94 / 150
Outbreak management focused on a two stage decontamination
process: 1. NaDCC solution; 2. hydrogen peroxide (H2O2) vapour
system.
Aim(s)/Objective(s):
Evaluate association of patient bed placement
with acquisition of
C. auris.
Method(s):
Retrospective audit.
Results:
217 patients who met cr69%iteria for sharing an environ-
mental with a positive
C. auris
patient. 14% (30/217) of patents were
subsequently found to be
C. auris
positive.
16 of the 30 positive patients had sequential bed occupancy that was
previously occupied by a positive
C. auris
case.
14 of 30 patients had direct
C. auris
patient exposure suggesting a 20%
(16/82) risk with sequential admission into a bed space previously
occupied by a
C. auris
+ patient, 10% (14/135) risk (if a direct positive
patient exposure took place).
11/16 69% cases acquired
C. auris
despite the fact that the room
environment had been decontamination prior to occupancy. Including
three patients who were placed directly into single rooms.
Discussion and/or Conclusion(s):
Environment poses risk of trans-
mission of
C. auris
.
69% of patients acquired
C. auris
despite decontamination with 2
disinfectant process.
Further studies needed to demonstrate the efficacy of specific
decontamination process used in controlling the risk of transmission
from the environment. Finding may suggest that routes of transmis-
sion may be multifactorial not solely due to environmental contam-
ination. No particular source including mobile medical equipment has
been identified.
Topic: Fungal infections
ID: 4433
Mucocutaneous candidiasis in neonates and infants
Adnan Bajraktarevic
1
, Amra Junuzovic Kaljic
1
, Amra Dzinovic
2
,
Alisa Abduzaimovic
3
, Aida Djulepa Djurdjevic
4
, Faruk Alendar
5
,
Almir Masala
6
, Marela Spahovic
7
, Alija Drnda
8
.
1
Public Health
Institution of Canton Sarajevo-Health Center Vrazova Sarajevo-
Department for Preschool Children,
2
Pediatrics Clinic Sarajevo,
3
Biochemistry and Microbiology laboratory,
4
General Hospital Sarajevo,
5
Dermatology Clinic Sarajevo,
6
Cantonal Government Sarajevo- Ministry
for Education and Health,
7
Pharmacology Faculty-Department for Clinical
Pharmacology,
8
Infectious Clinic Sarajevo-Department for Children
Infectious Diseases
Background:
Candida infections are rarely serious in otherwise
healthy children. Systemic candidiasis is the most serious Candida
infection. It affects many parts of the body and is usually caused by an
immune deficiency. Chronic mucocutaneouscandidiasisis a cluster of
disorders of cell-mediated immunity that presents as chronic severe
candidal infections of the skin and mucous membranes. The clinical
manifestations of infection with
Candida
species range from local
mucous membrane infections to widespread dissemination with
multisystem organ fail.
Aim(s)/Objective(s):
The clinical manifestations of
Candida
infection
in the neonate and infants vary, ranging from localized infections of
the skin andmucous membranes to life-threatening systemic infection
with multisystem organ failure.
Method(s):
The questions on test of dr Brian Martin help identify the
severity level of Candida overgrowth condition. Scoring this children
’
s
Candida questionnaire should help us to evaluate the role Candida
albicans contributes to child
’
s health problems.
Results:
There were 786 cases of mucocutaneous candidiasis during
last twenty years in dispansery for preschool children Center Sarajevo.
From that total number of children there were 502 (63,87%) cases in
neonates or infants until 12 months.
Discussion and/or Conclusion(s):
Symptomatic infections such as
thrush and
Candida
diaper dermatitis may develop at any age
thereafter, particularly following broad-spectrum antibiotic treat-
ment. Systemic candidiasis is rare, but is a particular risk for premature
infants.
ID: 4540
An unusual case of disseminated yeast infection
Tara Moshiri, Nikunj Mahida, Tim Boswell.
Department of Microbiology,
Nottingham University Hospitals
Background:
Trichosporon Mycotoxinivoras is a yeast that was first
isolated in 2004 from a termite hindgut. It has the ability to detoxify
mycotoxins and was given the above name meaning
“
mycotoxin
devouring
”
in Latin. It was first described as a human pathogen, in
2009, causing pneumonia in a patient with cystic fibrosis. In 2012, the
first disseminated case was identified, in a patient with cystic fibrosis
who had received a double-lung transplant.
Aim(s)/Objective(s):
To the best of our knowledge, this is the first case
of disseminated Trichsoporon Mycotoxinivorans infection in a cystic
fibrosis patient, diagnosed outside North America and in the absence
of lung transplantation.
Method(s):
The patient was transferred from a peripheral hospital
with severe, non-resolving pneumonia, to the intensive care unit for
specialist cystic fibrosis management. Yeast was cultured from
sputum, broncho-alveolar lavage and blood cultures. The organism
could not be identified using chromogenic media or Vitek-2
(bioMérieux). Ambisome was started for broad-spectrum antifungal
coverage whilst identification was pending.
Results:
Reference laboratory techniques using Maldi-Tof provided the
identification but the patient unfortunately had significantly deterio-
rated and a decision was made for palliative treatment.
Discussion and/or Conclusion(s):
This case highlights an important
pathogen for cystic fibrosis patients that hereto has not been seen in
the UK. The recommended treatment option is a combination of
Voriconazole and Ambisome. This combination of antifungal agents is
not commonly used but could be considered in cystic fibrosis patients
with suspected disseminated yeast infection until the organism is
identified.
ID: 4552
An audit of the management of invasive candidiasis
Faiha Eltayeb, Vivienne Weston.
Nottingham University Hospitals
Background:
Candidaemia is associated with significant morbidity
and mortality. National and international standards of care advocate
specific measures regarding appropriate management.
Aim(s)/Objective(s):
To evaluate management of invasive candidae-
mia against practice guidelines. A compliance of 85% is set as
acceptable recognizing complexity of case and presentations.
Method(s):
A retrospective study identifying twenty positive blood
cultures together with recorded final identification and sensitivities.
Administered antifungals, duration of management and outcomes
were recorded from clinical notes. Audit templates has been driven
from referenced guidelines, extracted data were examined against
recommended standards.
Results:
Of the 20 cases identified, 100% had final identifications and
sensitivities. 80% of cases had central lines removal within 48 hours of
positive cultures, 81% were started on appropriate antifungals, ocular
involvement was sought and evaluated only in 36% of the cases. In 70%
of cases treatment was not deescalated as recommended and only 40%
of cases received 14 days of treatment after clearance blood culture as
recommended.
Discussion and/or Conclusion(s):
All isolates were identified and
had appropriate sensitivities. There was timely removal of central
lines with explanation documented in cases where lines weren
’
t
removed, escalation /de-escalation of management was less evident
particularly in Candida albicans infection. Ocular involvement was
recommended/sought in less than half of the cases. There need to be
emphasis on advising 2 weeks of treatment following clearance blood
cultures.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S89