The Journal of Hospital Infection - Supplement 1 - November 2016

63 / 150

Discussion and/or Conclusion(s): It is important to monitor CK levels
although elevated levels are rare during daptomycin therapy and may
return to normal despite continuation.
ID: 4731
A patient with Aggregatibacter aphrophilus liver and brain
abscesses
Clare Murphy 1, Hannah Soulsby 1, Sarah Macalister-Hall2,
Ronald Andrew Seaton1, Teresa Inkster1. 1Greater Glasgow and Clyde
NHS Trust, 2NHS Greater Glasgow and Clyde NHS Trust
Background: Aggregatibacter aphrophilus is part of normal oropha-
ryngeal flora. It is a fastidious and slow growing gram negative cocco-
bacillus and part of the HACEK group of organisms. It is associated
not only with endocarditis but case reports have reported liver, brain
and epidural abcesses along with bone and joint infections, pneumo-
nia and empyema. Adhesin and virulence factors produced by this
organism enable intracranial abscess formation. A. aphrophilus can be
found in normal canine flora and brain abscesses have been reported
in patients who have close contact with dogs.
Method(s): A 66 year old lady presented with 3 weeks of vomiting,
diarrhoea and abdominal pain. Computer Tomography (CT) and
Magnetic Resonance Imaging scan (MRI) of the abdomen demon-
strated multiple liver lesions. Blood cultures grew A. aphrophilus.
Following deterioration on day thirteen brain CT demonstrated
multiple brain abscesses.
Results: This lady was treated with three months of ceftriaxone and
six weeks of metronidazole. She then switched to oral amoxicillin 1g
tds and completed a year of antibiotics in total. Repeat imaging six
months after the end of treatment only showed “tiny flecks of
persistent enhancement but no new lesions”. She has remained well
since completion of therapy.
Discussion and/or Conclusion(s): This case illustrates the importance
of taking blood cultures prior to antibiotic administration and
communicating clinical information to the microbiology laboratory.
Good communication improves the likelihood of isolating fastidious
organisms such as A. aphrophilus and thus optimising patient
management.
ID: 4733
A review of group A streptococcal bacteraemias in Glasgow in 2015
Jenna Gillies, Mairi Macleod. NHS Greater Glasgow and Clyde
Background: Since the 1980’s there has been a rise in cases of invasive
Group A Streptoocci (Streptococcus Pyogenes) with associated morbid-
ity and mortality.
Aim(s)/Objective(s): Our aim was to review all cases of Group A
streptococcal bacteraemia in Greater Glasgow and Clyde in 2015 to
determine the source, treatment plan, typing and mortality rates.
Method(s): Blood culture isolates and patient details were collected
using the local Laboratory system “Telepath”. Patients with one or
more positive blood culture within a 14 day period were classed as a
single episode. Electronic records patient records were reviewed.
Results: 49 episodes were identified (33 adult and 16 paediatric).
The most common source identified in the adult cohort was cellulitis
(36%) followed by no source identified (18%), septic arthritis (9%) and
pneumonia (9%). In the paediatric cohort the most common source
was skin infection associated with chickenpox (31%) followed by
septic arthritis (19%), port mortem finding (13%) and tonsillitis (9%). In
both adult and paeditric cohorts, 100% of the isolates were penicillin
sensitive. 9% of the adult isolates were resistant to macrolides
and clindamycin. 9% of the adult isolates tested against Doxycyline
were resistant. All the paediatric isolates were sensitive to macrolides/
clindamycin. The most common antibiotic regime was iv Benzylpeni-
cillin and Clindamycin in both adults (33%) and children (71%). The 7
day mortality was 9% in adults and 12.5% in paediatrics. Emm type 1
was the commonest emm type in both groups.
Discussion and/or Conclusion(s): Our findings showed awide variety
of sources and typing/mortality rates in keeping with the rest of
Europe.
ID: 4773
Hospital acquired Clostridium difficile infections at a large NHS
Hospital Trust: Outcomes and insights from a clinical audit
Charlotte Brookfield, Summya Fatima, Emma Bradley, Ivor Cartmill.
Pennine Acute Hospitals NHS Trust
Background: Clostridium difficile infection is associated with high
morbidity and mortality. National guidance is available to inform
management and this has been translated to local guidelines within
Pennine Acute Hospitals NHS Trust.
Aim(s)/Objective(s): The aim of this project was to evaluate local
compliance with both national and local standards and to improve
service as highlighted.
Method(s): An audit was conducted of all hospital acquired toxin
positive C. difficile cases (≥72 hours post admission) between 1st
January 2015 and 31st December 2015 which totalled 54 patients.
Audit standards evaluated severity assessment, MDT involvement,
appropriate treatment, monitoring, escalation and stopping of
inappropriate antibiotics/proton pump inhibitor therapy. Data was
taken from patient notes, infection control notes, the electronic
prescribing system and microbiology documentation.
Results: The audit demonstrated that an MDT approach is in place
with good communication of results and infection control liaison.
There was also evidence to support that patients were being regularly
reassessed and concomitant use of broad spectrum antibiotics
reviewed. The vast majority of patients (69%) were commenced on
oral vancomycin. Mortality outcomes from the audit were comparable
to national standards. Areas for improvement include documentation
of initial assessment and severity stratification both in clinical and
microbiology notes. 26% of patient could not be assessed for severity
which could potentially have led to under or over treatment.
Discussion and/or Conclusion(s): Actions from this audit have
focused on increased education to clinicians and involvement
around initial assessment, therapy choices and documentation. New
guidelines have been initiated and supportive assessment tools
developed ahead of a planned reaudit in 2016– 17.
ID: 4782
A vital role by microbiologists in enhancing the diagnosis of
infective endocarditis following positive blood culture and their
management
Wijitha Weerakoon1, Milind Khare2, Deborah Gnanarajah3,
Rebecca Turner3. 1Derby Teaching Hospitals NHS Trust, 2Derby Teaching
Hospital NHS Trust, 3Derby Teaching Hospital
Background: Consultant Microbiologists noted a high incidence of
infective endocarditis recently. Positive blood culture results were the
key which made Microbiologists to initiate further investigations in
most of the cases.
Aim(s)/Objective(s): To evaluate the compliance for the trust guide-
line on blood culture collection of suspected infective Endocarditis and
evaluate adherence to BSAC guideline for empiric and selective
treatment.
Method(s): Forty patients with Infective endocarditis were reviewed
over a period of 1 year.
Results: Blood culture timing could not be commented on 23(57%)
patients due to the delayed suspicion of Infective endocarditis in this
group, as echocardiography was advised by Microbiologists following
positive blood cultures.
Out of 40 patients, 12(30%) were found to have Streptococcal species
causing endocarditis. Enterococcal species were found in 8 (20%)
patients. Six patients had Staphylococcus aureus, 1 patient had MRSA, 1
had Staph epidermidis and one patient had Candida albicans.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S58