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and raised cardiac enzymes. The ECG showed diffuse ST elevation in

chest leads. Chest x-day showed clear lung fields but minimally

enlarged cardiac silhouette. Patient was treated for STEMI and

transferred for PCI.


On arrival at the tertiary care hospital, the dyspnoea

had significantly worsened with haemodynamic instability. Blood

biochemistry revealed worsening LFT, cardiac enzymes and AKI.

Auscultation of chest revealed muffled heart sounds with tachycardia

but no murmurs.

Coronary angiogram was normal. Echocardiogram showed a 5 cms

thick collection in the pericardial sac. As patient was symptomatic,

pericardiocentesis was performed. 300 mL pus aspirated via a pig tail

drain. I.v. piperacillin-tazobactam 4.5 g b.d. was commenced after

collecting blood culture.


The biochemical analysis of the pericardial fluid revealed

normal protein, very low glucose and raised LDH. Microscopy of

the pericardial fluid showed 2 + polymorphs while the Gram stain

showed Gram-negative cocci. Hence antibiotic switched to 2 g of i.v.


Patient was clinically stable on day 2 while blood parameters improved

gradually over next 7 days. The blood cultures did not isolate any

organism. Patient underwent surgical pericardiectomy and discharged

home after completing total 8 weeks antibiotic therapy.

ID: 5017

Something in the air

diagnosis and outcome

Luke Bedford


, Sani Aliyu


, Ruth Kappeler




Papworth NHS Foundation

Hospitals Trust,



s Hospital,


Papworth Hospital NHS

Foundation Trust


A 72 year old caucasian male presented with a 3 days of

increasing back pain. He had a past medical history of bladder calculi

and excess alcohol intake. He reported no foreign travel history and no

significant animal or occupational exposures. After admission the

patient became confused and feverish, and was treated with 5 days of

co-amoxiclav. This was escalated to piperacillin-tazobactam due to

persisting fever. An MRI spine showed multi-level lumbar discitis and

a psoas abscess. A transthoracic echocardiogram demonstrated a

mitral valve lesion with severe mitral regurgitation.

Blood cultures during admission were negative, but were taken on

antibiotic treatment. Urine microscopy did not indicate infection.

Serology for coxiella and brucella was eventually negative.

The patient switched treatment to IV vancomycin and IV gentamicin,

and was transferred to the local cardiothoracic surgery unit for

assessment. The patient underwent valve replacement, and the

excised valve was sent for microscopy and culture. The gram stain

showed gram positive cocci.

Staphylococcus epidermidis

was grown from broth cultures but direct

cultures were negative. This was not felt to be consistent with the


s presentation and the valve was referred for 16s PCR. This was

positive for

Aerococcus urinae


Aerococci are a rare cause of endocarditis, and endocarditis with spinal

infection has only been reported in one case of which we are aware.

This provided a unifying diagnosis for the patient given his risk factors

of bladder calculi, male gender and age.

The patient responded to 4 weeks of treatment with Benzypenicillin

and gentamicin.

ID: 5021

Urinary tract infections after supra-pubic catheter insertion in

spinal cord injury patients

Piera Santullo, Aga Louw, Fadel Derry.

National Spinal Injury Centre

Stoke Mandeville


Urinary tract infections (UTIs) following catheter inser-

tion is a very common complication and if not diagnosed promptly can

lead in severe systemic infection and death.


The purpose of this study was reviewing the

incidence of UTIs after SPC insertion, to note the most common MSU

result in patients with UTIs and to notice the relation between rate of

UTIs and demographical factors and length of time between the injury

and the SPC insertion.


A retrospective study of SCI patients that had supra pubic

catheter insertion in 2015 was conducted at the National Spinal Injury

Centre. Data were collected from electronic medical records. For

statistical analysis Minitab 14 was used.


64 patients were identified. Mean agewas 60.5. The incidence

of UTIs was 23% (15 out of 64). All the patients had prophylactic

antibiotic. 12 patients with UTIs had midstream specimen of urine

(MSU) collected. 7 patients had MSU sent after antibiotic commenced.

Mixed growth was the most common MSU result. 43 procedures were

done during the first admission to the spinal centre. Time from the

injury was on average 5 months. No statistical association between

occurrence of UTI and age, sex, and time from the injury.

Discussion and/or Conclusion(s):

MSU collection pre antibiotic

treatment is good practice and it should be a rule to limit the use of

wide spectrum antibiotics. Culture tests are futile if taken after

antibiotic therapy. UTIs was common in the population examined even

using prophylactic antibiotic treatment. Future research should look at

the prophylactic antibiotic use and effectiveness.

Topic: Clinical microbiology

ID: 4470

Determination and in silico study of new phylogenetic groups in


E. coli

in children under five years of age

Taru Singh


, Shukla Das


, V. G. Ramachandran







and GTBH



Escherichia coli

(EPEC) are a leading

cause of infantile diarrhea. At present,

E. coli

populations are

structured in seven major phylogenetic groups. Strains responsible

for extraintestinal infection belong to phylogroups B2 or D than A or

B1. Phylogroups E and F contain strains, of which O157:H7 is the best

known member, and form a sister group to phylo-group B2

respectively. The phylogroup C is closely related but distinct from

phylo-group B1.


The aim of this study was to gain insight on the

distribution of phylotypes in enteropathogenic

Escherichia coli

virulence genes and their association with clinical characteristics

in children under five years of age suffering from diarrhea in Delhi,



80 diarrheagenic

E. coli

strains were isolated from children

with diarrhea and examined for the presence of enteropathogenic



by real time PCR after performing antibiotic susceptibility testing.

A quadruplex PCR was performed to distribute isolates among seven

phylogroups as described by Clermont

et al

, 2013. Statistical analysis

was used for the comparison of the categorical data.


64 (80%) were found to be EPEC. There was predominance of

phylogenetic group A (38) followed by phylogenetic groups B1 (14), D

(4), F (3), B2 (2), C (2) and E (1). One isolate remain unclassified. In

silico studies was performed to understand their relationships.

Discussion and/or Conclusion(s):

Phylogenetic studies are important

to improve the understanding of

E. coli

population and the relationship

of strains and their hosts and disease and it established a link between

phylogenetic group and virulence.

ID: 4498

Prevalence of antibiotic associated diarrhoea in UK spinal cord

injuries centres

Piera Santullo


, Mofid Saif


, Naveen Kumar


, Joy Chowdhury



Ineta Zobina


, Sreedhar Kolli


, Jean O



, Ali Jamous







National Spinal Injury Centre Stoke Mandeville,



Jones and Agnes Hunt Orthopaedic Hospital, Oswestry,


Welsh Spinal Cord

Injuries Rehabilitation Centre, Rookwood Hospital, Cardiff,



Buckinghamshire Hospital, Aylesbury

Abstracts of FIS/HIS 2016

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