The Journal of Hospital Infection - Supplement 1

Management of invasive candidaemia is challenging, more emphasis

is needed regarding review and follow up of individual cases to

establish delivering appropriate management and care.

ID: 4680

Candidaemia in paediatrics

–

a 12 year retrospective analysis to

examine changes in species distribution and antifungal

susceptibilities

Alison Balfour

, Kathleen Harvey-Wood

, Carol Lucas

NHS Greater

Glasgow and Clyde South Sector Microbiology,

NHS Greater Glasgow

and Clyde

Background:

Bloodstream infections (BSI) caused by Candida species

are responsible for significant morbidity and mortality in hospitalised

children. Identification of Candida to species level can predict

antifungal susceptibilities, and the determination of Minimum

Inhibitory Concentrations (MICs) to antifungal agents informs thera-

peutic options.

Aim(s)/Objective(s):

We performed comparative analysis of two 6

year periods (2004-end 2009, 2010-end 2015) to calculate if there was

statistically significant variation in prevalent species. Antifungal

susceptibilities were examined to determine changes that would

influence management.

Method(s):

Laboratory records of all cases of candidaemia were

examined retrospectively using CDC/NHSN 2016 surveillance defini-

tions of BSI. Broth microdilution (Sensititre

YeastOne) was used to

determine MICs to a range of antifungal agents.

Results:

There was a decrease in overall number of isolates, episodes

and patients in the second timeframe, but epidemiological shift with

C. glabrata

and

C. lusitanae

. Calculation of p-values for species

predominance did not reveal significance, possibly influenced by small

sample numbers. All isolates from both timeframes were susceptible

to amphotericin B. For fluconazole susceptibility, in the earlier

timeframe 6.8% isolates were sensitive dose-dependent, in the later

timeframe 4% were sensitive dose-dependent and 10.4% were

resistant. All isolates were sensitive to voriconazole and caspofungin

in the first timeframe, but 6% had reduced susceptibility to

voriconazole and 2% to caspofungin in the later group.

Discussion and/or Conclusion(s):

C. parapsilosis

remains the preva-

lent species in this paediatric population. Of note is the increase in

incidence of reduced susceptibility to certain antifungal agents.

Continued vigilance is required to detect further changes in suscep-

tibility and species distribution.

ID: 4760

Voriconazole therapeutic drug monitoring (TDM)

Aiden Joseph Plant, Hannah Burnett, Cressida Auckland.

Royal Devon &

Exeter NHS Foundation Trust

Background:

Voriconazole is a triazole, broad-spectrum antifungal;

active against yeasts, dimorphic and filamentous fungi and lacking

activity against zygomycetes. Non-linear pharmacokinetics, cyto-

chrome P450 polymorphisms and oral bioavailability ranging from

60% to 86% in children and the sick explains extensive variation in

serum voriconazole concentrations. Therapeutic drug monitoring

(TDM) is recommended for both prophylaxis and treatment.

Aim(s)/Objective(s):

Assuming this as an auditable standard, we

describe a Trust-wide assessment of voriconazole TDM.

Method(s):

Pharmacy records of voriconazole dispensed from June

2015 to June 2016 were retrospectively reviewed. Adults and children

receiving voriconazole for more than two-weeks as prophylaxis or

treatment were included. Patient demographics, treatment indication

and TDM results were recovered from the Trust

’

s information

management systems.

Results:

Eight patients were identified, with a median age of 51 years

(range 2

–

69) and no gender difference. Three patients received

voriconazole prophylaxis during treatment for haematological malig-

nancy. The remaining five received treatment: three had invasive

aspergillosis, one had allergic bronchopulmonary aspergillosis and

one had endophthalmitis. There was one episode of voriconazole TDM

in these eight cases.

Discussion and/or Conclusion(s):

There is insufficient voriconazole

TDM in our patient population. Better outcomes are demonstrable in

patients who receive voriconazole TDM versus no TDM, and supra-

therapeutic troughs have been associatedwith toxicity. It is crucial that

patients receiving either prophylaxis or treatment with voriconazole

have TDM.

In response to this audit principles of good antimicrobial stewardship

(speciality-specific seminars and clinical practice guidelines) are being

introduced, with subsequent prospective audit and feedback to

improve utilisation of TDM in voriconazole use.

ID: 4834

The use of (1

→

3)-

-D-Glucan testing in bronchoalveolar lavage

samples in the diagnosis of invasive fungal disease and

pneumocystis pneumonia

Felicia Lim, Nelun Perera.

University Hospitals of Leicester NHS Trust

Background:

→

3)-

-D-Glucan (BDG) and Galactomannan (GM) are

both biomarker tests that have been used in recent years to aid the

diagnosis of Invasive Fungal Disease (IFD).

Aim(s)/Objective(s):

We conducted a service evaluation to look at the

utility of testing BDG compared to GM in BAL samples to aid the

diagnosis of IFD.

Method(s):

BAL samples from patients with haematological malig-

nancies and bone marrow transplantation were tested retrospectively

for BDG using the Fungitell

assay. Comparison was made between

BDG and GM from BAL samples. The Computerised Tomography of the

chest (CT chest) were reviewed for the same patients and were

classified into probable and possible IFD based on the revised 2008

European Organization for Research and Treatment of Cancer/

Mycoses Study Group (EORTC/MSG) definitions. BDG from BAL were

also compared with results of

Pneumocystis jirovecii

DNA PCR.

Results:

A total of 24 BAL samples had both biomarkers tested. Both

BDG and GM had similar sensitivity in the diagnosis of probable/

possible IFD (27.3% vs 25.0%). However BDG had a much lower

specificity compared to GM (53.9% vs 84.7%).

BDG in BAL showed a good negative predictive value for

Pneumocystis

jirovecii

DNA PCR positivity (NPV 92.9%, sensitivity 85.7%, specificity

56.5%).

Discussion and/or Conclusion(s):

BDG testing in BAL was not shown

to be of clinical utility in the diagnosis of IFD. However, it may be a

useful assay for ruling-out the diagnosis of pneumocystis pneumonia

in this patient population.

ID: 4851

Candida epidemiology and antifungal resistance: a ten year review

of candida blood stream infections in University Hospitals of

Leicester

Fadwa Elsanousi

, Helen Kirk-Granger

, Armin Ghanbari

Nelun Perera

Clinical Microbiology University Hospitals of Leicester

NHS Trust Level 5 Sandringham Building,

University Hospitals Leicester

NHS Trust

Background:

Candida blood stream infection (CBSI) is one of the com-

monest causes of bloodstream infections among hospitalised patients

and is associatedwith highmorbidity andmortality. The incidence and

antifungal resistance varies between countries and units.

Aim(s)/Objective(s):

To review the epidemiology and antifungal

resistance of CBSI in University Hospitals of Leicester (UHL) over a

period of 10 years (2005

–

2015).

Method(s):

Laboratory and clinical data of CBSI between 2005 and

2015 were reviewed retrospectively for patient demographics, species

and antifungal resistance.

Results:

A total of 337 patients with 337 episodes of CBSI were

identified (mean 33.7 episodes of CBSI/year). 87% of the episodes were

in adults with almost equal number of episodes among the two

genders (170 F, 167 M). Majority of the episodes were from patients in

Abstracts of FIS/HIS 2016

–

Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24

–

S134

S90