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A twenty five year review of adults admitted to a British hospital with non-Typhoidal Salmonella gastroenteritis
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Introduction Streptococcus Pneumoniae is a common commensal bacterium found in the human nasopharynx. It is also a major cause of pneumonia and meningitis in the world. Pneumococcal infections are treated with antibiotics and can be prevented by using multivalent vaccines. However, both of this management are not ideal due to restricted specificity of the available vaccines and the development of antibiotic resistance. Previous studies have identified the genetic variation of different S. Pneumoniae. However, the different cellular proteins produced by the bacteriums have not been identified. The objective of this research programme is to identify the differentially synthesised bacterial proteins between resistant and sensitive S. Pneumoniae isolates. In addition, proteins that define bacterial pathogenesis, particularly bacterial invasiveness, will also be located using proteomic and mass spectrometry technology to establish correlations between bacterial invasiveness, antibiotic resistance and the differential protein expression. The data obtained from the study can be used as a valid approach for the potential development of new therapeutic and diagnostic solutions.
Scientific findings The cellular proteins of 13 S. Pneumoniae isolates were analysed by 2D gell electrophoresis. Although a common protein profile was identified for all of the bacterial isolates, there was some protein variation observed between the isolates. Selected proteins have been selected for identification by mass spectrometry.
Discussion Despite the identification of different spot differences and similarities, more isolates will be needed to investigate the protein expressed by the different isolates. Additional sets of 2D gel electrophoresis from the same isolates are needed to confirm the consistency of spots produced and to investigate the presence of mutation hence spot differences by the same bacteria isolates. Current bacteria samples are grown in bovine cultures and future studies will be needed to look into growing the bacterium in different culture medium to optimise protein extractions and to compare different proteins expressed by the bacterium when grown in different mediums.
Conclusions Both spot differences and similarities were identified between the bacterial isolates. Pilot studies have been carried out for protein identification. Additional isolates are needed for comparative analysis to generate data that can allow more definite conclusion into the different protein expressions by the isolates.
Abstracts
A TWENTY FIVE YEAR REVIEW OF ADULTS ADMITTED TO A BRITISH HOSPITAL WITH NONTYPHOIDAL SALMONELLA GASTROENTERITISCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Sherine Thomas 1, Esther Aspinall 2, Chris Parry 2, Richard Cook 3, Nick Beeching 1 1
Tropical and Infectious diseases unit, Royal Liverpool University Hospital, Liverpool, United Kingdom 2 School of Infection and Host Defence, University of Liverpool, Liverpool, United Kingdom 3 Department of Medical Microbiology, University Hospital Aintree, Liverpool, United Kingdom
Introduction Non-typhoidal Salmonella (NTS) infections are a common cause of bacterial food poisoning, typically causing gastroenteritis but occasionally secondary bacteraemia. The frequency and importance of bacteraemia is debated. A retrospective cross-sectional survey included all patients admitted to a large general hospital in Liverpool, UK, with faecal culture confirmed NTS gastroenteritis, from 1982 through to 2006. Patients were identified from hospital discharge data and laboratory records. Clinical and laboratory data were extracted from patient records onto a standardised proforma.
Scientific findings 654patients admitted with NTS gastroenteritis were identified including 299 (46%) with serovar Enteritidis and 186 (28%) serovar Typhimurium. There was an average of 40 cases/year in 1982-1986, falling to 7/year in 2001-2006. None were known to be HIV positive. Secondary bacteraemia was detected in 60/372 (16.1%) of those that had blood cultures taken (9.2% of all patients). The frequency of bacteraemia was 30/186 (16.1%) for serovar Enteritidis, 8/99 (8.1%) for Typhimurium and 6/22 (27.2%) for Virchow Among patients who had a blood culture taken, bacteraemia was more common in those aged > 65 years [27/81 (33%) vs 33/291 (11%), p<0.001].
Discussion 107patients had a poor outcome including death [14 (2.1%)] or admission >2 weeks [93 (14%)] and this was more common in patients >65 years old [70/161 (43%) vs 37/493 (8%), p<0.001], suggesting that elderly patients have a poorer prognosis. 24/60 (40%) of patients with bacteraemia had a poor outcome compared with 29/312 (9%) without bacteraemia p<0.001). A urinary culture positive for NTS with elevated white cells ( 50/mm3) was found in 16/480 (3.3%) patients and was associated with a positive blood culture [5/ 51 (9.8%) vs 7/259 (2.7%), p¼0.03], and the rates of secondary bacteraemia were higher than previously reported.
