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Mycobacterium tuberculosis turnaround times - An audit in a large diagnostic laboratory
e24
Scientific findings 778 patients were studied. The overall rate of respiratory viral infection was 44%. The commonest virus detected in all groups was rhinovirus (50% of all viruses) followed by influenza A and B (24%). The rate of viral infection was especially high amongst patients with exacerbation of asthma (58%), patients with acute bronchitis (69%) and those with URTI (67%). Rates of viral infection were moderately high in subjects with AECOPD (38%), CAP (34%) and Acute decompensated heart failure(36%).
Abstracts Five hospital Trusts have contributed to this project to date. The evaluation tool was used to assess all patients on antibiotic treatment on acute wards on a given day. Data relating to presenting diagnosis, social situation, current antibiotic prescribing (drug, start date, route IV +/- oral, whether indication for antibiotic and focus of infection recorded in medical notes,, planned stop date recorded) and microbiology, if available, were collected. A physician recorded interpretive data: whether antibiotic therapy was still required, continuing requirement for IV administration, possibility for IV/oral switch, suitability for discharge and requirement for community support.
Discussion
Scientific findings
The burden of respiratory viral infection amongst patients hospitalised with acute respiratory illness is large across all clinical groups. Rhinoviruses (HRV) are the most commonly identified virus and have been under appreciated as a cause of severe respiratory illness. Rapid and reliable identification of respiratory viruses using multiplex PCR technology has several potential implications for clinical practise including; rationalisation of antibiotics, appropriate use of infcetion control measures and in some instances specific antiviral therapy.
Across the Trusts 285 acute medical and 95 surgical patients (n¼380) were receiving antibiotics. 234 of 380 (62%) were on oral antibiotics; 146 (38%) were on IV antibiotics. Of these 380 patients, it was possible to stop antibiotics immediately in 90 patients (28% of those on an IV), switch to an appropriate oral agent in 41 patients (11%) on an IV, with the remaining 80 patients (21%) still requiring IV. 95 (25%) of the 380 on antibiotics were judged to be suitable to be managed outside the hospital setting, with 20 (21% of those suitable for discharge) requiring community support.
Conclusions Future research efforts in this field should focus on the development of HRV vaccine and specific antiviral therapy.
ANTIBIOTIC MANAGEMENT AND EARLY DISCHARGE FROM HOSPITALCATEGORY: CLINICAL LESSON Matthew Dryden 1, Kordo Saeed 1, Robert Townsend 2, Chris Winnard 2, Sarah Bourne 1, Natalie Parker 1, John Coia 3, Brian Jones 3, Kathleen Bamford 4, Wendy Lawson 4, Paul Wade 5, Samantha Marshall 6, Marian Keetley 6
Discussion Data were subsequently collected on actual date of discharge in 282 patients in order to assess potential bed day savings. Of these, 45 could have left hospital earlier equating to a cost saving of £42,500 and to a potential total bed day saving of 170 days. Close antibiotic management and stewardship on acute wards by an infection team can result in improvement in the use of antibiotics, a reduction in the use of IV antibiotics, reduction in the cost of antibiotics, potential reduction in bed days, with probable reduction in the risk of health careassociated complications and infections.
Conclusions
1
Royal Hampshire County Hospital, Winchester, United Kingdom 2 Northern General Hospital, Sheffield, United Kingdom 3 NHS Greater Glasgow and Clyde, Glasgow, United Kingdom 4 Imperial College Healthcare NHS Trust, London, United Kingdom 5 Guys & St Thomas’s Healthcare NHS Foundation Trust, London, United Kingdom 6 pH Associates, Marlow, United Kingdom
Introduction An evaluation tool has been developed to allow bedside review of antibiotic use and infection management in acute medical and surgical patients, to assess whether patients with infections can be safely managed out of hospital with delivery of antibiotics (intravenous (IV) or oral) in the community. The tool also allows the potential bed day savings to be assessed from early discharge of antibiotic treated patients.
This study has looked at the potential advantages of early discharge in infection. The next step is to put this into practice. Many patients on antibiotics in hospital could be managed at home on IV or oral antibiotics. This has numerous potential advantages in particular a reduction in bed days, hospital costs and health care associated complications. Improved resourcing of infection teams to deliver antibiotic management and early discharge is likely to be cost effective.
