The Journal of Hospital Infection - Supplement 1 - November 2016

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Background: Little is known about the use of antibiotics and the
extent of antibiotic associated diarrhoea (AAD) in spinal cord injuries
(SCI) patients.
Aim(s)/Objective(s): The study aim was to (i) record the use of
antibiotics; (ii) establish the prevalence of AAD and; (iii) assess if there
is any seasonal variationwith respect to antibiotic use and incidence of
AAD.
Method(s): A retrospective study was conducted in three British SCI
centres during October 2014 to June 2015. Data was collected using a
standardised questionnaire. We define AAD as 2 or more watery stools
type 5, 6 or 7 (Bristol stool scale) over 24 hours.
Results: Six-hundred-and-twenty-five adults (median age: 55
years, 31.5% female) with SCI (54.4% tetraplegia; 39.3% complete SCI)
were included. Of 124 (19.8%) patients on antibiotics, the top
three indications for antibiotics were urinary-tract infections,
skin-infections and pressure ulcers infection. Twenty-one of 124
(16.9%) developed AAD. No statistical difference was observed on
number of antibiotics, severity of SCI, use of proton-pump-inhibitors
and H2-blockers and use of laxatives in both groups. AAD was
more common in the summer season when compared to spring,
autumn and winter. (32.3%, 6.9%, 16%, 16.1%, p = 0.04). AAD was
associated with older adults (p < 0.01); tetraplegia (p < 0.01); hypoal-
buminaemia (p = 0.02) and elevated body-mass-index (p = 0.02).
Urinary-tract-infection was more common during the autumn
season (p < 0.01).
Discussion and/or Conclusion(s): This multi-centre study found AAD
is common in SCI patients and maybe a risk factor for poorer outcome
and increased hospital cost. Further study testing whether probiotics
can reduce incidence of AAD is warranted, especially during summer
season.
ID: 4513
Effect on Staphylococcus aureus removal and recovery of properties
against skin damage by using new hand-cleansing formulation
without sanitizers
Kentaro Asaoka1,2, Shiro Endo1, Yuki Suzuki1, Satoru Komuro3,
Tadanobu Nemoto4, Mitsuo Kaku1. 1Department of Infection Control and
Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate
School of Medicine, 2Department of Research and Development,
Household Laboratory, Kao Corporation, 3Geriatric Health Services
Facility “Cosmos”, 4Izumi Orthopedic Hospital
Background: Staphylococcus aureus (S. aureus) is known to form a
biofilm and colonize on damaged skin of the hands.
Aim(s)/Objective(s): We investigated changes in the quantity of
S. aureus on the hands and changes in skin damage when using a
hand-cleansing formulation with potassium oleate but without a
sanitizer (Formulation A), which is highly effective in removing S.
aureus biofilm and causes minimal skin damage.
Design: Prospective, crossover, double-blind commissioning test.
Setting and participants: This study included 14 medical staff
members at Geriatric Health Services Facility “Cosmos”.
Intervention: The participants used two types of hand-cleansing
formulations (Formulations A and B), each for 4 weeks. S. aureus of the
hands was cultured from swab samples on agar plates. Surface
Evaluation of scaliness (SEsc), an indicator of scaliness and dryness of
keratin, was measured using a UV-microscope as a marker of skin
damage.
Results: The quantity of S. aureus after using Formulation A for 4 weeks
was 101.08±0.05 colony-forming units (CFU)/mL, a statistically signifi-
cant decrease from the quantity of S. aureus (101.59±0.19 CFU/mL) just
before use (P = 0.029). Additionally, the SEsc after using Formulation A
for 2 weeks (2.02 ± 0.59) was significantly lower than the SEsc 2
weeks before use (2.85 ± 0.48) ( P = 0.042). With Formulation B, the
quantity of S. aureus and the SEsc did not significantly change from
before to after use ( P > 0.05).
Conclusion: Formulation A removed S. aureus from the hands of
participants, and skin damage on the hands improved. This presum-
ably occurs because Formulation A gently removes S. aureus biofilm.
ID: 4558
An evaluation of the clinical utility of positive pneumocystis
pneumonia PCR in a large teaching hospital
Isobel Ramsay, Huina Yang, Vanessa Wong, Jumoke Sule. Addenbrookes
Hospital
Background: Pneumocystis pneumonia (PCP) therapy is not covered
by empirical broad spectrum antibiotics used for treatment of
pneumonia. A positive PCP-PCR result alone is not diagnostic of
infection and may represent colonisation.
Aim(s)/Objective(s): To determine the clinical utility of a positive PCR
result in guiding PCP therapy.
Method(s): PCP PCR is performed on all respiratory samples including
sputum where requested using an in-house assay. CT value ≤35 is
deemed positive.
The laboratory database was searched for patients with a positive
result for a 12-month period ending September 2015. Demographic,
clinical, diagnostic and therapeutic data that contributed to
therapeutic decision making were collected from hospital information
system.
Results: We identified 28 patients with a positive result: 27 were
immunosuppressed, 1 unknown; 27 had abnormal chest radiology (CT
or chest radiograph) with 8 mentioning PCP; samples from four of 19
patients sent for Grocott staining were positive.
Twelve of 28 patients started treatment before sample collection
(median 2 days; range 1–7 days), 1 was on prophylaxis. Two were
treated after sample collection before the result.
Following the positive result, 14 continued treatment, 9 started
treatment and one prophylaxis. Twenty of 23 patients received ≥ 21
days of treatment. Three of the treated patients died during the
hospital admission, 2 were discharged but died within 90 days from
admission. The remaining 18 treated patients and all untreated
patients survived over 90 days from admission.
Discussion and/or Conclusion(s): A positive PCR helped clinical
decision making, with 82% of patients starting or continuing PCP
treatment.
ID: 4678
Creatine kinase monitoring in patients receiving daptomycin
Jon Urch, Maha Albur. North Bristol NHS Trust
Background: In clinical studies increases in plasma creatine phos-
phokinase (CK) levels associated with muscular pains and/or weak-
ness have been reported during therapy with daptomycin. The product
license states that plasma CK levels should be measured at baseline
and at least once weekly during therapy.
Aim(s)/Objective(s): Primary outcomes were (i) Compliance with
recommendations of measurement of baseline and weekly CK levels;
(ii) significant elevation (>5 times baseline) of CK leading to cessation
of therapy.
Method(s): We conducted a retrospective study in a tertiary hospital
in England using the pharmacy system to identify patients who had
received daptomycin over three years. Baseline CK level was defined
as measurement at any point either in the previous six months or on
the day of first dose. For patients who had received more than 7 doses,
a subsequent level would be expected at around 7 days (margin of
error was 2 days).
Results: A total of 108 patients were identified with 117 different
patient-episodes. Baseline CK levels were measured in 62 cases (53%)
and 55 patients (47%) had no baseline levels. Sixteen patients (14%)
had no CK levels measured at all. Eighty-one patients (75%) received
more than seven doses of daptomycin and only 33 of these (41%) had
a repeat CK level taken at the appropriate time of around a week after
starting daptomycin therapy. There were four patients who had a high
level during daptomycin treatment.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S57