13th – 15th November 2018 | Sage Gateshead – Newcastle
13th – 15th November 2018 | Sage Gateshead – Newcastle
13th – 15th November 2018 | Sage Gateshead – Newcastle
Day 3: Thursday 15th November
08:00 – 09:30
Lessons in Microbiology and Infection Control
Chair: Dr Lisa Ridgway, Chair of HIS
C. difficile colonisation – what does it mean and what’s important?
Dr Chris Settle, Consultant Microbiologist, Sunderland Royal Hospital
Abstract - C. difficile colonisation – what does it mean and is it important?
The terms C. difficile colonisation and C. difficile carriage have been used interchangeably in the past and the precise definition of each is not certain. Detectable C. difficile in the stool, with or without detectable toxin, in the absence of clinical features that suggest infection (such as diarrhoea) is what is often meant by these terms. There has been much debate about the significance of colonisation, both to the colonised individual as well as the potential risk to others who may be susceptible to C. difficile infection (CDI). The confusion about what colonisation means to an individual or to a population may arise because a number of different categories of patient are included in the overall term ‘colonised’.
Detection of the organism or toxin may occur in several situations where the patient does not have symptoms at the time of the test.
- Shortly after first acquisition of the organism
- After a period of sustained colonisation (months)
- Just after resolution of difficile infection
Observations have been made about the higher risk of CDI amongst patients who have been found to be colonised, whilst at the same time other investigators have suggested that patients colonised by a toxigenic strain may be at lower risk of infection than non-colonised patients. This relates to the interplay between host immune system, gut flora and the presence of C. difficile.
If, after acquisition of C. difficile, the patient mounts a satisfactory antibody response and prevents C. difficile toxins damaging the colon, then a period of asymptomatic colonisation may arise. If, on the other hand, the antibody response is ineffective, then CDI is likely to arise if the organism produces significant amounts of toxin.
Similarly, after an episode of CDI, the patient may mount a strong antitoxin antibody response and be at low risk of a further episode, or if there is no significant antitoxin antibody production may remain at high risk of relapsing infection.
Now that epidemic ribotype 027 and 001 disease has disappeared in the UK, the minority of CDI cases are found to be related to other patients with infection, which begs the question – what is the source of the organism in the majority of cases? An undetected cohort of patients with C. difficile colonisation, who can develop diarrhoea for non-infective reasons, may be one of the contributory factors to this situation.
Infections in transplantation
Dr Julie Samuel, Consultant Microbiologist, Newcastle upon Tyne Hospitals
Abstract - Infections in transplantation
‘ Solid organ transplant recipients have variable outcomes depending on a multitude of factors. Common infections are still quite common and majority of patients have a fairly uncomplicated journey. As transplant microbiologists we see extreme ends of the spectrum. It’s marginally easier if you know your enemy and hope that they follow the rules’.
“Doctor knows best”: the mismatch between staff and patient views on the acceptability of infection prevention & control related screening and management
Professor Kay Currie, Professor of Nursing & Applied Healthcare Research, Glasgow Caledonian University
Abstract - “Doctor knows best”: the mismatch between staff and patient views on the acceptability of infection prevention & control related screening and management
Involving patients in decisions regarding their health and care management is now embedded in the realistic medicine movement and enshrined in person-centred care, both core to the delivery of quality healthcare. However, our research has found that healthcare professionals may overlook patient involvement in more ‘routine’ aspects of infection prevention or control, such as MRSA and CPE screening, or temporarily suspending visiting during norovirus outbreaks.
This paper will refer to the outcomes of our recent studies to illustrate the assumptions often made by healthcare professionals about patient or public views on screening and management of healthcare associated infections. It will argue that unless we actively seek evidence on patient and public perceptions, we risk perpetuating myths rather than basing our policy and practice on robust research. By sharing lessons learned from this work, we will show that Doctor, or nurse, may not always ‘know best’.
Detection of nontuberculous mycobacteria (NTM) in patients with cystic fibrosis and bronchiectasis
Professor John Perry, Clinical Scientist, Newcastle Laboratories
Abstract - Detection of nontuberculous mycobacteria (NTM) in patients with cystic fibrosis and bronchiectasis
Nontuberculous mycobacteria (NTM) are significant respiratory pathogens, particularly in individuals with pre-existing lung disease, for example, patients with cystic fibrosis (CF) or bronchiectasis. We evaluated a novel agar-based selective culture medium (RGM medium) for the detection of NTM in patients with CF (405 samples), bronchiectasis (323 samples) and other lung diseases necessitating lung transplantation (274 samples). In total, 1002 respiratory samples from 676 patients were included in the study and direct culture on RGM medium was compared with conventional culture of decontaminated samples for acid-fast bacilli (AFB) using both a solid medium (Löwenstein-Jensen medium) and a liquid medium (the Mycobacterial Growth Indicator Tube; MGIT).
