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4 patients were found to have unusual pathogens (




Haemphilus parainfluenzae


Eschericia coli

, and



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


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


Anu Mitra.

Imperial College Healthcare NHS Trust


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.


To improve investigation and diagnosis of UTI in



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.


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


Katherine Watson, Kathy Walton, Caroline Williams.

Newcastle upon

Tyne Hospitals NHS Foundation Trust


Found in the normal human urogenital tract,

Actinobaculum schaalii

is a Gram positive bacillus related to


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



To review

A. schaalii

isolates identified in the

Trust (January 2011

May 2016); patient demographics, clinical

significance, antimicrobial susceptibilities and patient outcomes.


Database search identified all isolates of

A. schaalii


Bacterial identification was by MALDI-TOF and sensitivity testing by

EUCAST methodology for Gram positive anaerobes.


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


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



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


(SAB): retrospective review at a university teaching hospital

Emma McGuire, Aqtab Mazhar Alias, Rachel Herbert, Eoghan de Barra.

Imperial NHS Healthcare Trust


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.


The purpose of this study is to assess the level of

adherence to these guidelines at our Trust.


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



Ninety four patients were identified; 60 (64%) with


S. aureus

(MSSA) and 34 with methicillin-


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


ID: 4876


species: An under-recognised and emerging

pathogen in orthopaedic infection?

Pauline Jumaa


, Nia Reeves


, Sarah Mimmack


, Michael Parry




University Hospitals Birmingham,


The Royal Orthopaedic Hospital




species are uncommon pathogens and

are most frequently reported in cases of endocarditis. There are few

reports of


species causing orthopaedic infection.


We describe the diagnosis, clinical characteristics

and treatment of six consecutive cases of orthopaedic infection

caused by


species from a specialist orthopaedic hospital

in the UK.

Abstracts of FIS/HIS 2016

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24