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Procalcitonin and C reactive protein in patients hospitalised with acute respiratory illness
Abstracts killing mechanisms in the context of mycobacterial infection. However, suppression of MMP production may be a protective response limiting extracellular matrix destruction and tissue damage. The Th2 cytokine IL-4 also blocks MMP secretion in response to Mtb infection, although different mechanisms are likely to be responsible.
7
519 ensure all TB infected patients are offered HIV testing with a view to increasing such testing to ensure optimal management of TB and HIV co-infection.
8
TRENDS IN HIV TESTING AMONGST TB PATIENTS IN LOTHIAN, SCOTLAND - 2007 TO 2009
THIRD SESSION: CHAIRS & DISCUSSANTS DR BRIAN JONES (GLASGOW) & DR HITEN THAKER (HULL)
Velu Prasad Palani 1, Gilhooley Sian 2, McSparron Ceri 2, Hill Adam 2, Stevenson Janet 3, Laurenson Ian F 2
PROCALCITONIN AND C REACTIVE PROTEIN IN PATIENTS HOSPITALISED WITH ACUTE RESPIRATORY ILLNESS
1
University of Edinburgh, Edinburgh, Scotland, UK Royal Infirmary of Edinburgh, Edinburgh, UK 3 Department of Public Health, Lothian NHS Board, Edinburgh, UK 2
Clark Tristan 1,2, Bafadel Mona 3, Reid Carlene 3, Medina Marie-jo 1, Barer Michael 2, Brightling Christopher 3, Nicholson Karl 1 1
Introduction HIV infection is a risk factor for tuberculosis (TB) infection and patients with TB and HIV co-infection are more likely to be infected with drug resistant strains of TB. Clinical practice guidelines produced by the Scottish Health Protection Network (2009), the National Institute for Health and Clinical Excellence, NICE (2006) and the British HIV Association (2005) recommend that patients newly diagnosed with TB be offered HIV testing. Our study assessed HIV testing rates amongst patients newly diagnosed with TB in Lothian from 2007 and 2009 and to determine epidemiological and clinical factors associated with testing.
Department Infectious Diseases, Leicester Royal Infirmary, Leicester, UK 2 Department of Infection, Immunity and Inflammation, University of Leicester, UK 3 Institute of Lung Health, University of Leicester, UK
Introduction Overuse of antibiotics in patients with acute respiratory illness is common and contributes to the increase in drug resistant bacteria and hospital acquired infection. Procalcitonin directed treatment algorithms have been successful in reducing antibiotic use in patients with acute respiratory illness without increasing adverse event. Less is known about the utility of C reactive protein (CRP) in this situation
Methods and results Microbiology records and case notes of patients diagnosed with TB were reviewed to identify if a HIV test was done and to gather information on age, gender, ethnicity, country of origin and history of drug or alcohol misuse. Of the 266 patients diagnosed with TB, 136 (55.97%) were tested for HIV and 6 tested positive (4.41%). There was a statistically significant rise in HIV testing rates (p¼0.0189). Factors associated with having a test include being aged between 20 and 39, being of Black African or South Asian ethnicity, being born outside the UK and having a history of drug misuse.
Conclusions This study has identified that rates of HIV testing amongst TB patients is at a moderately high level, and has improved following the introduction of Scottish clinical practice guidelines. Although not universal, testing is targeted at high-risk groups, maximizing the likelihood of identifying cases of TB and HIV co-infection. Steps should be taken to
Objectives We compared the utility of procalcitonin and C-reactive protein in distinguishing pneumonia from exacerbations of asthma and chronic obstructive pulmonary disease (COPD) in patients hospitalised with acute respiratory illness
Methods and results We recruited patients with a diagnosis of pneumonia, exacerbation of asthma or COPD hospitalised during the winter months of 2005e8. 319 patients were recruited. Procalcitonin and CRP levels were elevated in patients with pneumonia compared to asthma and COPD (p<0.001) and were highly correlated (rs ¼0.56, p<0.001). The area under the receiver operator curve (95%CI) for distinguishing between patients with pneumonia (antibiotics required) versus asthma (antibiotics not indicated) for procalcitonin and CRP was 0.93 [0.88e0.98] and 0.96 [0.93e1.00] respectively. A CRP cut off of 48mg/L
520
Abstracts
had a sensitivity of 91% and specificity of 93% for identifying subjects with pneumonia.
able to move around the home unassisted were at lower risk of MRSA (P¼0.04).
