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Demographic, clinical and microbiological data on all

patients from whom


species had been isolated were

extracted from the Bone Infection Unit database from September 2011

to April 2016.


Six patients from whom


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.


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


Discussion and/or Conclusion(s):


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 Johnson


, Jane Democratis


, Tae Lee




Wexham Park Hospital,


John Radcliffe Hospital


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


, Rasha Hassan


, Ghada Mashaly


, Enas Hammed



Amr Yassen


, Mohammed Wahab




Faculty of Medicine, Mansoura



Faculty of Medicine,


Liver Transplantation Unit,

Gastroenterology Surgical Center


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.


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.


This study enrolled 76 patients who experienced living

donor liver transplantation (LDLT) during the study period.


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


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


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.


Review compliance with the care bundle


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.


A retrospective audit of all patients intubated for 2 or more

days on ITU during a 30 day period.


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


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



ID: 4941

Sepsis and bleeding post TRUS biopsy of the prostate. Can we

identify those at increased risk?

Tomas Austin


, Tracey Rowe


, Claire Higgs


, Mary Parkes



Senthooran Kanthasamy


, Daniel Wilby


, Helen Chesterfield




Portsmouth NHS Trust,




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.


Canwe predict which patients are at a higher risk

of developing sepsis or significant bleeding after a TRUS Biopsy?


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.


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