Abstracts
e115
Conclusions The rate of secondary bacteraemia was higher than previously reported in adult patients. Elderly patients had a poorer prognosis regardless of whether they developed bacteraemia.
ANTIMICROBIAL WARD ROUNDS DO NOT RESULT IN CONTINUED IMPROVEMENT IN ANTIMICROBIAL PRESCRIBINGCATEGORY: SCIENTIFIC FREE PAPER Richard Brindle 1 2
1,2
, Adel Sheikh 1
Portsmouth Hospitals, Portsmouth, United Kingdom University Hospitals Bristol, Bristol, United Kingdom
Introduction Antimicrobial multidisciplinary teams (AMDT) are increasingly being used to improve the appropriateness of antimicrobial use. In Portsmouth Hospitals, medical wards were receiving two AMDT rounds each week. In order to clarify the benefits, both in terms of changes made to prescriptions and improvements associated with the educational input, we undertook a service evaluation. This was an eight-month ward cross-over study, from August 2008, in which groups of wards for alternate months, had twice-weekly antimicrobial rounds (active wards) or patient consultations on demand (passive wards). Wards were assessed on the appropriateness of their antimicrobial prescribing at the end of each month. Ward antimicrobial costs were used to provide supporting evidence of changes in therapy.
Scientific findings There were 1642 patient reviews (1207 patients: mean age of 69.1 years), with 2,225 prescriptions being reviewed and each ward received 28 routine (twice weekly) rounds, and 9 audit (end of each month) rounds. 61% of the prescribing was appropriate on the active wards compared to 51% on the passive wards (P ¼ 0.04). The removal of patients, whose therapy had been reviewed by the team previously, reduced the number of appropriate prescriptions on the active wards to 57% (P ¼ 0.25). The cost of antimicrobials for the active wards was £49,354 compared to £87,069 for the passive wards.
Discussion The study showed that at the end of a month of rounds those wards receiving the rounds had a higher proportion of patient with appropriate prescriptions. However approximately forty percent of this improvement was because of changes recommended on the rounds. Despite regular exposure of the ward doctors to routine rounds, there was no detectable improvement in prescribing over the
study period. This is demonstrated by the absence of any improvement between the baseline and final audits, as well as the lack of upward trend in either the routine round scores or the end of month audit scores.
Conclusions This service evaluation has shown the AMDT rounds are beneficial and cost-effective but do not result in month on month improvement in the appropriateness of antimicrobial prescribing. It is suggested that monitoring, modifying and educating the prescribingof senior speciality trainees and consultants would be needed to gain furtherimprovement in prescribing.
NON-TRANSFUSION RELATED YERSINIA ENTEROCOLITICA BACTERAEMIASCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Karthiga Sithamparanathan, Martin Williams, Richard Brindle HPA Microbiology, Bristol Royal Infirmary, Bristol, United Kingdom
Introduction Yersinia enterocolitica is a psychrotropic, pleomorphic, Gram-negative bacillus within the family Enterobacteriaceae. Septicaemia due to Y.enterocolitica is uncommon, but can be severe and even fatal. Bacteraemia with Y.enterocolitica have been associated with blood transfusions, but non-transfusion-related cases have been reported in patients who are immunocompromised, elderly and those with iron overload states.
Scientific findings We present two cases of Y.enterocolitica bacteraemia. The first patient presented with small bowel ischaemic necrosis that required a laparatomy with resection of small bowel. Following isolation of Y.enterocolitica in blood cultures the patient received a ten day course of meropenem and ciprofloxacin and made a full recovery. The reference laboratory confirmed the identification of the isolate as Y.enterocolitica serotype 3, biotype 3. The second patient presented with acute cholangitis. The patient received gentamicin followed by co-amoxiclav and made a full recovery. Typing from the reference laboratory confirmed Y.enterocolitica biotype 1A but the serotype could not be identified.
