64 / 150
4 patients were found to have unusual pathogens (
Erysephalothix
rusipathiae
,
Haemphilus parainfluenzae
,
Eschericia coli
, and
Citrobacter
spp).
7 patients were found to have culture negative Infective endocarditis.
Prior antibiotic therapy and inappropriate timing of blood cultures
was the most probable reason for a 5 cases of culture negative
endocarditis.
Discussion and/or Conclusion(s):
Good clinical assessment and
consideration of risk factors and taking 3 sets of blood cultures at
appropriate time is the key for the diagnosis of Infective endocarditis
and its appropriate management.
ID: 4789
Improving the investigation and diagnosis of urinary tract
infection in the Emergency Department
Sarah Young, Hugo Donaldson, Felicity Lalloo, Cynthia O
’
Sullivan,
Anu Mitra.
Imperial College Healthcare NHS Trust
Background:
A previous audit showed 15% of patients who presented
to Charing Cross adult A&E were diagnosed with a urinary tract
infection (UTI). Criteria for diagnosis varied and 47% of patients had a
urine culture sent without clear clinical indication. Public Health
England provides primary care guidance on UTI diagnosis. This study
looked at using this guidance, with the addition of fever and confusion
as symptoms whichmay also present when patients attend hospital, to
ensure samples are sent appropriately.
Aim(s)/Objective(s):
To improve investigation and diagnosis of UTI in
A&E.
Method(s):
The number of samples sent for culture 3 months pre and
post introduction of the guidance was recorded for the laboratory
system. Symptoms and antimicrobial therapy were recorded for all
patients who had a sample sent for two weeks pre and post
introduction from electronic medical records.
Results:
The number of samples sent decreased from 714 to 378
following introduction of guidance. The proportion of patients who
had a urine sent with one or no symptoms of UTI fell from 64% to 45%.
The proportion of samples with no growth or no significant growth fell
from 39% to 24%. Pre-intervention, 34 patients with no symptoms had
growth in their urine (asymptomatic bacteriuria). Of these, 10% were
commenced on antibiotics. This decreased to 22 patients asymptom-
atic bacteriuria and 1 received antibiotics.
Discussion and/or Conclusion(s):
Introduction of guidance has led to
fewer samples sent for culture and decreased the proportion with no
growth. It has also decreased the number of patients receiving
inappropriate antibiotics for asymptomatic bacteriuria.
ID: 4837
A review of
Actinobaculum schaalii
isolated from clinical
specimens in the Newcastle upon Tyne Hospitals NHS Foundation
Trust
Katherine Watson, Kathy Walton, Caroline Williams.
Newcastle upon
Tyne Hospitals NHS Foundation Trust
Background:
Found in the normal human urogenital tract,
Actinobaculum schaalii
is a Gram positive bacillus related to
Actinomyces.
It has specific growth requirements and is difficult
to identify, leading to potential under-reporting of infections.
Rapid identification methods, including Matrix Assisted Laser
Desorption Ionisation, Time-Of-Flight (MALDI-TOF) mass spectrom-
etry, have increased recognition of its pathogenic role, mainly causing
urinary infection in elderly patients with underlying urological
conditions.
Aim(s)/Objective(s):
To review
A. schaalii
isolates identified in the
Trust (January 2011
–
May 2016); patient demographics, clinical
significance, antimicrobial susceptibilities and patient outcomes.
Method(s):
Database search identified all isolates of
A. schaalii
.
Bacterial identification was by MALDI-TOF and sensitivity testing by
EUCAST methodology for Gram positive anaerobes.
Results:
A. schaalii
isolates were identified from 14 patients, mean age
70 years (range 46
–
92). The commonest source of infection was
urinary; 5 patients had bacteraemia secondary to urosepsis and 5
had positive kidney urine or bladder biopsy cultures. Four presented
with scrotal abscess, breast abscess, necrotising otitis externa and
pacemaker pocket infection. Some isolates were assessed as clinically
insignificant.
Patients who were given antibiotics received empirical piperacillin/
tazobactam or co-amoxiclav, to which all isolates were susceptible. 12
patients were discharged; 2 patients with bacteraemia received
piperacillin/tazobactam but died shortly afterwards.
Discussion and/or Conclusion(s):
Our findings support the role of
A.
schaalii
in urinary infection and bacteraemia, particularly in elderly
patients with urological abnormalities. Its clinical significance is less
clear in other infections. Formal identification is advised to prevent its
misclassification as a contaminant in blood and urine cultures and to
improve the understanding of its pathogenic potential.
ID: 4838
Echocardiography practice in
Staphylococcus aureus
bacteraemia
(SAB): retrospective review at a university teaching hospital
Emma McGuire, Aqtab Mazhar Alias, Rachel Herbert, Eoghan de Barra.
Imperial NHS Healthcare Trust
Background:
SAB is frequently complicated by metastatic deposits
and carries a high mortality rate. BSAC guidelines recommend
echocardiography within seven days of treatment commencement to
assess for cardiac involvement.
Aim(s)/Objective(s):
The purpose of this study is to assess the level of
adherence to these guidelines at our Trust.
Method(s):
All SAB cases between April 2014 and March 2016 were
identified from the laboratory system. We conducted a retrospective
analysis of clinical and echocardiography data. Data was collected on
time, indication and outcome of echocardiography as well as clinical
information.
Results:
Ninety four patients were identified; 60 (64%) with
methicillin-sensitive
S. aureus
(MSSA) and 34 with methicillin-
resistant
S. aureus
(MRSA) bacteraemia. Fifty four (57%) had an
echocardiogram; either transthoracic echocardiogram (TTE) or trans-
oesophageal echocardiogram (TOE); 52 vs 2 respectively. The median
time to TTE was 6 days (range 2
–
17 days).
Forty three (83%) of TTEs were reported with as no evidence for
infective endocarditis (IE); 7 TTEs found equivocal features. A TTE
report was not found in 2 patients. Forty (43%) cases of
S. aureus
bacteraemia did not have evidence of echocardiography. Eighty five
(90%) of patients with SAB had complicated infections. Appropriate
indication for echocardiography request was not documented in 11
(16%) of cases.
Discussion and/or Conclusion(s):
The low incidence of SAB IE in this
series is concerning, published rates are 25%. The reasons for the
lowechocardiography rate needs to assessed. Time to echo, limited use
of TOE and lack of documented indication may have reduced
sensitivity.
ID: 4876
Granulicatella
species: An under-recognised and emerging
pathogen in orthopaedic infection?
Pauline Jumaa
1
, Nia Reeves
2
, Sarah Mimmack
2
, Michael Parry
2
.
1
University Hospitals Birmingham,
2
The Royal Orthopaedic Hospital
Birmingham
Background:
Granulicatella
species are uncommon pathogens and
are most frequently reported in cases of endocarditis. There are few
reports of
Granulicatella
species causing orthopaedic infection.
Aim(s)/Objective(s):
We describe the diagnosis, clinical characteristics
and treatment of six consecutive cases of orthopaedic infection
caused by
Granulicatella
species from a specialist orthopaedic hospital
in the UK.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S59