- Email: [email protected]
Clinical utility of endotracheal tube cultures from neonates in a Neonatal Intensive Care Unit: Completion of an audit cycle
e44 only 2 confirmed cases did not receive this drug. No patients died of H1N1 influenza.
Conclusions This study confirmed a small overall impact of H1N1 influenza on our organisation concurring with hospital trends observed nationally. However it is acknowledged that impact on community services was appreciable. Despite later guidance advocating empirical treatment of the disease without confirmatory testing, we found that patient management and infection prevention and control practices were optimised by continued PCR testing allowing efficient side-room allocation. Cohort isolation of cases was never required. Pandemic preparedness was effective within the Trust and this retrospective review will further inform laboratory, clinical and infection control developments that could be utilised in future pandemic clinical scenarios.
AUDIT OF RATES OF SEPSIS POST TRANS RECTAL ULTRA SOUND BIOPSY OF THE PROSTATE AND ESTABLISHMENT OF ACTIVE SURVEILLANCE FOR SEPSIS IN THE RAPID ACCESS PROSTATE CLINIC IN UNIVERSITY HOSPITAL GALWAYCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Sarah Bergin 1, Farhad Kheradmand 1, Dara Lundon 1, Eamonn Rogers 1, Martin Cormican 2 1 2
University Hospital, Galway, Ireland School of Medicine NUI, Galway, Ireland
Introduction Transrectal ultrasound guided (TRUS) biopsy of the prostate is used routinely in the diagnosis of cancer of the prostate. Although antimicrobial prophylaxis (ciprofloxacin in this institution) is used routinely there is a recognized risk of blood stream infection (BSI) following biopsy. A number of reports have documented antimicrobial resistant bacteria including extended spectrum beta-lactamase (ESBL) producers in this setting. Recently standard practice has changed from performance of 6 biopsies per patient to 12 biopsies although this number of biopsies may not be taken in all cases. Prompted by the presentation of a number of cases of BSI post TRUS biopsy in the first half of 2010 we performed a retrospective review of cases for the first 8 months of 2010 and developed a process for prospective clinical and laboratory surveillance of BSI following TRUS biopsy and a protocol for management of BSI post TRUS.
Abstracts were associated with biopsies in this hospital and 8 with other facilities. Of the E. coli respectively 5, 4 and 2 were resistant to amoxicillin, ciprofloxacin and gentamicin. All were susceptible to piperacillin/tazobactam and to cefotaxime. ESBL producers were not detected. The levels of resistance are comparable to that in other BSI isolates of E. coli . The incidence of BSI post TRUS biopsy for this hospital was 0.5%(2 of 387patients biopsied).
Discussion Although case ascertainment may have been incomplete, the observed rate of infection (0.5%) is within the range reported (0.1%- 3.06%). As the majority of cases related to biopsies performed elsewhere, limited risk factor data was available on these cases. Prospective data collection from all patients at approximately 30 days post biopsy and from all patients admitted with post TRUS sepsis has been instituted. This includes data on use of prophylaxis, estimate of prostate size, number of biopsies performed, occurrence and intensity of haematuria. A protocol for management of investigation and management of cases has been developed.
Conclusions Prostate cancer is the 4th commonest cancer among men. Post TRUS biopsy BSI accounted for approximately 10% of all confirmed E.coli blood stream infection presenting to this hospital. The rate of BSI post TRUS biopsy at this institution (0.5%) is within the reported range. The majority of cases presenting are related to biopsies performed elsewhere. Piperacillin/tazobactam is appropriate for empirical therapy. Structured prospective surveillance has been developed to monitor rates of infection and to attempt to define high risk groups.