Conclusions
Conclusions
CRP levels could be used to direct and reduce antibiotic therapy in hospitalised patients with exacerbation of asthma and COPD. Large interventional randomised control studies using CRP guided treatment algorithms are needed to validate its use in this way.
Our findings suggest that cross-infection by care home staff caring for more dependant and less mobile residents plays a significant role in the spread of MSSA and MRSA in care homes, with residents able to move around the home unassisted less likely to be colonised with MRSA. Consequently, improving care home staff compliance with hand hygiene, reducing hospitalisation of care home residents and removing unnecessary urinary catheters would reduce the burden of MSSA and MRSA in care homes. However, more research is required in care homes, to develop a multifaceted intervention that will tackle the numerous risk factors associated with MSSA and MRSA carriage.
9 STAPHYLOCOCCUS AUREUS (MSSA AND MRSA) CARRIAGE IN CARE HOMES: IDENTIFICATION OF RISK FACTORS, INCLUDING THE ROLE OF DEMENTIA Lasseter Gemma 1, Charlett Andre ´ 2, Lewis Deirdre 3, 4 Donald Ian , Howell-Jones Rebecca 5, McNulty Cliodna 1 1
Primary Care Unit, Health Protection Agency, Gloucester, UK 2 Department of Statistics, Health Protection Agency, Colindale, London, UK 3 South West, Health Protection Agency, Brockworth, Gloucester, UK 4 Department of Geriatrics, Gloucestershire Royal Hospital, Gloucester, Gloucestershire, UK 5 HIV & STI Department, Health Protection Agency, Colindale, London, UK
Introduction The aim of this study was to investigate the prevalence of methicillin sensitive and methicillin resistant Staphylococcus aureus (MSSA and MRSA) nasal carriage in residents of care homes in Gloucestershire and Greater Bristol (UK). To identify care home and resident related risk factors associated with carriage of these organisms, with particular focus on dementia.
Methods and results Point-prevalence survey of 748 residents in 51 Gloucestershire and Greater Bristol care homes. Dementia was assessed via abbreviated mini-mental or clock test. Swabs cultured on chromogenic and blood agar. Of the 748 residents, 179 (24.0%) were positive for S. aureus; 121 (16.2%) MSSA and 59 (7.8%) MRSA. Univariate analysis found no significant association between dementia and MSSA or MRSA carriage. Multivariate analysis found four risk factors significantly associated with carriage of MSSA or MRSA; age (p¼0.03, p¼0.05), geographical area (p¼0.006, p¼0.13), hospitalisation 6 months (p¼0.04, p¼0.1) and number of residents/home (p¼0.006, p>0.05). Residents
10 UNDERSTANDING THE CONTRIBUTION OF THE TEMPERATE BACTERIOPHAGES OF C. DIFFICILE TO CLINICAL OUTCOME Tromans Samuel Jenkins David 1 1 2
1,2
, Nale Janet 1, Clokie Martha 1,
University of Leicester, UK University Hospitals of Leicester, UK
Introduction Clostridium difficile is an important cause of pseudomembranous colitis and nosocomial diarrhoea in the UK. In recent years, the emergence of the PCR ribotype 027 strain has been associated with increased numbers of cases and, putatively, increased disease severity. Some C. difficile isolates contain prophages (bacteriophages resident within their genomes). In other bacterial species, bacteriophages have been shown to enhance antimicrobial resistance and virulence. Bacteriophage contribution to C. difficile-associated disease (CDAD) severity has not been investigated. This study aimed to isolate and characterise C. difficile bacteriophages from clinical isolates and determine the influence of bacteriophage carriage on CDAD severity.
