The Journal of Hospital Infection - Supplement 1 - November 2016

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Method(s): Demographic, clinical and microbiological data on all
patients from whom Granulicatella species had been isolated were
extracted from the Bone Infection Unit database from September 2011
to April 2016.
Results: Six patients from whom Granulicatella species were isolated
were identified. 5/6 isolates were Granulicatella adiacens, 1/6 was
Granulicatella elegans . 3/6 infections were associated with orthopaedic
implants (1 total hip replacement, 1 total knee replacement, 1 femoral
endoprosthesis). The other 3 cases comprised infections following
hemi-pelvectomy; below knee amputation and excision of a liposar-
coma. 5/6 patients had malignancy and 4/6 cases reported dental
treatment prior to their infection. All patients who had an implant had
a two-stage revision. Granulicatella was cultured from deep tissue
samples taken at surgery in all 6 cases. The median time to isolate
Granulicatella species was 4 days (range: 1–8 days). In one case 16s
rRNA PCR identified G. adiacens in addition to culture. Three patients
had polymicrobial infection. In 4/6 cases treatment was successful
with eradication of infection. One patient died of causes unrelated to
infection.
Discussion and/or Conclusion(s): Granulicatella species are rare and
challenging pathogens in orthopaedic infection. Our experience
suggests that they may be associated with malignancy and prior
dental treatment.
ID: 4884
Lightning strikes thrice
Jessica Johnson1, Jane Democratis1, Tae Lee2. 1Wexham Park Hospital,
2John Radcliffe Hospital
Background: Capnocytopagia Canimorsus infection is rare. A national
survey done in the Netherlands identified 0.67 cases per million a year.
It has a 28–31% case fatality rate.
We present three cases of severe sepsis, 1 fatal, 2 associated with
animal bite, presenting in the last 12 months. Blood cultures grew
Gram negative rods but unable to culture or identify by standard
laboratory techniques. All were identified as Capnocytophagia
Canimorsus by reference laboratory. Capnocytophagia is a rare
important cause of severe sepsis that can be difficult to identify in
the laboratory.
ID: 4891
Early bacterial infections in liver transplant patients in
Gastroenterology Surgical Center, Mansoura University, Egypt
Rawia Badr 1, Rasha Hassan 2, Ghada Mashaly2, Enas Hammed2,
Amr Yassen3, Mohammed Wahab3. 1Faculty of Medicine, Mansoura
University, 2Faculty of Medicine, 3Liver Transplantation Unit,
Gastroenterology Surgical Center
Background: Liver transplant is life saving for end stage liver
disease patients. Infection following liver transplantation is a serious
complication. Few data are reported regarding drug resistance in liver
transplantation in Egypt.
Aim(s)/Objective(s): This study was carried out to detect the fre-
quency of post transplantation infections, common sites of infection,
types of bacterial isolates, the antibiotic sensitivity pattern and drug
resistant bacteria in Gastroenterology Surgical Center, Faculty of
Medicine, Mansoura University within a period of eight month from
1st April to the 30th November 2014.
Method(s): This study enrolled 76 patients who experienced living
donor liver transplantation (LDLT) during the study period.
Results: The bacterial infection rate was 14/76 patients (18.4%) within
the first thirty days post-operative, 6 patients had only one infection,
while 8 patients experienced multiple infections (19 infection).
Respiratory tract was the commonest site of infection detected in
this study (13\25) (52%). Among 14 infected patients enrolled in this
study, twenty seven pathogens were detected with the predominance
of Gram negative organisms (17\27–63%). Drug resistance among
isolates was very high including 12 (44.4%) and 9 (33.3%) isolates multi
and extensively drug resistant respectively.
Discussion and/or Conclusion(s): Drug resistance is very common
among liver transplant patients post operatively in Gastroenterology
Surgical Center Mansoura University. Therefore, a comprehensive
understanding of common pathogens in this care facility with their
resistance pattern will help in good implementation of infection
control policies with an impact on the quality of life of liver transplant
patients.
ID: 4937
Royal Victoria Infirmary ventilator associated pneumonia care
bundle audit
Katherine Watson, Manjusha Narayanan, Huw McConnell, Phil Laws.
Newcastle upon Tyne Hospitals NHS Foundation Trust
Background: Ventilator associated pneumonia (VAP) causes increased
duration of ventilation, ITU and hospital stay and increased costs. The
Department of Health high impact intervention care bundle provides
an evidence based approach to reducing incidence of VAP. This audit
was prompted by a period of increased incidence of VAP on ITU.
Aim(s)/Objective(s): Review compliance with the care bundle’ s
key action points for elevation of the head of the bed, sedation level
assessment, oral hygiene, subglottic aspiration, tracheal tube cuff
pressure and ventilator tubing management.
Method(s): A retrospective audit of all patients intubated for 2 or more
days on ITU during a 30 day period.
Results: 21 patients (15 men and 6 women, average age 50 years)
were ventilated for a total of 118 days. Overall the compliance with the
VAP care bundle actions points was very high. 4 of the 6 audit standards
had greater than 90% compliance. Sedation level assessment had
the lowest compliance (80.5%). 3 of the 21 patients ventilated for ≥2
days (14.3%) were treated for ventilator associated pneumonia.
Discussion and/or Conclusion(s): Results were presented at the ITU
clinical governance meeting. One point for improvement was to
emphasise the need for complete documentation. We plan to re-audit
compliance to check that standards remain high. The audit provided
an opportunity to look at culture results of respiratory specimens
from the ventilated patients. Most organisms isolatedwere susceptible
to cefuroxime and co-amoxiclav. This supports the use of narrow
spectrum antibiotics, especially as no Pseudomonas aeruginosa was
isolated.
ID: 4941
Sepsis and bleeding post TRUS biopsy of the prostate. Can we
identify those at increased risk?
Tomas Austin1, Tracey Rowe1, Claire Higgs1, Mary Parkes1,
Senthooran Kanthasamy1, Daniel Wilby2, Helen Chesterfield2.
1Portsmouth NHS Trust, 2Portsmouth
Background: Prostate cancer diagnosis is a rapidly evolving diagnostic
pathway. TRUS (Transrectal ultrasound) biopsy of the prostate remains
one of the main diagnostic tools but can be associated with post-TRUS
biopsy sepsis and bleeding.
Aim(s)/Objective(s): Canwe predict which patients are at a higher risk
of developing sepsis or significant bleeding after a TRUS Biopsy?
Method(s): Potential risk factors for sepsis and bleeding were
prospectively recorded in 328 consecutive patients at a single
institution using a new proforma sheet over a 9 month period. Data
including previous travel, antibiotic use, previous UTIs, hospital
admissions, presence of diabetes, immunosuppression, indwelling
or intermittent self-catheterisation and anti-coagulant use were
recorded. Standard antibiotic prophylaxis (Ciprofloxacin) was given
to all patients.
Results: Of the 328 patients undergoing TRUS biopsy 5 (1.5%) patients
developed SIRS defined sepsis, 6 (1.8%) required re-admission for
rectal bleeding and 2 (0.6%) developed Urinary retention. The
Readmission rate was 4% (13). 177 (54%) patients had no risk factors
for sepsis. Previous antibiotic use was noted in 75 (23%) patients, prior
travel in 61 (19%) and a previous UTI in 32 (10%). Of the patients
readmitted with sepsis only 1 had any previous risk factors for sepsis.
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S60