CLINICAL UTILITY OF ENDOTRACHEAL TUBE CULTURES FROM NEONATES IN A NEONATAL INTENSIVE CARE UNIT: COMPLETION OF AN AUDIT CYCLECATEGORY: CLINICAL LESSON Peter Yew 2, Patricia O’Hare 1, Gordon Yip 1, Jonathan Boyd 1, Richard Tubman 1, Clifford Mayes 1, Grace Ong 2 1
Regional Neonatal Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom 2 Department of Microbiology, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom
Introduction Scientific findings Ten patients presented with suspected sepsis post TRUS biopsy. BSI was confirmed in eight. E. coli (7)and Bacteroides spp.(1) were identified. Two cases (1 confirmed)
A proportion of neonates in the neonatal intensive care unit (NICU) are intubated for respiratory support. All neonates extubated from mechanical ventilation had the tip of their endotracheal (ET) tube cultured for bacterial organisms at the Royal Victoria Hospital Microbiology Department. We
Abstracts conducted an audit in 2009 (audit 1), looking at whether ET tip cultures influenced the treatment of the neonate and whether culture results led to further investigations of sepsis. We repeated this audit in 2010 (audit 2) following the recommendation from the 2009 audit that ET tips should not be sent routinely unless sepsis or pneumonia was suspected. All neonatal patients who had been intubated in the NICU over an 8 week period were identified in the audit and re audit. At the point of extubation or tube change, a proforma was completed by the medical staff in the NICU. Information regarding details of intubation, period of intubation, and whether the ET tube tip had been sent for culture was collected. The reason for sending the ET tip for culture was noted: a) routine no clinical concern b) septic neonate. Clinical information regarding standard observations and documentation of inflammatory marker status was also included on the proforma.
Scientific findings In the first audit, 21/25 ET tips were sent routinely for culture and 4/25 were sent on suspicion of sepsis. Nine of these were culture positive, of which 7/9 grew Staphylococcus epidermidis and 2/9 grew Klebseilla species. In audit 2, only 1/25 ET tips was sent as part of a septic screen. This ET tip was culture negative but treatment of the neonate was influenced by secretions which grew Escherichia coli, sent around the time of ET removal. The mean duration of intubation was 4 days in both audits.
Discussion All ET tips have routinely been sent for culture on extubation of the neonate regardless of clinical status. Bacterial colonisation of ET tubes increases with duration of intubation, with significant numbers grown if intubated > 4 days, potentially contributing to respiratory tract infection (Friendland D, 2001). However none of the positive ET tip cultures influenced the management of our patients. Audit 2 illustrates that secretions would be a more useful way of diagnosing pneumonia. This would be in keeping with studies that show endotracheal aspirates to be a sensitive test in diagnosis of ventilated associated pneumonia (Cook D, 2000).
e45
AN AUDIT OF TREATMENT AND FOLLOW-UP OF PATIENTS DIAGNOSED WITH GENITAL GONORRHOEA IN SOUTH WARWICKSHIRE GUM DEPARTMENTCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Gemma Winzor, Amgad Habib South Warwickshire GUM department, Warwick, United Kingdom
Introduction N.Gonorrhoeae is a gram negative intracellular diplococcus. In the GUM department it is detected by microscopy and/or culture after a sexual history and examination with relevant swab taking. Local1 and national2 guidelines differ on how to follow-up these cases after treatment. The guidelines suggest different roles for the "test of cure" following treatment of these patients. Local guidelines1 suggest that all patients diagnosed with Gonorrhoea should have "at least one test of cure 7-10 days after treatment". However BASHH2 suggest "A microbiological test of cure is not routinely necessary" and go on to outline specific indications for a test of cure. These include having initially isolated a resistant strain of organism or persistent symptoms. The aim of the audit was to determine the compliance with treatment and follow up of patients diagnosed with genital and/or rectal Gonorrhoea with local1 and national2 guidelines. The audit objectives included:
Determining the percentage of positive cases that returned for a "test of cure". Determining the percentage of cases treated (and cured) with first line therapy. Determining the percentage of cases that were re-treated. Determining the percentage of cases that were screened and / or presumptively treated for Chlamydia infection.
Scientific findings Conclusions There has been a significant decrease (96%) in the numbers of ET tips sent to the laboratory for culture in the second audit. A decrease in antibiotic usage during the re-audit was also anecdotally noted. There was no detrimental effect on the clinical management of neonates in the second audit that did not have ET tip cultures sent. We recommend that routine ET tip cultures in well infants should not be performed. We also suggest that tracheal secretions would be a more reliable diagnostic tool for the investigation of pneumonia; however this requires further research in this patient group.
144 cases were retrospectively audited, that had been diagnosed between 01/01/04 and 30/04/09 within South Warwickshire GUM department. 85% of cases diagnosed with Gonorrhoea returned for a "test of cure". 57% of patients were treated with Ceftriaxone & 35% with Ciprofloxacin as first line agent. Following initial treatment 3 returning patients had a positive test of cure (2 had positive culture and 1 had likely positive microscopy only). 7 patients were re-treated following an initial treatment course. Other reasons cited for re-treatment included none-compliance with first line therapy or repeat sexual intercourse during treatment. 100% of cases were also screened for Chlamydia.