MYCOBACTERIUM TUBERCULOSIS TURNAROUND TIMES - AN AUDIT IN A LARGE DIAGNOSTIC LABORATORYCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Fiona McGill, Grant Robinson, Tracey Parnell, Timothy Collyns Leed Teaching Hospitals Trust, Leeds, United Kingdom
Abstracts
Introduction Using the standards set in the Department of Health’s toolkit for Tuberculosis prevention and treatment (2007), we audited whether our current, 5 day a week, service was achieving these standards. The laboratory processes z 7500 samples per year, with "all" receiving continuously monitored liquid culture (Bactec MGIT 960 Ò, BD Diagnostic Systems, Sparks, MD). Positive cultures for acid-fast bacilli are sent to the regional mycobacteriology reference laboratory for further identification & sensitivity testing. Standards
Microscopy performed and result issued within one working day of receipt of sample (microscopy to be done 6 days a week) Culture, Isolation and identification should be completed for 90% of isolates within 21 days of receipt in the laboratory Positive cultures should go to reference laboratory within 1 working day of culture becoming positive Results of susceptibility testing to primary agents required within 30 days of receipt of specimen in source lab for 95% of samples Source laboratory needs to inform clinical team within one working day of sensitivities
e25 however to aim for the overall incidence of TB in England to fall as it has in United States, it is imperative that Microbiology laboratories review their practice in line with these standards, in order to improve diagnostics and reduce M tuberculosis transmission.
Conclusions These targets can’t be met within a 5 day a week service and there needs to be changes to service methods & delivery both locally and from the reference laboratory in order to meet the standards.
OUTBREAK OF PNEUMOCYSTIS JIROVECII PNEUMONIA IN A BRITISH RENAL TRANSPLANT CENTRE: EVIDENCE FOR HUMAN TO HUMAN TRANSMISSION, OR AN ENVIRONMENTAL SOURCE OF INFECTIONCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Sherine Thomas 1, Lance Turtle 1, Muhammad Imran 2, Matthew Howse 2, Ali Bakran 3, Caroline Corless 4, Roberto Vivancos 5, Mike Beadsworth 1, Nick Beeching 1 1
Methods: We derived a list of all positive cultures for Mycobacterium tuberculosis over a one year period from Sept 2007 ‘til August 2008, from the laboratory information system (LIS) (415 specimens, 248 patients). From the LIS, we then identified the dates of smear & culture positivity (and the dates of reporting to clinicians), and also the reporting dates of further identification and sensitivities.
Scientific findings Results
96.6% had a smear within one working day. 80% cultured positive within 21 days. 31% cultured positive and identified within 21 days. Average length of time to sending samples off to reference lab was 4 days. Average length of time for the initial identification result to be reported from the reference laboratory was 10 days. 13.7% identified with susceptibility results within 30 days. Median time to reporting sensitivities when received locally was 0 days (average of 0.56 days).
Discussion Our laboratory’s performance fell short of all the targets set in the TB toolkit. To our knowledge there are no other reports of a similar analysis, on this scale, in the UK literature. The standards are undoubtedly challenging;
Tropical and Infectious diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom 2 Department of Nephrology, Royal Liverpool University hospital, Liverpool, United Kingdom 3 Department of Transplant surgery, Royal Liverpool UNiversity hospital, Liverpool, United Kingdom 4 Department of Microbiology, Royal Liverpool University hospital, Liverpool, United Kingdom 5 Cheshire & Merseyside Health Protection Unit, Health Protection Agency, Liverpool, United Kingdom
Introduction Apart from sporadic cases, a few outbreaks of Pneumocystis jirovecii pneumonia (PCP) have been reported in renal transplant patients (RTP). The mechanisms and modes of transmission in the outbreak setting are not yet established. The Royal Liverpool University Hospital (RLUH) provides ‘hub and spoke’ follow-up of over 900 RTP. In the ten years, 1999-2008 only one case of PCP had been reported. We describe epidemiology, risk factors, genotyping and environmental sampling during one of the largest out-breaks in Europe amongst RTP. Diagnosis was based on a combination of clinical assessment consistent with PCP, radiological changes and/or positive molecular diagnostics using RT-PCR of induced sputum or bronchoalveolar lavage fluid with the ß-tubulin gene as the target. We undertook a case-control study with cases and controls from the RTP register. Demographic data and risk factors were compared. They included time from transplant, type of, use of and changes in immunosuppressive agents. Genotypic sequencing of RT-PCR positive samples and environmental sampling were undertaken to assess for a common infection source.
