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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


Clare Murphy


, Hannah Soulsby


, Sarah Macalister-Hall



Ronald Andrew Seaton


, Teresa Inkster




Greater Glasgow and Clyde

NHS Trust,


NHS Greater Glasgow and Clyde NHS Trust


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.


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.


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


ID: 4733

A review of group A streptococcal bacteraemias in Glasgow in 2015

Jenna Gillies, Mairi Macleod.

NHS Greater Glasgow and Clyde


Since the 1980

s there has been a rise in cases of invasive

Group A Streptoocci (

Streptococcus Pyogenes

) with associated morbid-

ity and mortality.


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.


Blood culture isolates and patient details were collected

using the local Laboratory system


. 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.


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


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


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.


The aim of this project was to evaluate local

compliance with both national and local standards and to improve

service as highlighted.


An audit was conducted of all hospital acquired toxin


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.


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


ID: 4782

A vital role by microbiologists in enhancing the diagnosis of

infective endocarditis following positive blood culture and their


Wijitha Weerakoon


, Milind Khare


, Deborah Gnanarajah



Rebecca Turner




Derby Teaching Hospitals NHS Trust,


Derby Teaching

Hospital NHS Trust,


Derby Teaching Hospital


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.


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



Forty patients with Infective endocarditis were reviewed

over a period of 1 year.


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