98 / 150
These features not only contribute to its virulence, but also to its
survival in hospital environments, increasing its ability to cause
outbreaks. The results of the
in vivo
model mimic our clinical
experience and highlight
C. auris
as a highly virulent species,
equivalent to
C. albicans
.
ID: 5095
Candidaemia in hospital inpatients: An audit of management
across three acute hospital trusts
Alex Howard
1
, Caroline Corless
2
, Jenifer Mason
2
, Olusola Akinbame
3
.
1
Mersey Deanery,
2
Liverpool Clinical Laboratories,
3
Aintree University
Hospital
Background:
Despite increasing incidence of candidaemia, most
clinicians lack experience in its management and it carries a
mortality rate of 20
–
40%. Recently-updated international clinical
guidelines recommend specific investigations and treatments for
candidaemia.
Aim(s)/Objective(s):
To audit candidaemia management against
standards from Infectious Diseases Society of America (IDSA),
European Society of Microbiology and Infectious Diseases (ESCMID)
and Liverpool Clinical Laboratories (LCL) Standard Operating
Procedure guidelines in three acute hospital trusts.
Method(s):
A retrospective search was performed for patients at Royal
Liverpool University Hospital, Aintree University Hospital and
Liverpool Heart and Chest Hospital with candida species in blood
cultures over 5 years. The management of their first episode of
candidaemia was compared against audit standards using patient
notes and computerised records.
Results:
161 cases were reviewed. 56% of patients received correct
antifungals and doses. 42% received at least 14 days
’
treatment. 18%
had transthoracic echocardiograms (TTE) and were considered for
transoesophageal echocardiogram (TOE). 27% had fundoscopic exam-
ination by an ophthalmologist. 12% had blood cultures taken on
alternate days until resolution of candidaemia. 76% were reviewed by
infection specialists within 48 hours. 61% of CVCs were considered for
removal. 98% of isolates were speciated, 57% had minimum inhibitory
concentrations identified and 56% had appropriate sensitivities
released.
Discussion and/or Conclusion(s):
Many patients did not receive
recommended management for their candidaemia, with source
investigations and blood culture monitoring done particularly infre-
quently. Infection service departmental guidelines and a treatment
bundle will therefore be developed to aid infection specialists and
clinical teams before re-audit.
ID: 5097
Homographiella aspergillata
, a non-aspergillus mould, causing
fungal granuloma involving the anterior cranial fossa in an
immunocompetent individual
Dhara Shah
1
, Rungmei Marak
1
, Rabi Narayan Sahu
2
, Sanjay Bihari
2
,
Ajai Dixit
2
, Tapankumar Dhole
2
.
1
Sanjay Gandhi Post Graduate Institute
of Medical Sciences,
2
Sanjay Gandhi Postgraduate Institute of Medical
Sciences
Background:
In recent years, the emergence of non-aspergillu
s
moulds in brain infections has been observed.
Hormographiella
aspergillata
, a
fi
lamentous basidiomycete present in compost/
sewage, has previously been implicated in pneumonia, lung abscess,
endocarditis and keratomycosis in patients.
Case Report:
Forty-year old immunocompetent female presented
with anosmia, headache, bilateral vision loss, vomiting, impaired
olfaction/visual acuity, right optic atrophy without any facial
hypoesthesia/asymmetry. Radiological Investigations revealed large
basifrontal mass lesions in anterior cranial fossa, involving ethmoid &
sphenoid sinuses, right cavernous sinus & optic nerve. Bilateral frontal
craniotomy/total excision of mass was performed and multiple
tissue pieces from olfactory groove mass were sent for laboratory
investigations.
Method(s):
Tissue pieces were homogenized and processed for KOH
wet mount direct microscopy and culture on Sabouraud
’
s Dextrose
Agar (SDA)(25°C,37°C).
Results:
Direct microscopy showed plenty hyaline septate fungal
hyphae. Culture grew white-to cream-colored cotton-like colonies
with white mycelia tufts & irregular margin after 11 days of incubation.
Lactophenol cotton blue mount revealed hyaline hyphae, septate
simple/sympodially branched conidiophores, apically bearing a
cluster of conidiogenous hyphae which are septate & disarticulating
into arthroconidia with smooth-walled, cylindrical conidia aggregat-
ing in slimy heads; morphologically identified as
Homographiella
aspergillata
. Patient was treated successfully with voriconazole and
liposomal amphotericin B. Follow-up (6 months) showed improve-
ment without persistent infection.
Discussion and/or Conclusion(s):
This is a rare case of
H.aspergillata
causing fungal granuloma of anterior cranial fossa in an immuno-
competent individual. With the continuous expanding spectrum of
fungi causing invasive disease, it is important to consider the
clinical relevance of every fungus cultured from clinical samples for
a successful outcome.
ID: 5111
An overview of the Fungal Service Evaluation Tool (FSET)
Harblas Ahir, Stuart Robertson.
Merck Sharp & Dohme Limited
Background:
Patients at a high-risk of neutropenia are administered
antifungal prophylaxis to prevent breakthrough invasive fungal
infections (bIFI). BIFI
’
s are associated with a high morbidity and
mortality rate within this patient group. The rate of bIFI
’
s at hospital
Trusts is unclear and the Fungal Service Evaluation Tool (FSET) can aid
in providing optimal patient management. As of August 2016, there are
currently 10 registered NHS Trusts using the tool.
Aim(s)/Objective(s):
To enable NHS Trusts in:
•
Determining the proportion of high-risk patients developing
bIFI
’
s.
•
Analysing the management of high-risk patients developing
bIFI
’
s.
•
Analysing the subsequent impact on healthcare resource use.
Method(s):
The FSET is a computer-based tool, hosted on the secure
UK NHS N3 network. The FSET can collect data on non-identifiable
patient characteristics, underlying disease, details of diagnostic tests,
antifungal management and hospital visits in the defined patient
group. An amalgamation of the pooled data can generate simple visual
reports that summarises the key outputs.
Results:
The FSETallows hospital Trusts to extensively analyse patients
cohorts undertaking prophylaxis with antifungals, capturing holistic
resource usage incurred during the overall patient management
pathway.
Discussion and/or Conclusion(s):
The FSET produces a number of
reports incorporating a variety of data, inputted for every patient. This
covers a number of topics; ranging from patient demographics to the
service costs associated with managing patients, who may or may not
develop a bIFI. The FSET establishes an indicative level of resource
utilisation which can help Trusts review antifungal patient manage-
ment and estimate future budgetary resourcing.
ID: 5136
Invasive pulmonary Aspergillosis occurring in immunocompetent
patients with influenza A
Christina Johnston
1
, Aleks Marek
2
, Mairi Macleod
2
, Scott Farrelly
3
,
Rory Gunson
4
.
1
NHS Greater Glasgow and Clyde,
2
Consultant
Microbiologist, NHS Greater Glasgow and Clyde,
3
Biomedical Scientist,
NHS Greater Glasgow and Clyde,
4
Consultant Virology Clinical Scientist,
West of Scotland Specialist Virology Centre
Background:
Invasive pulmonary aspergillosis is a severe disease
which most commonly occurs in immunocompromised patients.
There are a small number of case reports that have been published
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S93