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Four quarterly audits have been completed during the course

of the academic year 2015

2016. Average compliance across the five

standards for these quarters was 76%, 74%, 81% and 78%, respectively.

Overall annual compliance with the above standards was 77.25%.

Following the delivery of teaching sessions, the above standards will

be re-audited. Targets set for 2016/2017 and 2017/2018 are 85% and

95% compliance, respectively.

Discussion and/or Conclusion(s):

Despite previous interventions,

compliance with prescribing standards has remained relatively static.

Following formal education through peer-to-peer teaching, an

improvement is expected, sufficient to meet the desired targets.

ID: 5147

Multidisciplinary development of initial treatment guidance of

adult patients with suspected sepsis in the community health


Rhian Manley, Steve DuBois, Mike Paynter, Karen Anderson, Liz Berry,

Paul Aldwinkle, Claire Nettleton.

Somerset Partnership NHS Foundation



Acuity and complexity of patients treated in community

health services have increased dramatically as pressures on all NHS

services escalate. In rural Somerset high risk patients presenting with

suspected sepsis may require initial treatment in geographically

dispersed and potentially isolated Minor Injuries Units or community

hospitals where:

transfer to acute trusts could result in unacceptable delays in

treatment initiation

principles of patient-centred care support appropriate avoidance

of unnecessary hospital transfers.


Development of a sepsis treatment pathway in

rural community health service settings which:

provide prompt and safe care to septic patients and optimise

outcomes within confines of the commissioned service model

implement and maintain good medicines governance for, initially

unfamiliar, high risk medicines

promote appropriate antibiotic stewardship in line with local

strategies and local resistance


A prospective review of the process undertaken and

lessons learnt when developing antibiotic guidance for sepsis by a

multidisciplinary clinical team.


Development of a robust uniform pathway across geograph-

ically dispersed and sometimes disparate service settings, proved

challenging. Safe and timely treatment of sepsis using high risk

drugs, not traditionally administered in community health service

(e.g. gentamicin, teicoplanin and vancomycin), required novel

approaches and considerations.

Discussion and/or Conclusion(s):

The legacy of the historical NHS

community health service operating model includes limited access to

medical prescribers, clinical pharmacy services, consultant micro-

biology support, rapid diagnostic testing and other infrastructure

routinely available in acute hospital settings. Resources for developing

local and national antibiotic guidelines require review to ensure that

the current gaps identified through this process are acknowledged and


ID: 5158

Barrier and facilitators of antimicrobial guidelines adherence in

dentistry: knowledge and attitude assessment tool

Noha Seoudi, Zhang Xu.



Antimicrobial stewardship is one of the most important

strategies to tackle the increasingly serious threat of antimicrobial

resistance globally. The Faculty of General Dental Practitioners (FGDP)

and the Public Health England (PHE) issued guidelines to regulate the

use of antimicrobials in primary dental care. However, poor adherence

was reported in the literature. Barriers to guidelines adherence are

expected to be different according to the local setting. Therefore,

analysing these barriers is a very important step before developing the

antimicrobial stewardship intervention.


To develop a validated knowledge and attitude assessment tool

assessing barriers and facilitators to guidelines adherence.


A questionnaire was developed based on Mitchi

s behaviour

change wheel to assess capability, motivation and opportunity in

relation to the dental antimicrobial prescribing habits. The knowledge

part of the questionnaire was modified from a previously published

tool (Palmer et al., 2001). After a peer review and consultation stage, a

pilot audit was conducted. To validate the tool the results of the pilot

was compared to the results of a prospective antimicrobial prescribing

patterns audit in the same setting.


30 participants took part in the questionnaire and 200

antimicrobial prescription episodes were also audited. There were no

statistical significant difference in the concordance rate with the

national and local guidelines when comparing the questionnaire and

the prospective audit.


We aim to present the newly developed knowledge and

attitude assessment tool, which can be used to audit antimicrobial

prescribing patterns and identify the best local antimicrobial stew-

ardship interventions in dentistry.

Topic: Clinical cases

ID: 4452

Mitral valve endocarditis secondary to

Paenibacillus provencensis

Ana-Catarina Pinho-Gomes, Abdul Nasir, Sajjad Mirza, Isaac Kadir.

University Hospital of South Manchester


Despite the recent advances in diagnostic and thera-

peutic strategies, infective endocarditis remains challenging to

treat and thus associated with bad prognosis in terms of morbidity

and mortality, particularly when uncommon microorganisms are



We report the first case of infective endocarditis caused by

Paenibacillus provencensis

, a very rare Gram-negative spore-forming



Amitral valve vegetationwas incidentally discovered by intra-

operative transoesophageal echocardiography in a 70-year old lady

undergoing aortic valve replacement. Empirical antibiotic treatment

for infective endocarditis with gentamicin and teicoplanin was

started. The precise identification of the causative agent relied on

genotypic characterisation with 16S rDNA gene sequencing.

Microbiologic culture was subsequently performed to obtain the

antimicrobial susceptibility profile and adjust the antibiotic regimen

accordingly. The patient was treated with a 4-week course of

vancomycin and meropenem, followed by a further 2 weeks of

daptomycin due to the identification of vancomycin-resistant entero-

cocci in a rectal swab. After a long in-hospital stay, the patient

eventually recovered clinically and biochemically and transthoracic

echocardiogram demonstrated awell functioning mitral valve without

residual lesions from the endocarditis.

Discussion and/or Conclusion(s):

This is, to the best of our knowl-

edge, the first report showing that

Paenibacillus provencensis

can be a

pathogen in humans and that a member of the genus Paenibacillus

may be involved in native valve endocarditis. This case also emphasis

the importance of 16S rDNA gene sequencing by real-time polymerase

chain reaction, as a rapid and accurate method to identify micro-

organisms, like Paenibacillus, which can be missed by conventional

microbiology investigations.

ID: 4539

A case of brucellosis in a patient heading for liver transplantation

Shradha Bhagani, Adrian Kennedy, Phil Stanley, Paul McWhinney,

Sulman Hasnie, Riccardo Guintini, Ben Jeffs.

Bradford Royal Infirmary


A 48 year old woman was admitted to hospital in

October 2015 with symptoms of fever, intermittent diarrhoea and

Abstracts of FIS/HIS 2016

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