Scientific findings 778 patients were studied. The overall rate of respiratory viral infection was 44%. The commonest virus detected in all groups was rhinovirus (50% of all viruses) followed by influenza A and B (24%). The rate of viral infection was especially high amongst patients with exacerbation of asthma (58%), patients with acute bronchitis (69%) and those with URTI (67%). Rates of viral infection were moderately high in subjects with AECOPD (38%), CAP (34%) and Acute decompensated heart failure(36%).
Abstracts Five hospital Trusts have contributed to this project to date. The evaluation tool was used to assess all patients on antibiotic treatment on acute wards on a given day. Data relating to presenting diagnosis, social situation, current antibiotic prescribing (drug, start date, route IV +/- oral, whether indication for antibiotic and focus of infection recorded in medical notes,, planned stop date recorded) and microbiology, if available, were collected. A physician recorded interpretive data: whether antibiotic therapy was still required, continuing requirement for IV administration, possibility for IV/oral switch, suitability for discharge and requirement for community support.
Discussion
Scientific findings
The burden of respiratory viral infection amongst patients hospitalised with acute respiratory illness is large across all clinical groups. Rhinoviruses (HRV) are the most commonly identified virus and have been under appreciated as a cause of severe respiratory illness. Rapid and reliable identification of respiratory viruses using multiplex PCR technology has several potential implications for clinical practise including; rationalisation of antibiotics, appropriate use of infcetion control measures and in some instances specific antiviral therapy.
Across the Trusts 285 acute medical and 95 surgical patients (n¼380) were receiving antibiotics. 234 of 380 (62%) were on oral antibiotics; 146 (38%) were on IV antibiotics. Of these 380 patients, it was possible to stop antibiotics immediately in 90 patients (28% of those on an IV), switch to an appropriate oral agent in 41 patients (11%) on an IV, with the remaining 80 patients (21%) still requiring IV. 95 (25%) of the 380 on antibiotics were judged to be suitable to be managed outside the hospital setting, with 20 (21% of those suitable for discharge) requiring community support.
Conclusions Future research efforts in this field should focus on the development of HRV vaccine and specific antiviral therapy.
ANTIBIOTIC MANAGEMENT AND EARLY DISCHARGE FROM HOSPITALCATEGORY: CLINICAL LESSON Matthew Dryden 1, Kordo Saeed 1, Robert Townsend 2, Chris Winnard 2, Sarah Bourne 1, Natalie Parker 1, John Coia 3, Brian Jones 3, Kathleen Bamford 4, Wendy Lawson 4, Paul Wade 5, Samantha Marshall 6, Marian Keetley 6
Discussion Data were subsequently collected on actual date of discharge in 282 patients in order to assess potential bed day savings. Of these, 45 could have left hospital earlier equating to a cost saving of £42,500 and to a potential total bed day saving of 170 days. Close antibiotic management and stewardship on acute wards by an infection team can result in improvement in the use of antibiotics, a reduction in the use of IV antibiotics, reduction in the cost of antibiotics, potential reduction in bed days, with probable reduction in the risk of health careassociated complications and infections.
Conclusions
1
Royal Hampshire County Hospital, Winchester, United Kingdom 2 Northern General Hospital, Sheffield, United Kingdom 3 NHS Greater Glasgow and Clyde, Glasgow, United Kingdom 4 Imperial College Healthcare NHS Trust, London, United Kingdom 5 Guys & St Thomas’s Healthcare NHS Foundation Trust, London, United Kingdom 6 pH Associates, Marlow, United Kingdom
Introduction An evaluation tool has been developed to allow bedside review of antibiotic use and infection management in acute medical and surgical patients, to assess whether patients with infections can be safely managed out of hospital with delivery of antibiotics (intravenous (IV) or oral) in the community. The tool also allows the potential bed day savings to be assessed from early discharge of antibiotic treated patients.
This study has looked at the potential advantages of early discharge in infection. The next step is to put this into practice. Many patients on antibiotics in hospital could be managed at home on IV or oral antibiotics. This has numerous potential advantages in particular a reduction in bed days, hospital costs and health care associated complications. Improved resourcing of infection teams to deliver antibiotic management and early discharge is likely to be cost effective.