For all three patient groups, significantly more isolates of NTM were recovered using RGM (sensitivity: 94.6% vs. 22.4% for conventional AFB culture; P < 0.0001). Significantly more isolates of M. abscessus complex were isolated on RGM than by AFB culture (sensitivity: 96.1% vs. 58.8%; P < 0.0001). The recovery of M. avium complex was also greater using RGM medium compared to AFB culture (sensitivity: 83% vs. 70.2%), although this difference was not statistically significant and a combination of methods was necessary for optimal recovery (P = 0.21). In the largest study of RGM medium to date, we reaffirm its utility for isolation of NTM from patients with CF. Furthermore, we show that it provides an effective tool for culture of respiratory samples from patients with bronchiectasis and other lung diseases.
Supported by HIS / IPS
09:30 – 10:30
Gary French Lecture
Dr Lisa Ridgway, Chair of HIS
The rise and fall of MRSA in England
Professor Gary French, President, Healthcare Infection Society
Abstract - The rise and fall of MRSA in England
The epidemiology of healthcare-associated MRSA was known by the mid 1990s but widely accepted methods of prevention and control were poorly implemented and in many cases more or less ignored. In English hospitals, annual numbers of MRSA bacteraemias rose from a handful in 1990 to nearly 8000 by 2004. Increasing concern amongst lay people, politicians and the media, and resulted in the introduction of a national programme of infection control. This included new guidelines, mandatory publishing of MRSA bacteraemia rates, audits and feedback of hygienic practice and environmental cleanliness, targets for MRSA reductions and aggressive performance management of failing hospitals. There followed a dramatic 90% fall in MRSA bacteraemias to around a total of around 800 total a year by 2014, with hospital-onset cases at around 300 per year. There was a similar dramatic fall deaths associated with MRSA. The reasons for the rise and fall of MRSA and its implications will be discussed.
Supported by HIS
10:30 – 11:00
COFFEE, Exhibition & Poster Viewing
10:30 – 11:00
Dr Natasha Ratnaraja, Coventry and Dr Debbie Wearmouth, Hull
11:00 – 12:15
Plenary Session: Outbreak Control
Dr Matthias Schmid, Consultant Physician, Infection & Tropical Medicine,
Royal Victoria Infirmary, Newcastle &
Dr Anne Tunbridge, Consultant in Infectious Diseases, Sheffield Teaching Hospitals
Lassa fever control and the UK Public Health Rapid Support Team
Professor Daniel G. Bausch, Director of Public Health, UK Public Health Rapid Support Team
Abstract - Lassa fever control and the UK Public Health Rapid Support Team
Lassa fever (LF) is a severe hemorrhagic illness caused by Lassa virus (LASV), a member of the family Arenaviridae. Hundreds of thousands of LASV infections are estimated to occur yearly across West Africa, especially in Nigeria, Sierra Leone, Liberia, and Guinea. Furthermore, the incidence appears to be increasing, with a large outbreak in Nigeria in 2017-18. Although LASV is known to be transmitted to humans through contact with contaminated excreta of rodents of the genus Mastomys, fundamental questions remain regarding the natural history of transmission. For unexplained reasons, the incidence of LF in humans and prevalence of LASV-infected Mastomys appears to be quite heterogeneously distributed across West Africa, and sometimes even within the same region or village. Possible factors influencing this heterogeneity include virus strain variation, varied distribution or reservoir competence of sub-species of Mastomys, animal behavior and environmental restrictions shaping virus flow in rodent populations, climatic factors influencing the probability of aerosol transmission, human behavior influencing prevalence and exposure to Mastomys, and the duration of immunity shaping population susceptibility in humans. Recent new initiatives from a variety of stakeholders provide opportunity to better understand and control LF. This presentation will include a review of the present knowledge base regarding LF and the developing strategies to address the pertinent questions in LASV transmission and control, including through the recently formed UK Public Health Rapid Support Team.
Controlling medical emergencies in outbreak situations
Professor John Simpson, Consultant in Health Protection, Public Health England
Abstract - Controlling medical emergencies in outbreak situations
Professor Simpson will cover the present thinking about WHO ratified emergency medical teams and the response to outbreaks and how this will be an important component of their work in the future.
