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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



. 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


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