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nontyphoidal Salmonella) has largely not been seen as a public health
priority. Over the coming years, life-threatening Salmonella disease
will become even more prominent as highly effective protein-
conjugate vaccines against Haemophilus influenzae type b (Hib),
Neisseria meningitidis, and Streptococcus pneumoniae are widely
introduced. In this context, there remain large gaps in our knowledge
of Salmonella disease pathogenesis, routes of transmission, and
infection reservoirs. Many still hold to the established dogma that
nontyphoidal Salmonella largely causes self-limited enterocolitis and
that animals are a likely reservoir. It is frequently argued that since
typhoid fever is associated with a relatively lowmortality rate, there is
a low burden of illness. Recently, high throughput whole genome
sequencing has shown how the complex epidemiology and host
adaptation amongst different Salmonella serovars is reflected in the
bacterial genome, revealing putative pathways for the spread of
Salmonella and the origin of multidrug resistance. With the
appropriate epidemiological context and novel diagnostics, it is
hoped that we will be able to finally unravel the mysteries of invasive
Salmonella disease.
Update on ESPAUR
Susan Hopkins.
Infectious Diseases and Healthcare Epidemiology, Royal
Free London and Public Health England
The English Surveillance Programme on Antimicrobial Use and
Resistance (ESPAUR) was established by PHE in 2013 in response to
the cross-government UK five-year antimicrobial resistance (AMR)
strategy. The aim of the programme is to develop and maintain robust
data for antimicrobial use (AMU) and resistance, in order to optimise
antimicrobial prescribing across healthcare settings and measure the
impact of AMU and antimicrobial stewardship (AMS) on AMR and
patient safety. The programme has established and improved
surveillance data; published annual reports with greater data
granularity over time; AMR indicators are available to professionals
and public through
http://
fingertips.phe.org.uk/profile/amr-local-
indicators
. It has performed and published an assessment of AMS
activities and implementation of AMS toolkits. It has worked with NHS
England to develop and enable data collection to improve AMS as part
of NHS incentive schemes. ESPAUR launched the
‘
Antibiotic Guardian
’
campaign to drive changes in public and professional behaviour
around AMU -more than 32,000 people have engaged with this
campaign. In collaborationwith Health Education England ESPAUR has
scoped and developed implementation options related to education
and training of healthcare professionals for antimicrobial prescribing
and stewardship competencies. Half way through the AMR strategy
(2013
–
2018), ESPAUR is on target to meet its challenging objectives.
An update in anaerobic microbiology: Relevance to clinical practice
Harriet Hughes.
Microbiology and Infectious Diseases, University
Hospital of Wales, UK
Anaerobes play an important role in clinical infection, with significant
associated morbidity and mortality. Logistical difficulties in obtaining
appropriate clinical specimens in a timely manner, together with
technical difficulties of traditional diagnostic methods have resulted in
a relatively low rate of culture of clinically significant organisms. The
impact of this, together with the difficulties of susceptibility testing in
many laboratories, means that anaerobic infections risk being under-
diagnosed and inappropriately treated. The use of new diagnostic
techniques in the routine clinical laboratory over recent years however,
has resulted in increased identification of anaerobic pathogens in
different clinical scenarios, and is shifting our understanding of the
role of these organisms in clinical infection. Molecular techniques not
yet routinely available are pushing this understanding further.
Alongside this, identification of resistance mechanisms and suscepti-
bility profiles of these organisms can be used to direct specific therapy
and inform future empirical antibiotic choices. This talk will highlight
the changes to routine diagnostic methods for anaerobes, and discuss
how this has impacted on the range of anaerobic infections being
diagnosed in our hospitals. It will also discuss the trends in local
resistance patterns and how this may affect future empirical antibiotic
choices. Finally, it will consider future challenges and solutions in the
field of clinical anaerobic microbiology.
Infection control and antimicrobial resistance: what guidance is
there and how should it be used?
Peter Jenks.
Microbiology, Plymouth Hospitals NHS Trust
There is a multitude of guidance on infection control and antimicrobial
resistance, so much so that one is almost spoilt for choice. Good quality
guidance that is soundly evidence-based can promote the provision of
excellent clinical practice and support quality improvement schemes.
When used to guide decision making, they can also deliver efficiencies
in clinical service provision and facilitate negotiation with commis-
sioners. However, there are many areas of infection prevention and
control practice where good quality evidence is lacking. While expert
best practice guidance covers many of these areas, it is here that the
practitioner needs to use their professional expertise and judgement.
This presentation will describe the different guidance available on
infection control and antimicrobial resistance and discuss how these
might be used both clinically and strategically.
The impact of climate on healthcare-associated infections
Martin Kiernan.
University of West London
This paper will review the literature on the effect of climate on
healthcare-associated infections, drawing a distinction between
seasonality and weather. Changes in meteorological factors can
promote pathogen propagation and spread, and in patients, induce
decreased immune function of patients. Temperature and humidity are
important factors and have some influence on HCAIs. There is some
evidence of seasonality for viral infections such as influenza and
bacterial infections such as Legionella however there are also seasonal
aspects to healthcare-associated infections such as gram-negative,
staphylococcal and surgical site infections. The possible factors for this
will be explored and discussed however seasonality (summer) and
higher temperature (weather) do seem to be associated with higher
rates of gram-negative healthcare-associated infection.
Infections in burns patients
John Kinsella.
Intensive Care Medicine, University of Glasgow
Although burns are recognized to have a high mortality much of this
mortality occurs in the Prehospital phase. As a consequence in hospital
mortality is surprisingly low with typical mortalities from major
centres in the low single figure percentages. Burn mortality is also
falling, with an approximate 10% reduction in fires, burn casualties and
mortality annually. Burn morbidity remains high, with long hospital
stays, repeated procedures and multiple complications. Burn wound
infections and sepsis increases the risk of mortality, impairs wound
healing, increases graft failure and prolongs hospital stay. The
diagnosis of burn wound infection is not simple, and relies on clinical
appearances, markers of infection along with laboratory confirmation
that is difficult to interpret. The earl y excision of burn wounds with
grafting and coverage with synthetic materials appears to be reducing
infection risk. Good epidemiological evidence now exists to demon-
strate typical patterns of infect, particularly with gram-negative
organisms that should lead tomore accurate blind antibiotic regimens.
The lecture will cover: · The current epidemiology of burns, · Burn
outcomes, · The current Scottish burn care service · Typical patterns of
infection in burn patients · Research challenges.
An update on non-tuberculous mycobacteria (NTMs)
Ian Laurenson.
Scottish Mycobacteria Reference Laboratory
To Follow: Non tuberculous mycobacteria occur widely in the
environment but many can cause significant clinical infections as
well as contaminating samples and equipment. I will endeavour to
summarise some of the key current issues and in healhcare.
Abstracts of FIS/HIS 2016
–
Invited Speaker Abstracts / Journal of Hospital Infection 94S1 (2016) S1
–
S10
S4