Rohingya diphtheria outbreak
Dr Stephen Owens, Consultant Paediatric Immunology and Infectious Diseases, Great North Children’s Hospital
Abstract - Rohingya diphtheria outbreak
In November 2017, the first of more than 8000 cases of diphtheria was reported to the World Health Organisation (WHO) in Cox’s Bazar, Bangladesh. This outbreak among Rohingya refugees from Myanmar is the largest recorded anywhere in the world for more than 20 years. It has called for the integrated responses of a number of international partners, including the UK Emergency Medical Team (UKEMT) working with WHO and the Government of Bangladesh to help bring it under control. However the humanitarian crisis which generated the outbreak continues to unfold and the risk of ongoing transmission in pockets of unvaccinated communities is still present despite three mass diphtheria campaigns.
12:15 – 13:15
Satellite Symposium: The impact of Near Patient testing for influenza and norovirus at a District General Hospital
Dr Beryl Oppenheim, Cepheid
Cepheid technology, time to processing and diagnostic reliability compared to centralised testing for C. difficle, norovirus, RSV and influenza
Dr Mark Wilks, Clinical Scientist and Mr John Haigh, Senior Biomedical Scientist, Barts Health NHS Trust, Whipps Cross University Hospital
Clinical and infection control importance of early norovirus and influenza detection at a local District General Hospital
Dr Diana Mabayoje, Specialist Registrar in Microbiology & Infectious Diseases, Barts Health NHS Trust, Whipps Cross University Hospital
Writing a business case for Near Patient testing
Dr Mark Melzer, Consultant in Microbiology & Infectious Diseases, Barts Health NHS Trust, London
Supported by Cepheid
12:15 – 13:15
Satellite Symposium: Optimising the management of invasive mould infections
Professor Malcolm Richardson, Director & Consultant Clinical Scientist in Medical Mycology, Mycology Reference Centre, Manchester University NHS Foundation Trust, Manchester, UK
Opportunities to maximise patient outcomes (diagnosticdriven approach)
Professor Malcolm Richardson
Antifungal stewardship in daily practice: exploring pharmacologic options, challenges and benefits in an adult haemato-oncology unit
Dr Nelun Perera Consultant Microbiologist, University Hospitals of Leicester, Leicester, UK
Panel discussion and Q&A
Supported by Pfizer
13:15 – 14:15
LUNCH, Exhibition & Poster Viewing
13:15 – 14:15
Professor Tom Rogers, Belfast
Travel and Tropical Medicine
Dr Matthias Schmid, Newcastle and Dr Ashley Price, Newcastle
14:15 – 15:00
Dr Katie Jeffery, Consultant in Clinical Infection, Oxford University Hospitals
Control of CPE
Professor Amy J. Mathers, Assistant Professor, Infectious Diseases and International Health, University of Virginia, USA
Abstract - Control of CPE
Focusing on the urgent clinical problem of increasing carbapenem resistance in Enterobacteriaceae we have been evaluating detection methods in clinical microbiology and molecular transmission of carbapenemase genes for the last twelve years. Molecular characterization has included analysis of mobile resistance mechanisms with evaluation of plasmid evolution and mobility across species with next generation sequencing paired with more traditional techniques. We have also been evaluating clinical risk factors and outcomes for patients acquiring differing species of carbapenemase producing Enterobacteriaceae.
With the recent finding of involvement of the hospital environment as a reservoir for drug resistant organisms we have expanded our work to model dispersion, refine detection methods and understand complex transmission pathways of carbapenemase producing Enterobacteriaceae from hospital wastewater to patients. This has been done within a laboratory sink model as well as within the hospital. The primary thesis of the talk will be to describe our current understanding around the detection and microbial transmission of genetic mechanisms of resistance from the hospital environment to patients and thereby understand the scope and challenges we may face with the spread of antimicrobial resistance among Enterobacteriaceae in hospitals.
