The Journal of Hospital Infection - Supplement 1 - November 2016

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70 (21%) patients were taking some form of anticoagulation
medication but only 1 of the 70 was readmitted with rectal bleeding.
Discussion and/or Conclusion(s): Risk stratification of sepsis risk for
patients undergoing TRUS biopsy remains a challenge. This study
failed to identify any factors that increase post-TRUS biopsy sepsis or
bleeding.
ID: 4944
Emergence of Legionella maceachernii infection in the United
Kingdom
Jennifer Poyner1, Louise Wellington1, Diane Lindsay 2, Robert Weir1,
Kate Templeton1, Donald Inverarity 1, Ian Laurenson1. 1NHS Lothian,
2SHLMPRL
Background: Legionella maceachernii is a rarely identified cause of
Legionnaires ’ disease. There have been only six previously reported
cases worldwide. To our knowledge, these are the only two UK cases
and maybe the largest case series of L. maceachernii ever reported.
Results: Patient one presented in September 2014 with severe
pneumonia and a previously undiagnosed, underlying lymphoproli-
ferative disorder. The patient died of this infection eight days later.
Patient two presented in November 2015; a renal transplant patient
with cough and diarrhoea. A CT scan showed right basal pneumonia.
The patient died eight weeks later with respiratory failure caused by
infections including Legionella.
Neither case had travelled during the typical Legionellosis incubation
period.
In both cases Legionella spp. was detected by in-house qPCR as part of
initial respiratory screen. Thereafter confirmed as L. maceachernii at
the Scottish National Reference laboratory. Levofloxacin was used as
the core treatment.
In the UK, Legionellosis is a notifiable disease. Lothian health
protection team investigated both cases but no clear source was
identified from multiple environmental samples. No household
members developed infection.
Discussion and/or Conclusion(s): L. maceachernii may be an emerging
cause of legionellosis. Diagnosis is dependant on the use of PCR and
culture as routine urinary antigen testing and serology do not detect
this species.
No clear link was established between the two cases despite both
living within Lothian region and no clear environmental exposure
was identified.
These two cases (and previous case reports) suggest L. maceachernii
is associated with a high mortality, particularly in the
immunosuppressed.
ID: 4959
What is the normal range for CSF white cell counts in children?
James Cargill, Richard Cooke. Alder Hey Children’s Hospital
Background: Meningitis can occur in children with ‘normal’ CSF
microscopy. Nevertheless, decisions to treat for bacterial meningitis
will often be based on an ‘ elevated’ CSF white cell count (WCC)
response. Typically ‘normal’ CSF WCCs consist of lymphocytes and not
neutrophils. CSF WCCs are also higher in normal term infants,
compared to older children, though fall rapidly after the first few
weeks of life.
Aim(s)/Objective(s): To establish reference ranges for CSF cell counts
for routine reporting from a microbiology department in a specialist
paediatric hospital.
Method(s): We review the interpretative guidance from NICE and
PHE for what constitutes a normal CSF WCC in children. The NICE
clinical guidance document CG102 ( “Meningitis (bacterial) and
meningococcal speticaemia in uder 16s: recognition, diagnosis and
management”; 2010 updated 2015) was compared and contrasted
to the PHE UK Standard for Microbiology Investigation B27
(“Investigation of Cerebrospinal Fluid”; issue 6, 2015).
Results: In neonates, NICE suggests treatment for bacterial meningitis
if the CSF WCC is at least 20/mm 3 but does not comment on the
expected number of neutrophils. In older children, >5 WCC/mm3 or >1
neutrophil/mm3 is considered abnormal. PHE guidance uses the
following age related CSF WCC ranges/mm3 neonates 0–30, 1– 4 years
0–20, 5 years to puberty 0–10, adults 0– 5, but makes no comment on
the significance of the neutrophil count.
Discussion and/or Conclusion(s): There is no consensus between
NICE and PHE guidance as to what constitutes a normal CSF WCC in
children. At a local level, microbiology laboratories should agree
interpretative criteriawith paediatricians which should be reflected in
all CSF laboratory reports.
ID: 5009
Carbapenemase-producing organisms: risk factors for infections
and mortality at a London Teaching Hospital
Kerry Roulston1, Yvonne Carter1, Vicky Pang1, Gemma Vanstone2,
Indran Balakrishnan1, Damien Mack1, Robin Smith1. 1Royal Free London
NHS Foundation Trust, 2HSL Analytics
Background: At the Royal Free Hospital, screening for carbapene-
mase-producing organisms (CPO) is performed for all Intensive Care
Unit patients. Risk-based screening is performed for private, renal,
liver, haematology, infectious diseases, stroke and oncology patients.
Aim(s)/Objective(s): To reviewall patients with CPO and ascertain risk
factors for infection and mortality.
Method(s): A retrospective review of all patients with CPO at the Royal
Free Hospital from July 2013 to December 2015 was undertaken. A
standardised questionnaire was used to collect data from the
laboratory information management system and electronic care
records.
Results: A total of 52 patients with CPO were identified (60% male,
mean age 65). In-patient hospital stay in the past year was documen-
ted for 33 patients; abroad (n = 16), UK (n = 13), both (n = 4). 27
patients (52%) had positive clinical samples and 19 (37%) were treated
for infection including; urinary tract (n = 4), pneumonia (n = 3), intra-
abdominal (n = 3), intra-abdominal and pneumonia (n = 3), blood
stream (n = 2), and osteomyelitis (n = 2). After multivariate analysis,
having CPO isolated from clinical samples was associated with
infection (OR = 11.86, 95%CI: 1.47–95.46, p = 0.020). The overall
30-day mortality rate was 16% from first positive sample, and in
those treated for infection, 42% from the start of treatment. All eight
deaths occurred in patients with a history of hospitalisation within
the previous 12 months but this association did not reach statistical
significance (p = 0.79).
Discussion and/or Conclusion(s): Patients with CPO are at risk of
infection with high mortality. The ability to predict patients at
increased risk of CPO infection could help to optimise empiric
antimicrobial therapy and improve outcomes.
ID: 5062
An unusual case of Erysipelothrix rhusiopathiae bacteraemia in a
patient with shingles and an overview of cases in GGC
Kirsty Keenan1, Ashutosh Deshpande1, Barbara Weinhardt2. 1NHS
GG&C, 2NHS GGC
Background: We describe the case of a woman admitted with sepsis
and an exacerbation of shingles. Bloods were unremarkable with the
exception of a relative neutrophilia and CRP of 17. Blood cultures on
admission grew Gram positive bacilli which turned out to be identified
as Erysipelothrix rhusiopathiae. We describe the clinical history
and management of this case as well as presenting an overview of
laboratory reported cases in our health board.
ID: 5064
Faecal carriage of resistant organisms in the community and
in-patient setting
Huan Hsin Cheng1, Manjusha Narayanan2, Caroline Williams2,
John Perry2. 1Newcastle University, 2Freeman Hospital
Background: The increased prevalence in antibiotic-resistant organ-
isms secondary to overuse or inappropriate use of antibiotics have
Abstracts of FIS/HIS 2016 – Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24–S134 S61