The Journal of Hospital Infection - Supplement 1

Electronic patient records and case notes were used to find

demographic, microbiological and clinical information, and assess

adherence to audit standards about antifungal agents, duration,

removal of vascular catheters, and investigation for serious sequelae.

Results:

There were 102 episodes in 94 patients (median age 63 years

range 32

–

87 years), evenly distributed throughout the study period.

55% were C. albicans. 88.2% had sensitivity-testing and 74.6%

fluconazole sensitive. 23 episodes had either fluconazole or itracona-

zole resistance, of which 20 were

C.glabrata

The most frequent predisposing factors were broad-spectrum anti-

bacterial use and central venous catheters.

Where adherence to IDSA initial treatment guidelines could be

assessed, there was 94% compliance and 90% received the correct

course length.

29%(17/59) had an appropriately-timed retinal examination and 67%

(68/102) had an echocardiogram.

Thirty-day mortality data 47.8%(32/67).

Discussion and/or Conclusion(s):

Candidaemia remains a major

source of healthcare-associated morbidity with a high mortality.

IDSA standards were met for therapeutics- likely attributable to anti-

fungal stewardship ward rounds, easily accessible trust guidelines and

that all positive blood cultures are telephoned by a medical

microbiologist. Investigation for significant sequelae, which happens

later, was not done well and reflects the need for greater education.

ID: 5037

Non-tuberculous mycobacterium and chronic pulmonary

aspergillosis co-infection: management challenges and prognosis

Isabel Rodriguez Goncer

, Chris Kosmidis

, Stephanie Thomas

Pippa Newton

, David W. Denning

University Hospital of South

Manchester,

National Aspergillosis Centre, University of Manchester,

National

Aspergillosis Centre, University of Manchester,

National Centre

Aspergillosis, University of Manchester

Background:

Chronic pulmonary aspergillosis (CPA) frequently coex-

ists with non-tuberculous mycobacterial (NTM) infection. The infec-

tions may be diagnosed sequentially or concurrently; CPA arising

during the course of treatment for NTM is a marker of worse prognosis.

The optimal management of patients with NTM/CPA co-infection is

not known and carries several difficulties.

Method(s):

We retrospectively reviewed medical records of 42

patients with NTM/CPA co-infection followed in our CPA clinic from

2008 to 2015. Criteria for NTM infection and CPA were according to

published international guidelines. We evaluated baseline character-

istics, comorbidities, microbiology and radiological findings, treat-

ment, side effects and outcomes.

Results:

Twenty-six patients were males (61.9%). In 35 patients (83.3%)

CPA followed, whereas in 4 patients it preceded NTM infection. Three

patients were diagnosed with both infections simultaneously. All

patients had microbiological and serological evidence of Aspergillus

infection. The most common NTM species were

M. malmoense

(23.8%)

and

M. avium

(21.4%). Fibrocavitary changes were observed on imaging

in 73.8% of patients (n = 31) and COPD was the most common

underlying condition. Eighteen patients received concomitant treat-

ment for both infections; 72% of patients (n = 13) were alive at two

years after diagnosis of coinfection. Most common regimen was

Itraconazole + Clarithromycin + Ethambutol + Moxifloxacin (27.7%).

Fifteen patients (83.3%) needed a treatment change, because of

intolerance or clinical failure. Seven patients (38.9%) had IFN-gamma

production deficiency. Mortality was not linked to a specific regimen.

Discussion and/or Conclusion(s):

NTM/CPA coinfection is associated

with significant mortality and frequent treatment modifications due to

side effects. IFN-gamma replacement therapy may provide an

alternative when antimicrobial treatment fails.

ID: 5070

Evaluating the importance of biofilms and their impact on

antifungal therapy in recurrent vaginal candidiasis: an

underappreciated and chronic condition

Leighann Sherry

, Rebecca Metcalfe

, Brian Jones

, Gordon Ramage

University of Glasgow,

NHS Greater Glasgow & Clyde

Background:

Vulvovaginal candidiasis (VVC) is estimated as the most

common fungal infection worldwide, predominately caused by the

fungus

Candida albicans.

Approximately 138 million women world-

wide complain of >4 episodes of VVC per year, clinically defined as

recurrent VVC (RVVC). One factor contributing to treatment failure and

chronic infection is the lack of a thorough understanding of its

epidemiology and pathogenesis.

Aim(s)/Objective(s):

The aims of this study were to undertake

epidemiology analysis of a RVVC group within NHS Greater Glasgow

& Clyde and assess the pathogenesis and antifungal susceptibility of

these isolates.

Method(s):

All RVVC cases (n = 300) reported in Glasgow during

May 2016 had isolates collected and species identified using

MALDI-TOF. Minimum inhibitory concentration (MIC) testing was

performed for fluconazole following CLSI guidelines. Isolates were

screened for biofilm formation, and sessile susceptibility testing

performed.

Results:

Although

C. albicans

proved to be the most frequent species

isolated (71%), its prevalence is substantially lower than

∼

95%

currently reported. The remaining 29% of organisms consisted of

glabrata

(15%) and

C. dubliniensis

(6%). All isolates showed differential

sensitivity to fluconazole, with majority of isolates requiring >32 mg/L

to kill planktonic and sessile communities. Biofilm formation was

shown to be highly variable across all isolates tested.

Discussion and/or Conclusion(s):

We have observed a shift in

prevalence of

Candida spp

, with an increasing isolation of non-

albicans

species. Reduced susceptibility to the frequently used VVC

antifungal, fluconazole, was observed. It was demonstrated that VVC

isolates could form biofilms in vitro, which has implications for

antifungals, as azoles are notoriously resistance to biofilms.

ID: 5073

Candida auris

is highly virulent and resistant, and capable of

forming biofilms

Leighann Sherry

, Ryan Kean

, Malcolm Richardson

Riina Rautemaa-Richardson

, Gordon Ramage

University of Glasgow,

University Hospital of South Manchester

Background:

Candida auris

is an emerging pathogen, first reported in

2009, and has attracted attention due to its reduced antifungal

susceptibility. More recently, it has been detected in a UK ICU, where

20% of patients colonised developed candidaemia. The ability of

C. auris

to form biofilms and resist antimicrobial therapy and host

responses has not been studied.

Aim(s)/Objective(s):

Therefore, we assessed

C. auris

pathogenicity in

the context of biofilm forming capacity, susceptibility to a panel of

antimicrobials, and its virulence

in vivo

Method(s):

Candida albicans

SC5314,

Candida glabrata

WT2001 and

Candida auris

M/67838 were used for minimum inhibitory concen-

tration testing, for six antifungals in addition to chlorhexidine,

following CLSI guidelines. Isolates were screened for biofilm forma-

tion, and sessile susceptibility testing performed. The

G. mellonella

model was used to assess pathogenicity

in vivo

Results:

C. auris

displayed intermediate biofilm formation, consisting

predominately budding yeast and occasional pseudo-hyphae.

Chlorhexidine was effective against

C. auris

biofilms unlike other

antifungals, where >16 mg/L was required to kill the biofilm. Although

C. albicans

and

C. auris

had similar kill kinetics

in vivo

C. auris

infection

achieved a 100% mortality rate more rapidly than

C. albicans

Discussion and/or Conclusion(s):

C. auris

is able to form biofilms and

resist antifungals that are active against its planktonic counterparts.

Abstracts of FIS/HIS 2016

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

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