Methods and results 92 C. difficile toxin-positive stools from University Hospitals of Leicester in-patients were cultured for C. difficile and classified into 027 or non-027 ribotypes. Prophage release was induced using norfloxacin. Bacteriophage morphologies were determined by transmission electron microscopy. Patient information was extracted from medical notes. 38/92 C difficile isolates (both 027 and non-027 ribotypes) possessed 1 bacteriophage type.(Siphoviridae-29/92;
7
519 ensure all TB infected patients are offered HIV testing with a view to increasing such testing to ensure optimal management of TB and HIV co-infection.
8
TRENDS IN HIV TESTING AMONGST TB PATIENTS IN LOTHIAN, SCOTLAND - 2007 TO 2009
THIRD SESSION: CHAIRS & DISCUSSANTS DR BRIAN JONES (GLASGOW) & DR HITEN THAKER (HULL)
Velu Prasad Palani 1, Gilhooley Sian 2, McSparron Ceri 2, Hill Adam 2, Stevenson Janet 3, Laurenson Ian F 2
PROCALCITONIN AND C REACTIVE PROTEIN IN PATIENTS HOSPITALISED WITH ACUTE RESPIRATORY ILLNESS
1
University of Edinburgh, Edinburgh, Scotland, UK Royal Infirmary of Edinburgh, Edinburgh, UK 3 Department of Public Health, Lothian NHS Board, Edinburgh, UK 2
Clark Tristan 1,2, Bafadel Mona 3, Reid Carlene 3, Medina Marie-jo 1, Barer Michael 2, Brightling Christopher 3, Nicholson Karl 1 1
Introduction HIV infection is a risk factor for tuberculosis (TB) infection and patients with TB and HIV co-infection are more likely to be infected with drug resistant strains of TB. Clinical practice guidelines produced by the Scottish Health Protection Network (2009), the National Institute for Health and Clinical Excellence, NICE (2006) and the British HIV Association (2005) recommend that patients newly diagnosed with TB be offered HIV testing. Our study assessed HIV testing rates amongst patients newly diagnosed with TB in Lothian from 2007 and 2009 and to determine epidemiological and clinical factors associated with testing.
Department Infectious Diseases, Leicester Royal Infirmary, Leicester, UK 2 Department of Infection, Immunity and Inflammation, University of Leicester, UK 3 Institute of Lung Health, University of Leicester, UK
Introduction Overuse of antibiotics in patients with acute respiratory illness is common and contributes to the increase in drug resistant bacteria and hospital acquired infection. Procalcitonin directed treatment algorithms have been successful in reducing antibiotic use in patients with acute respiratory illness without increasing adverse event. Less is known about the utility of C reactive protein (CRP) in this situation
Methods and results Microbiology records and case notes of patients diagnosed with TB were reviewed to identify if a HIV test was done and to gather information on age, gender, ethnicity, country of origin and history of drug or alcohol misuse. Of the 266 patients diagnosed with TB, 136 (55.97%) were tested for HIV and 6 tested positive (4.41%). There was a statistically significant rise in HIV testing rates (p¼0.0189). Factors associated with having a test include being aged between 20 and 39, being of Black African or South Asian ethnicity, being born outside the UK and having a history of drug misuse.
Conclusions This study has identified that rates of HIV testing amongst TB patients is at a moderately high level, and has improved following the introduction of Scottish clinical practice guidelines. Although not universal, testing is targeted at high-risk groups, maximizing the likelihood of identifying cases of TB and HIV co-infection. Steps should be taken to
Objectives We compared the utility of procalcitonin and C-reactive protein in distinguishing pneumonia from exacerbations of asthma and chronic obstructive pulmonary disease (COPD) in patients hospitalised with acute respiratory illness
Methods and results We recruited patients with a diagnosis of pneumonia, exacerbation of asthma or COPD hospitalised during the winter months of 2005e8. 319 patients were recruited. Procalcitonin and CRP levels were elevated in patients with pneumonia compared to asthma and COPD (p<0.001) and were highly correlated (rs ¼0.56, p<0.001). The area under the receiver operator curve (95%CI) for distinguishing between patients with pneumonia (antibiotics required) versus asthma (antibiotics not indicated) for procalcitonin and CRP was 0.93 [0.88e0.98] and 0.96 [0.93e1.00] respectively. A CRP cut off of 48mg/L
520
Abstracts
had a sensitivity of 91% and specificity of 93% for identifying subjects with pneumonia.
able to move around the home unassisted were at lower risk of MRSA (P¼0.04).