15:00 – 16:15
Dr Ian Laurenson, Consultant Medical Microbiologist, Royal Infirmary of Edinburgh
A “One Health Approach” to Antimicrobial Resistance
Professor Dominic Mellor, Consultant in Veterinary Public Health, Professor of Epidemiology and Veterinary Public Health, Health Protection Scotland & University of Glasgow
Staphylococcus aureus at the human-animal interface
Professor Ross Fitzgerald, Professor of Molecular Bacteriology, Roslin Institute, University of Edinburgh
Abstract - Staphylococcus aureus at the human-animal interface
Supported by Scottish Microbiology Association
15:00 – 16:15
Collaborative Projects – NITCAR
Projects within a collaborative: making it work
Dr Jordan Skittrall, Deputy Chair, National Infection Trainee Collaborative for Audit and Research, Cambridge University Hospitals NHS Foundation Trust
Abstract - Projects within a collaborative: making it work
A multicentre retrospective audit of native vertebral osteomyelitis cases
Dr Isobel Ramsay and Dr Rachel Bousfield, Specialist Registrars in Infectious Diseases & Microbiology, Cambridge University Hospitals
Abstract - A multicentre retrospective audit of native vertebral osteomyelitis cases
Complicated intra-abdominal infections: the impact of antibiotic duration on relapse and mortality
Dr Shadia Ahmed, Microbiology Clinical Research Fellow, Leeds Teaching Hospitals
Abstract - Complicated intra-abdominal infections: the impact of antibiotic duration on relapse and mortality
Complicated intra-abdominal infections (cIAIs) are common in-hospital clinical challenges which are associated with significant morbidity and mortality. Management strategies centre on source control and antibiotic therapy. However, the optimal treatment strategy is uncertain due to a lack of robust evidence. We undertook a multi-centre service evaluation to describe the management and outcomes of cIAIs in the United Kingdom (UK), with a view to informing a clinical trial of short versus long course antibiotic therapy
A multi-centre service evaluation of cIAI was conducted from August 2016 to February 2017 via the National Infection Trainee Collaborative for Audit and Research. Adult patients diagnosed with a cIAI were eligible to be included. Data collected included information on patient demographics, clinical characteristics, management strategies and outcomes at 90 days following diagnosis. Multi-variable logistic regression analysis was performed to assess which variables were associated with cIAI relapse and with mortality.
In total 417 patients were included from 31 centres, of which 53.7% were female and the median age was 65.5 years (IQR 55.5 to 75.5). Diverticular disease was the most frequently reported underlying pathology, accounting for 32.1% of cases. The median duration of antibiotic treatment was 12 days and 30.7% of patients did not have a source control procedure. Overall, 17.3% of patients had a cIAI relapse and mortality was 11.3%.
Multivariable analysis found cancer (OR 3.76) and increasing age (OR 1.10 per 10-year increase in age) to be predictors of mortality. A longer duration of antibiotics was associated with lower mortality (OR 0.69 per 1-week increase in antibiotic duration), but this did not reach statistical significance (p 0.076). Antibiotic duration was not associated with cIAI relapse. Factors associated with an increase in the risk of relapse were failure of initial management (OR 8.58) and source control via radiologically guided percutaneous drainage (OR 2.56).
We found that practice relating to the management of cIAI varied across the United Kingdom. Antibiotic treatment durations on average exceeded those recommended in guidelines from the Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) and the World Society of Emergency Surgery. Our results suggest a hypothesis that longer durations of antibiotic are associated with lower mortality. However, since this was an observational study, associations do not infer causation and further studies are required to determine the optimal antibiotic treatment duration.
NAMM – National audit of meningitis management
Dr Fiona McGill, Academic Clinical Lecturer, Infectious Diseases & Medical Microbiology, University of Liverpool
Abstract - NAMM - National audit of meningitis management
In recent years the incidence of bacterial meningitis has been declining1. However, despite this mortality remains high. This means we are faced with a potentially lethal disease that we, as clinicians, may not see all that often. As a result it is imperative that any case of suspected meningitis is managed well, in order to ensure the best outcome for any patients later confirmed to have bacterial meningitis.
In 2016 the UK’s national guidelines on the management of meningitis and meningococcal sepsis in adults were updated2. Previous studies in the UK have shown poor adherence to meningitis guidelines3,4. In stark contrast studies from other countries have shown an improvement in outcome following changes in national guidelines5,6.
The NAMM audit aims to assess current practice across the UK using the 2016 guidelines as the standard.
This is a multi-centre national audit – still open to new sites. Currently there are 46 sites planning on contributing data. Data collection will be via an online data collection tool (REDCap). Only fully anonymised data will be inputted onto REDCap. All sites are asked to audit all cases of meningitis seen in 2017. If this is too onerous we are happy to reduce that to 2 per month. Data collection will commence in October-November 2018 and should be finished by Mar 2019.
The results of this audit will be fedback to individual sites and individualised feedback within sites will be encouraged. A repeat audit will be completed following feedback to ascertain any improvement in practice. The findings of the audit will also feed into any revisions of the guidelines.
As data collection has not started yet this talk will focus on the background and rationale for the audit. It may be of particular interest to sites either already signed up or keen to be part of this exciting national audit.
Supported by National Infection Trainee Collaborative for Audit and Research
16:15 – 16:30
FORMAL CLOSING CEREMONY
Dr Albert Mifsud, President of the British Infection Association &
Dr Hiten Thaker, Chairman of FIS2018 Organising Committee