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.
Something in the air
diagnosis and outcome
, Sani Aliyu
, Ruth Kappeler
Papworth NHS Foundation
Papworth Hospital NHS
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.
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
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
Urinary tract infections after supra-pubic catheter insertion in
spinal cord injury patients
Piera Santullo, Aga Louw, Fadel Derry.
National Spinal Injury Centre
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
Determination and in silico study of new phylogenetic groups in
in children under five years of age
, Shukla Das
, V. G. Ramachandran
UCMS & GTBH,
(EPEC) are a leading
cause of infantile diarrhea. At present,
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
The aim of this study was to gain insight on the
distribution of phylotypes in enteropathogenic
virulence genes and their association with clinical characteristics
in children under five years of age suffering from diarrhea in Delhi,
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
, 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
population and the relationship
of strains and their hosts and disease and it established a link between
phylogenetic group and virulence.
Prevalence of antibiotic associated diarrhoea in UK spinal cord
, Mofid Saif
, Naveen Kumar
, Joy Chowdhury
, 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