Conclusions This study confirmed a small overall impact of H1N1 influenza on our organisation concurring with hospital trends observed nationally. However it is acknowledged that impact on community services was appreciable. Despite later guidance advocating empirical treatment of the disease without confirmatory testing, we found that patient management and infection prevention and control practices were optimised by continued PCR testing allowing efficient side-room allocation. Cohort isolation of cases was never required. Pandemic preparedness was effective within the Trust and this retrospective review will further inform laboratory, clinical and infection control developments that could be utilised in future pandemic clinical scenarios.
AUDIT OF RATES OF SEPSIS POST TRANS RECTAL ULTRA SOUND BIOPSY OF THE PROSTATE AND ESTABLISHMENT OF ACTIVE SURVEILLANCE FOR SEPSIS IN THE RAPID ACCESS PROSTATE CLINIC IN UNIVERSITY HOSPITAL GALWAYCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Sarah Bergin 1, Farhad Kheradmand 1, Dara Lundon 1, Eamonn Rogers 1, Martin Cormican 2 1 2
University Hospital, Galway, Ireland School of Medicine NUI, Galway, Ireland
Introduction Transrectal ultrasound guided (TRUS) biopsy of the prostate is used routinely in the diagnosis of cancer of the prostate. Although antimicrobial prophylaxis (ciprofloxacin in this institution) is used routinely there is a recognized risk of blood stream infection (BSI) following biopsy. A number of reports have documented antimicrobial resistant bacteria including extended spectrum beta-lactamase (ESBL) producers in this setting. Recently standard practice has changed from performance of 6 biopsies per patient to 12 biopsies although this number of biopsies may not be taken in all cases. Prompted by the presentation of a number of cases of BSI post TRUS biopsy in the first half of 2010 we performed a retrospective review of cases for the first 8 months of 2010 and developed a process for prospective clinical and laboratory surveillance of BSI following TRUS biopsy and a protocol for management of BSI post TRUS.
Abstracts were associated with biopsies in this hospital and 8 with other facilities. Of the E. coli respectively 5, 4 and 2 were resistant to amoxicillin, ciprofloxacin and gentamicin. All were susceptible to piperacillin/tazobactam and to cefotaxime. ESBL producers were not detected. The levels of resistance are comparable to that in other BSI isolates of E. coli . The incidence of BSI post TRUS biopsy for this hospital was 0.5%(2 of 387patients biopsied).
Discussion Although case ascertainment may have been incomplete, the observed rate of infection (0.5%) is within the range reported (0.1%- 3.06%). As the majority of cases related to biopsies performed elsewhere, limited risk factor data was available on these cases. Prospective data collection from all patients at approximately 30 days post biopsy and from all patients admitted with post TRUS sepsis has been instituted. This includes data on use of prophylaxis, estimate of prostate size, number of biopsies performed, occurrence and intensity of haematuria. A protocol for management of investigation and management of cases has been developed.
Conclusions Prostate cancer is the 4th commonest cancer among men. Post TRUS biopsy BSI accounted for approximately 10% of all confirmed E.coli blood stream infection presenting to this hospital. The rate of BSI post TRUS biopsy at this institution (0.5%) is within the reported range. The majority of cases presenting are related to biopsies performed elsewhere. Piperacillin/tazobactam is appropriate for empirical therapy. Structured prospective surveillance has been developed to monitor rates of infection and to attempt to define high risk groups.
CLINICAL UTILITY OF ENDOTRACHEAL TUBE CULTURES FROM NEONATES IN A NEONATAL INTENSIVE CARE UNIT: COMPLETION OF AN AUDIT CYCLECATEGORY: CLINICAL LESSON Peter Yew 2, Patricia O’Hare 1, Gordon Yip 1, Jonathan Boyd 1, Richard Tubman 1, Clifford Mayes 1, Grace Ong 2 1
Regional Neonatal Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom 2 Department of Microbiology, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom
Introduction Scientific findings Ten patients presented with suspected sepsis post TRUS biopsy. BSI was confirmed in eight. E. coli (7)and Bacteroides spp.(1) were identified. Two cases (1 confirmed)
A proportion of neonates in the neonatal intensive care unit (NICU) are intubated for respiratory support. All neonates extubated from mechanical ventilation had the tip of their endotracheal (ET) tube cultured for bacterial organisms at the Royal Victoria Hospital Microbiology Department. We
Abstracts conducted an audit in 2009 (audit 1), looking at whether ET tip cultures influenced the treatment of the neonate and whether culture results led to further investigations of sepsis. We repeated this audit in 2010 (audit 2) following the recommendation from the 2009 audit that ET tips should not be sent routinely unless sepsis or pneumonia was suspected. All neonatal patients who had been intubated in the NICU over an 8 week period were identified in the audit and re audit. At the point of extubation or tube change, a proforma was completed by the medical staff in the NICU. Information regarding details of intubation, period of intubation, and whether the ET tube tip had been sent for culture was collected. The reason for sending the ET tip for culture was noted: a) routine no clinical concern b) septic neonate. Clinical information regarding standard observations and documentation of inflammatory marker status was also included on the proforma.