Conclusions
Conclusions
CRP levels could be used to direct and reduce antibiotic therapy in hospitalised patients with exacerbation of asthma and COPD. Large interventional randomised control studies using CRP guided treatment algorithms are needed to validate its use in this way.
Our findings suggest that cross-infection by care home staff caring for more dependant and less mobile residents plays a significant role in the spread of MSSA and MRSA in care homes, with residents able to move around the home unassisted less likely to be colonised with MRSA. Consequently, improving care home staff compliance with hand hygiene, reducing hospitalisation of care home residents and removing unnecessary urinary catheters would reduce the burden of MSSA and MRSA in care homes. However, more research is required in care homes, to develop a multifaceted intervention that will tackle the numerous risk factors associated with MSSA and MRSA carriage.
9 STAPHYLOCOCCUS AUREUS (MSSA AND MRSA) CARRIAGE IN CARE HOMES: IDENTIFICATION OF RISK FACTORS, INCLUDING THE ROLE OF DEMENTIA Lasseter Gemma 1, Charlett Andre ´ 2, Lewis Deirdre 3, 4 Donald Ian , Howell-Jones Rebecca 5, McNulty Cliodna 1 1
Primary Care Unit, Health Protection Agency, Gloucester, UK 2 Department of Statistics, Health Protection Agency, Colindale, London, UK 3 South West, Health Protection Agency, Brockworth, Gloucester, UK 4 Department of Geriatrics, Gloucestershire Royal Hospital, Gloucester, Gloucestershire, UK 5 HIV & STI Department, Health Protection Agency, Colindale, London, UK
Introduction The aim of this study was to investigate the prevalence of methicillin sensitive and methicillin resistant Staphylococcus aureus (MSSA and MRSA) nasal carriage in residents of care homes in Gloucestershire and Greater Bristol (UK). To identify care home and resident related risk factors associated with carriage of these organisms, with particular focus on dementia.
Methods and results Point-prevalence survey of 748 residents in 51 Gloucestershire and Greater Bristol care homes. Dementia was assessed via abbreviated mini-mental or clock test. Swabs cultured on chromogenic and blood agar. Of the 748 residents, 179 (24.0%) were positive for S. aureus; 121 (16.2%) MSSA and 59 (7.8%) MRSA. Univariate analysis found no significant association between dementia and MSSA or MRSA carriage. Multivariate analysis found four risk factors significantly associated with carriage of MSSA or MRSA; age (p¼0.03, p¼0.05), geographical area (p¼0.006, p¼0.13), hospitalisation 6 months (p¼0.04, p¼0.1) and number of residents/home (p¼0.006, p>0.05). Residents
10 UNDERSTANDING THE CONTRIBUTION OF THE TEMPERATE BACTERIOPHAGES OF C. DIFFICILE TO CLINICAL OUTCOME Tromans Samuel Jenkins David 1 1 2
1,2
, Nale Janet 1, Clokie Martha 1,
University of Leicester, UK University Hospitals of Leicester, UK
Introduction Clostridium difficile is an important cause of pseudomembranous colitis and nosocomial diarrhoea in the UK. In recent years, the emergence of the PCR ribotype 027 strain has been associated with increased numbers of cases and, putatively, increased disease severity. Some C. difficile isolates contain prophages (bacteriophages resident within their genomes). In other bacterial species, bacteriophages have been shown to enhance antimicrobial resistance and virulence. Bacteriophage contribution to C. difficile-associated disease (CDAD) severity has not been investigated. This study aimed to isolate and characterise C. difficile bacteriophages from clinical isolates and determine the influence of bacteriophage carriage on CDAD severity.
Methods and results 92 C. difficile toxin-positive stools from University Hospitals of Leicester in-patients were cultured for C. difficile and classified into 027 or non-027 ribotypes. Prophage release was induced using norfloxacin. Bacteriophage morphologies were determined by transmission electron microscopy. Patient information was extracted from medical notes. 38/92 C difficile isolates (both 027 and non-027 ribotypes) possessed 1 bacteriophage type.(Siphoviridae-29/92;