MYCOBACTERIUM TUBERCULOSIS TURNAROUND TIMES - AN AUDIT IN A LARGE DIAGNOSTIC LABORATORYCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Fiona McGill, Grant Robinson, Tracey Parnell, Timothy Collyns Leed Teaching Hospitals Trust, Leeds, United Kingdom
Abstracts
Introduction Using the standards set in the Department of Health’s toolkit for Tuberculosis prevention and treatment (2007), we audited whether our current, 5 day a week, service was achieving these standards. The laboratory processes z 7500 samples per year, with "all" receiving continuously monitored liquid culture (Bactec MGIT 960 Ò, BD Diagnostic Systems, Sparks, MD). Positive cultures for acid-fast bacilli are sent to the regional mycobacteriology reference laboratory for further identification & sensitivity testing. Standards
Microscopy performed and result issued within one working day of receipt of sample (microscopy to be done 6 days a week) Culture, Isolation and identification should be completed for 90% of isolates within 21 days of receipt in the laboratory Positive cultures should go to reference laboratory within 1 working day of culture becoming positive Results of susceptibility testing to primary agents required within 30 days of receipt of specimen in source lab for 95% of samples Source laboratory needs to inform clinical team within one working day of sensitivities
e25 however to aim for the overall incidence of TB in England to fall as it has in United States, it is imperative that Microbiology laboratories review their practice in line with these standards, in order to improve diagnostics and reduce M tuberculosis transmission.
Conclusions These targets can’t be met within a 5 day a week service and there needs to be changes to service methods & delivery both locally and from the reference laboratory in order to meet the standards.
OUTBREAK OF PNEUMOCYSTIS JIROVECII PNEUMONIA IN A BRITISH RENAL TRANSPLANT CENTRE: EVIDENCE FOR HUMAN TO HUMAN TRANSMISSION, OR AN ENVIRONMENTAL SOURCE OF INFECTIONCATEGORY: LESSON IN MICROBIOLOGY & INFECTION CONTROL Sherine Thomas 1, Lance Turtle 1, Muhammad Imran 2, Matthew Howse 2, Ali Bakran 3, Caroline Corless 4, Roberto Vivancos 5, Mike Beadsworth 1, Nick Beeching 1 1
Methods: We derived a list of all positive cultures for Mycobacterium tuberculosis over a one year period from Sept 2007 ‘til August 2008, from the laboratory information system (LIS) (415 specimens, 248 patients). From the LIS, we then identified the dates of smear & culture positivity (and the dates of reporting to clinicians), and also the reporting dates of further identification and sensitivities.
Scientific findings Results
96.6% had a smear within one working day. 80% cultured positive within 21 days. 31% cultured positive and identified within 21 days. Average length of time to sending samples off to reference lab was 4 days. Average length of time for the initial identification result to be reported from the reference laboratory was 10 days. 13.7% identified with susceptibility results within 30 days. Median time to reporting sensitivities when received locally was 0 days (average of 0.56 days).
Discussion Our laboratory’s performance fell short of all the targets set in the TB toolkit. To our knowledge there are no other reports of a similar analysis, on this scale, in the UK literature. The standards are undoubtedly challenging;
Tropical and Infectious diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom 2 Department of Nephrology, Royal Liverpool University hospital, Liverpool, United Kingdom 3 Department of Transplant surgery, Royal Liverpool UNiversity hospital, Liverpool, United Kingdom 4 Department of Microbiology, Royal Liverpool University hospital, Liverpool, United Kingdom 5 Cheshire & Merseyside Health Protection Unit, Health Protection Agency, Liverpool, United Kingdom
Introduction Apart from sporadic cases, a few outbreaks of Pneumocystis jirovecii pneumonia (PCP) have been reported in renal transplant patients (RTP). The mechanisms and modes of transmission in the outbreak setting are not yet established. The Royal Liverpool University Hospital (RLUH) provides ‘hub and spoke’ follow-up of over 900 RTP. In the ten years, 1999-2008 only one case of PCP had been reported. We describe epidemiology, risk factors, genotyping and environmental sampling during one of the largest out-breaks in Europe amongst RTP. Diagnosis was based on a combination of clinical assessment consistent with PCP, radiological changes and/or positive molecular diagnostics using RT-PCR of induced sputum or bronchoalveolar lavage fluid with the ß-tubulin gene as the target. We undertook a case-control study with cases and controls from the RTP register. Demographic data and risk factors were compared. They included time from transplant, type of, use of and changes in immunosuppressive agents. Genotypic sequencing of RT-PCR positive samples and environmental sampling were undertaken to assess for a common infection source.