Scientific findings In the first audit, 21/25 ET tips were sent routinely for culture and 4/25 were sent on suspicion of sepsis. Nine of these were culture positive, of which 7/9 grew Staphylococcus epidermidis and 2/9 grew Klebseilla species. In audit 2, only 1/25 ET tips was sent as part of a septic screen. This ET tip was culture negative but treatment of the neonate was influenced by secretions which grew Escherichia coli, sent around the time of ET removal. The mean duration of intubation was 4 days in both audits.
Discussion All ET tips have routinely been sent for culture on extubation of the neonate regardless of clinical status. Bacterial colonisation of ET tubes increases with duration of intubation, with significant numbers grown if intubated > 4 days, potentially contributing to respiratory tract infection (Friendland D, 2001). However none of the positive ET tip cultures influenced the management of our patients. Audit 2 illustrates that secretions would be a more useful way of diagnosing pneumonia. This would be in keeping with studies that show endotracheal aspirates to be a sensitive test in diagnosis of ventilated associated pneumonia (Cook D, 2000).
e45
AN AUDIT OF TREATMENT AND FOLLOW-UP OF PATIENTS DIAGNOSED WITH GENITAL GONORRHOEA IN SOUTH WARWICKSHIRE GUM DEPARTMENTCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Gemma Winzor, Amgad Habib South Warwickshire GUM department, Warwick, United Kingdom
Introduction N.Gonorrhoeae is a gram negative intracellular diplococcus. In the GUM department it is detected by microscopy and/or culture after a sexual history and examination with relevant swab taking. Local1 and national2 guidelines differ on how to follow-up these cases after treatment. The guidelines suggest different roles for the "test of cure" following treatment of these patients. Local guidelines1 suggest that all patients diagnosed with Gonorrhoea should have "at least one test of cure 7-10 days after treatment". However BASHH2 suggest "A microbiological test of cure is not routinely necessary" and go on to outline specific indications for a test of cure. These include having initially isolated a resistant strain of organism or persistent symptoms. The aim of the audit was to determine the compliance with treatment and follow up of patients diagnosed with genital and/or rectal Gonorrhoea with local1 and national2 guidelines. The audit objectives included:
Determining the percentage of positive cases that returned for a "test of cure". Determining the percentage of cases treated (and cured) with first line therapy. Determining the percentage of cases that were re-treated. Determining the percentage of cases that were screened and / or presumptively treated for Chlamydia infection.
Scientific findings Conclusions There has been a significant decrease (96%) in the numbers of ET tips sent to the laboratory for culture in the second audit. A decrease in antibiotic usage during the re-audit was also anecdotally noted. There was no detrimental effect on the clinical management of neonates in the second audit that did not have ET tip cultures sent. We recommend that routine ET tip cultures in well infants should not be performed. We also suggest that tracheal secretions would be a more reliable diagnostic tool for the investigation of pneumonia; however this requires further research in this patient group.
144 cases were retrospectively audited, that had been diagnosed between 01/01/04 and 30/04/09 within South Warwickshire GUM department. 85% of cases diagnosed with Gonorrhoea returned for a "test of cure". 57% of patients were treated with Ceftriaxone & 35% with Ciprofloxacin as first line agent. Following initial treatment 3 returning patients had a positive test of cure (2 had positive culture and 1 had likely positive microscopy only). 7 patients were re-treated following an initial treatment course. Other reasons cited for re-treatment included none-compliance with first line therapy or repeat sexual intercourse during treatment. 100% of cases were also screened for Chlamydia.