Discussion We present a review of the literature on non-transfusion associated Y.enterocolitica bacteraemia
Introduction Streptococcus Pneumoniae is a common commensal bacterium found in the human nasopharynx. It is also a major cause of pneumonia and meningitis in the world. Pneumococcal infections are treated with antibiotics and can be prevented by using multivalent vaccines. However, both of this management are not ideal due to restricted specificity of the available vaccines and the development of antibiotic resistance. Previous studies have identified the genetic variation of different S. Pneumoniae. However, the different cellular proteins produced by the bacteriums have not been identified. The objective of this research programme is to identify the differentially synthesised bacterial proteins between resistant and sensitive S. Pneumoniae isolates. In addition, proteins that define bacterial pathogenesis, particularly bacterial invasiveness, will also be located using proteomic and mass spectrometry technology to establish correlations between bacterial invasiveness, antibiotic resistance and the differential protein expression. The data obtained from the study can be used as a valid approach for the potential development of new therapeutic and diagnostic solutions.
Scientific findings The cellular proteins of 13 S. Pneumoniae isolates were analysed by 2D gell electrophoresis. Although a common protein profile was identified for all of the bacterial isolates, there was some protein variation observed between the isolates. Selected proteins have been selected for identification by mass spectrometry.
Discussion Despite the identification of different spot differences and similarities, more isolates will be needed to investigate the protein expressed by the different isolates. Additional sets of 2D gel electrophoresis from the same isolates are needed to confirm the consistency of spots produced and to investigate the presence of mutation hence spot differences by the same bacteria isolates. Current bacteria samples are grown in bovine cultures and future studies will be needed to look into growing the bacterium in different culture medium to optimise protein extractions and to compare different proteins expressed by the bacterium when grown in different mediums.
Conclusions Both spot differences and similarities were identified between the bacterial isolates. Pilot studies have been carried out for protein identification. Additional isolates are needed for comparative analysis to generate data that can allow more definite conclusion into the different protein expressions by the isolates.
Abstracts
A TWENTY FIVE YEAR REVIEW OF ADULTS ADMITTED TO A BRITISH HOSPITAL WITH NONTYPHOIDAL SALMONELLA GASTROENTERITISCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Sherine Thomas 1, Esther Aspinall 2, Chris Parry 2, Richard Cook 3, Nick Beeching 1 1
Tropical and Infectious diseases unit, Royal Liverpool University Hospital, Liverpool, United Kingdom 2 School of Infection and Host Defence, University of Liverpool, Liverpool, United Kingdom 3 Department of Medical Microbiology, University Hospital Aintree, Liverpool, United Kingdom
Introduction Non-typhoidal Salmonella (NTS) infections are a common cause of bacterial food poisoning, typically causing gastroenteritis but occasionally secondary bacteraemia. The frequency and importance of bacteraemia is debated. A retrospective cross-sectional survey included all patients admitted to a large general hospital in Liverpool, UK, with faecal culture confirmed NTS gastroenteritis, from 1982 through to 2006. Patients were identified from hospital discharge data and laboratory records. Clinical and laboratory data were extracted from patient records onto a standardised proforma.
Scientific findings 654patients admitted with NTS gastroenteritis were identified including 299 (46%) with serovar Enteritidis and 186 (28%) serovar Typhimurium. There was an average of 40 cases/year in 1982-1986, falling to 7/year in 2001-2006. None were known to be HIV positive. Secondary bacteraemia was detected in 60/372 (16.1%) of those that had blood cultures taken (9.2% of all patients). The frequency of bacteraemia was 30/186 (16.1%) for serovar Enteritidis, 8/99 (8.1%) for Typhimurium and 6/22 (27.2%) for Virchow Among patients who had a blood culture taken, bacteraemia was more common in those aged > 65 years [27/81 (33%) vs 33/291 (11%), p<0.001].
Discussion 107patients had a poor outcome including death [14 (2.1%)] or admission >2 weeks [93 (14%)] and this was more common in patients >65 years old [70/161 (43%) vs 37/493 (8%), p<0.001], suggesting that elderly patients have a poorer prognosis. 24/60 (40%) of patients with bacteraemia had a poor outcome compared with 29/312 (9%) without bacteraemia p<0.001). A urinary culture positive for NTS with elevated white cells ( 50/mm3) was found in 16/480 (3.3%) patients and was associated with a positive blood culture [5/ 51 (9.8%) vs 7/259 (2.7%), p¼0.03], and the rates of secondary bacteraemia were higher than previously reported.
