried out in

conjunction with the microbiology department. The audit standards,

based on Public Health England

s guidance, are as follows:

Standard 1: Compliance with trust guidelines.

Standard 2: Indication for treatment written in patient case notes.

Standard 3: Indication for treatment written in antibiotic section

of prescription charts.

Standard 4: Stop/review date documented in patient case notes by


72 hours.

Standard 5: Stop/review date documented on prescription charts

by 48

72 hours.

Using data collected from this audit, foundation doctor-led teaching

sessions will be designed and delivered to improve safe prescribing of

antibiotics by fellow foundation trainees.

Abstracts of FIS/HIS 2016

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