74 / 150
Efficacy of hydrogen peroxide in the killing
C. auris
was evaluated by
vaporized H
2
O
2
. Vaporization was performed as per manufacturer
’
s
instructions
[www.bioquell.com].
Candida
were desiccated in 96-well
plates (1 × 10
8
Cells/mL), reconstituted with RPMI after H
2
O
2
exposure,
incubated and viability assessed.
Results:
C. auris
isolates demonstrated growth inhibition to chlor-
hexidine (0.125
–
1.5%; 3 minutes exposure).
C. auris
and
C. parapsilosis
expressed higher MICs compared to
C. albicans
,
C. tropicalis
and
C. krusei
.
C. auris
showed growth inhibition at concentrations of
0.07
–
1.25% iodinated povidone.
C. parapsilosis
had higher MICs
compared to other
Candida
but was still effective at 1.25% iodinated-
povidone.
All
Candida
were killed at 1000 ppm chlorine accept
C. parapsilosis
which failed to be killed at a 3 minutes exposure.
H
2
O
2
vapour was 96.6
–
100% effective in killing
C. auris
and 100% for
other
Candida.
Discussion and/or Conclusion(s):
In summary
C. auris
was effectively
inhibited by chlorhexidine
in-vitro
at concentrations below recom-
mended use of 2 and 4% for skin decolonization. Iodinated-povidone
was also effective much below the 10% concentration used as
antiseptic agent. For the environmental decontamination during our
C. auris
outbreak we used chlorine releasing agents (1000 ppm for
routine cleaning; 10,000 ppm for terminal cleaning) and H
2
O
2
which
both appear effective
in-vitro.
Topic: Device related infection
ID: 4434
Case series on the management of culture negative vascular graft
infections at a regional surgical unit using outpatient parenteral
antibiotic therapy (OPAT)
Gareth Hughes, Mirella Ling.
Worcestershire Royal Hospital
Background:
Vascular graft infections can present a number of
challenges to infection specialists. Empiric antibiotic choice in
culture negative cases often relies on covering both enteric gram
negatives in addition to
Staphylococci
and
Streptococci
. There is paucity
of guidance on exact antibiotic choice. Outpatient parenteral antibiotic
therapy (OPAT) has not been used much in this patient group.
Aim(s)/Objective(s):
We present 3 patients with culture negative
vascular graft infection who presented to a regional vascular surgery
unit in Worcestershire & Herefordshire, UK.
Method(s):
We searched for patients admitted to our unit from 01/01/
2014 to 11/10/2015 using medical records for our trust and speaking
with the Infectious diseases physicians and Vascular surgeons who
would have managed patients in this time frame.
Our search term was ICD-10
Code T82.7
–
Infection and inflammatory
reaction due to other cardiac and vascular devices, implants and graft.
Results:
43 patients were identified all via ICD code. 30 of these were
excluded as they had vascular catheter or cardiac device infections.
Of the 13 remaining, 3 had clinical and radiological evidence of culture
negative graft infection.
Discussion and/or Conclusion(s):
In the 3 patients described, all were
managed as culture negative vascular graft infections with good
treatment outcomes. All received an intravenous course of a
glycopeptide and a carbapenem followed by oral continuation phase
with gram negative and gram positive cover. All received teicoplanin
and ertapenem via OPAT.
Our results suggest whilst vascular graft infections are challenging,
teicoplanin with ertapenem may merit more investigation as an
antibiotic choice for vascular graft infection and is suitable for OPAT.
ID: 4492
External ventricular drainage and CSF leakage as major risk factors
for nosocomial meningitis in neuro-ICU
Natalya Kurdumova
1
, Gleb Danilov
1
, Olga Ershova
1
, Michael Shifrin
1
,
Ivan Savin
1
, Irina Alexandrova
1
.
1
Burdenko Neurosurgery Institute,
Moscow, Russia
Background:
Nosocomial meningitis (NM) is a hazardous complica-
tion in neurosurgery leading to increased mortality, treatment pro-
longation and its higher costs. The emergence of multidrug-resistant
pathogens causing NM is disastrous.
Aim(s)/Objective(s):
Our aimwas to assess the incidence, identify the
main risk factors and highlight the etiology of NM in intensive care
unit (ICU) patients following neurosurgical procedures.
Method(s):
The results of ongoing prospective surveillance of NM in
ICU were analysed for 2010
–
2015. Data on 2148 patients staying in ICU
for more than 48 hours were daily collected into electronic database.
NM was defined using standard case definitions by the US Centers for
Disease Control and Prevention.
Results:
External ventricular drainage (EVD) was used in 540 patients,
143 patients experienced CSF leaks postoperatively. NM was diag-
nosed in 180 patients (8.4% ± 0.8 (95% CI 6.7
–
9.9)): in 98 (18.1%) with
EVD and in 49 cases (34%) of CSF leaks. The relative risk of meningitis
was 6.6 for EVD group and 5.1 for patients with liquorrhea (p < 0.01).
NM developed in 2.0% of patients without any risk factors and in 54.6%
when both factors were presented (p < 0.01). Meningitis etiology was
identified in 65.0% of cases. NM was associated with Gram-positive
(CoNS) CSF isolates in
∼
50% of EVD cases while in 80% of patients with
CFS leaks it was caused by Gram-negative bacteria (
Acinetobacter
baumannii
,
Klebsiella pneumoniae
).
Discussion and/or Conclusion(s):
EVD and CSF leakage are major risk
factors for NM in neuro-ICU. EVD is associated mainly with Gram-
positive agents while liquorrhea is a risk factor for Gram-negative
infection.
ID: 4571
Device associated bacteraemia surveillance
Benjamin Cooke, Jonathan Horwood, Trisha Miller, Eliza Jenkins,
Kathleen McCartney, Diane Williamson, Caroline McDermott,
Isabelle Gordon, Saranaz Jamdar.
NHS Forth Valley
Background:
Device associated infections are a significant cause of
iatrogenic harm, and are a Clinical Governance focus in NHS Forth
Valley. Benefits have been shown from the national care bundle
approach to central line insertion and maintenance, but other types of
implantable device may also cause problems. Variability of infection
rates across the Board represents an opportunity to identify good
practice, and target intervention.
Aim(s)/Objective(s):
To identify bacteraemias associated with implantable medical devices.
To identify high risk areas for device infection.
To allow feedback to clinical teams about practice in relation to
devices.
Method(s):
Over a period of 42 months, all bacteraemias were
reviewed by a Microbiologist. Those that were clinically linked to an
infected device were identified, and the patient
’
s notes were
examined. Additionally, all
Staphylococcus aureus
bacteraemias were
reviewed. All cases were then discussed at a weekly meeting to decide
on the source of infection, and any evidence of failure to complete an
insertion or maintenance bundle (where one existed) resulted in a
critical incident report. Information was collected on the type of
device, where the infection was acquired, and the organism involved.
Results:
Of 45,009 blood cultures, 192 Device Associated Bacteraemias
(DABs) were identified. 87 were hospital acquired and 96 were
healthcare-associated. Urinary catheters were the most commonly
associated device, accounting for 85 DABs.
Discussion and/or Conclusion(s):
As a result of this study, standar-
dised Board-wide insertion and maintenance bundles for urinary
catheters, peripheral venous cannulae and Hickman lines have been
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S69