Abstracts
e115
Conclusions The rate of secondary bacteraemia was higher than previously reported in adult patients. Elderly patients had a poorer prognosis regardless of whether they developed bacteraemia.
ANTIMICROBIAL WARD ROUNDS DO NOT RESULT IN CONTINUED IMPROVEMENT IN ANTIMICROBIAL PRESCRIBINGCATEGORY: SCIENTIFIC FREE PAPER Richard Brindle 1 2
1,2
, Adel Sheikh 1
Portsmouth Hospitals, Portsmouth, United Kingdom University Hospitals Bristol, Bristol, United Kingdom
Introduction Antimicrobial multidisciplinary teams (AMDT) are increasingly being used to improve the appropriateness of antimicrobial use. In Portsmouth Hospitals, medical wards were receiving two AMDT rounds each week. In order to clarify the benefits, both in terms of changes made to prescriptions and improvements associated with the educational input, we undertook a service evaluation. This was an eight-month ward cross-over study, from August 2008, in which groups of wards for alternate months, had twice-weekly antimicrobial rounds (active wards) or patient consultations on demand (passive wards). Wards were assessed on the appropriateness of their antimicrobial prescribing at the end of each month. Ward antimicrobial costs were used to provide supporting evidence of changes in therapy.
Scientific findings There were 1642 patient reviews (1207 patients: mean age of 69.1 years), with 2,225 prescriptions being reviewed and each ward received 28 routine (twice weekly) rounds, and 9 audit (end of each month) rounds. 61% of the prescribing was appropriate on the active wards compared to 51% on the passive wards (P ¼ 0.04). The removal of patients, whose therapy had been reviewed by the team previously, reduced the number of appropriate prescriptions on the active wards to 57% (P ¼ 0.25). The cost of antimicrobials for the active wards was £49,354 compared to £87,069 for the passive wards.
Discussion The study showed that at the end of a month of rounds those wards receiving the rounds had a higher proportion of patient with appropriate prescriptions. However approximately forty percent of this improvement was because of changes recommended on the rounds. Despite regular exposure of the ward doctors to routine rounds, there was no detectable improvement in prescribing over the
study period. This is demonstrated by the absence of any improvement between the baseline and final audits, as well as the lack of upward trend in either the routine round scores or the end of month audit scores.
Conclusions This service evaluation has shown the AMDT rounds are beneficial and cost-effective but do not result in month on month improvement in the appropriateness of antimicrobial prescribing. It is suggested that monitoring, modifying and educating the prescribingof senior speciality trainees and consultants would be needed to gain furtherimprovement in prescribing.
NON-TRANSFUSION RELATED YERSINIA ENTEROCOLITICA BACTERAEMIASCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Karthiga Sithamparanathan, Martin Williams, Richard Brindle HPA Microbiology, Bristol Royal Infirmary, Bristol, United Kingdom
Introduction Yersinia enterocolitica is a psychrotropic, pleomorphic, Gram-negative bacillus within the family Enterobacteriaceae. Septicaemia due to Y.enterocolitica is uncommon, but can be severe and even fatal. Bacteraemia with Y.enterocolitica have been associated with blood transfusions, but non-transfusion-related cases have been reported in patients who are immunocompromised, elderly and those with iron overload states.
Scientific findings We present two cases of Y.enterocolitica bacteraemia. The first patient presented with small bowel ischaemic necrosis that required a laparatomy with resection of small bowel. Following isolation of Y.enterocolitica in blood cultures the patient received a ten day course of meropenem and ciprofloxacin and made a full recovery. The reference laboratory confirmed the identification of the isolate as Y.enterocolitica serotype 3, biotype 3. The second patient presented with acute cholangitis. The patient received gentamicin followed by co-amoxiclav and made a full recovery. Typing from the reference laboratory confirmed Y.enterocolitica biotype 1A but the serotype could not be identified.
Discussion We present a review of the literature on non-transfusion associated Y.enterocolitica bacteraemia