Medical Microbiology
Programme sponsor
Is phenotypic visualisation of resistance needed to guide antimicrobial stewardship?
Is phenotypic visualisation of resistance needed to guide antimicrobial stewardship?
Medical Microbiology
Abstract
Following on from a talk given last year on the Precision AMR Project, this presentation will look at the incorporation of WGS and genotypic methods vs phenotypic methods and how they can impact on diagnostic laboratory practices, antibiotic reporting and prescribing.
This presentation follows on from the research on the Precision AMR project and discusses how this can be translated into routine practice. Also looking at potential new workflows that may be incorporated into laboratory's to support clinicians and infection control.
Learning outcomes
Delegates attending this presentation will gain knowledge on:
- Developments in antibiotic diagnostic testing.
- The use of molecular techniques for looking at resistance mechanisms in the routine diagnostic laboratory.
- Utilising diagnostic tests for improving antimicrobial stewardship.
Speakers
Francis Yongblah
Bench to Bedside: Clinical Cases from an HSST
Bench to Bedside: Clinical Cases from an HSST
Medical Microbiology
Abstract
Clinical case based presentation demonstrating the reach of microbiology from bench to bedside- what does that result mean outside of the laboratory walls? Cases have been chosen to highlight how the bugs on the plate are only part of the patients story and aims to link the BMS experience with patients and clinical outcomes.
Speakers
Amy Read
Sepsis and systemic or disseminated infections
Sepsis and systemic or disseminated infections
Medical Microbiology
Abstract
UK Standards for Microbiology Investigations (UK SMIs) have developed a syndromic document for the microbiological investigation of sepsis and systemic or disseminated infections. The UK SMI brings together the bacteriology, virology, mycology and parasitology disciplines under a syndromic approach, reflecting the changes in testing methods and consideration of the whole specimen pathway from bedside to receipt of the final result. UK SMIs are NICE accredited national standards developed under the auspices of the UK Health Security Agency (UKHSA).
The document highlights that significant changes are needed in both clinical and laboratory practise to improve the sensitivity and utility of blood cultures. This is critical in our endeavour to tackle the significant issue of antimicrobial resistance and inappropriate use of antimicrobials.
Key points of S12 – Sepsis and systemic or disseminated infections:
- Collecting adequate volume of blood for culture is critical. Every mL of blood increases the sensitivity of blood culture by 3%.
- A minimum of 2 blood culture sets (2x2 bottles, 40mL) are recommended to detect bacteriaemia in adults. These can be collected in one draw.
- Collecting a third set (total of 3x2 bottles, 60mL) is recommended if candidaemia is suspected. All three sets can be collected in one draw.
- If endocarditis is suspected, 3 blood culture sets (3x2 bottles, 60mL) should be collected as separate draws over a 24h period.
- Samples are ideally collected before starting antimicrobial therapy. However certain clinical conditions may dictate giving antimicrobials prior to blood culture collection e.g., unstable septic patients, patient with suspected meningococcal disease etc. Blood cultures should still be taken if clinical condition dictates in patients receiving ongoing antimicrobials.
- The blood culture bottles must be transported to the laboratory and loaded into a blood culture analyser without delay, ideally within 4 hours from collection, subject to local constraints and agreements.
- List of auditable outcomes are provided
The document is endorsed by 24 professional colleges and societies committed to contribute to the development of UK SMIs including the Royal College of Pathologists (RCPath) and Institute of Biomedical Science (IBMS).
Learning outcomes
The aim of the lecture is to provide an overview of the new syndromic UK SMI S12 'Sepsis and systemic or disseminated infections' and to provide a summary of:
- The background to the development of a guidance document for 'Sepsis and Disseminated Infections' through the NICE accredited UK Standards for Microbiology Investigations process.
- The key aspects of the full pathway for microbiological investigations from the pre-analytical to the post-analytical phase including the types of samples and tests, sample volume & number, and timing of sample collection.
Speakers
Dr Riina Richardson
FMT/NICE guidance
FMT/NICE guidance
Medical Microbiology
Abstract
Clostridioides difficile is responsible for the eponymous C. difficile infection (CDI). Faecal microbiota transplant (FMT), a NICE recommended treatment for recurrent CDI, is effective but logistic and safety concerns remain.
With the advent of non-donor derived products, the presentation will outline the principles and evidence related to correcting gut dysbiosis and explore whether there is a need for current or expanded FMT services in the future.
Speakers
Michael Perry
Neonatal Meningitis
Neonatal Meningitis
Medical Microbiology
Abstract
This presentation will outline the content of Paola's Clincal Case Study from her Higher Specialist Portfolio in Medical Microbiology. Here she will present the initial clinical presentation, diagnosis and treatment of a case of neonatal sepsis that linked to a previous unusual maternal screening swab. She will also outline her experience of the Higher Specialist Diploma and her plans for developing a training plan within Microbiology QMC, Nottingham for future candidates within their trust.
Learning outcomes
Through the discussion of a case submitted for the IBMS Higher Specialist Diploma delegates attending this presentation will learn about:
- Clinical presentation of a premature rupture of membranes and subsequent neonatal infection.
- Previous medical history, tests performed, management and treatment.
- Use of molecular techniques to improve diagnosis through increased sensitivity and reduced turnaround time.
- Personal reflection on the case study and also the presenters experience of the HSD.
Speakers
Paola Espin
Molecular Profiling of Acanthamoeba species directly from Ocular Tissue
Molecular Profiling of Acanthamoeba species directly from Ocular Tissue
Medical Microbiology
Abstract
To explore the molecular profiles of Acanthamoeba from laboratory-confirmed Acanthamoeba keratitis (AK) cases reported within the United Kingdom (UK) using DNA taken directly from clinical samples.
Acanthamoeba species are free-living organisms responsible for causing a debilitating, sight-threatening disease of the cornea. Of the 24 known Acanthamoeba species, 14 cause AK.
Thirty-five Acanthamoeba DNA-positive corneal samples from the Scottish Microbiology Reference Laboratories (SMiRL), Glasgow collection were selected from cases reported from 2017 - 2019. Following extraction of the DNA directly from each clinical specimen, the DNA was subjected to in-depth molecular typing using a nested PCR / bi-directional sequencing approach.
Molecular profiling was successful for 32 samples which comprised of two genotypes namely T3 and T4. The T4 genotype were further sub-typed; five sub-types existed namely; T4A, T4B, T4C, T4E and T4F.
Using a molecular typing assay applied directly to corneal tissue, this study highlights the T4 genotype and the T4A subtype are the predominant molecular variants of Acanthamoeba to cause ocular disease in the UK. Gaining in-depth information on the molecular profiling of Acanthamoeba is essential to increase our knowledge and understanding of the epidemiology, transmission pathways and potential associations with clinical outcomes for this rare, yet potentially debilitating ocular disease.
Speakers
Lisa Connelly
Anaerobe update
Anaerobe update
Medical Microbiology
Abstract
Antimicrobial resistance (AMR) in anaerobic bacteria varies greatly between institutions and countries. It is crucial that we have robust and widely available methods and perform regular surveillance to raise awareness of AMR amongst laboratory and clinical teams.
The UKARU offers a UK-wide service for the identification and antimicrobial susceptibility testing (AST) of anaerobic clinical isolates. Since 2016, this service has included weekly AST by agar dilution. The MIC population distributions for isolates referred are presented in real time via the ARUMIC platform, facilitating continuous monitoring of the development of resistance and valuable data for the review and development of epidemiological cut-offs (ECOFFs) and species-specific breakpoints, alongside the European Committee for Antimicrobial Susceptibility Testing (EUCAST).
During 2017 – 2021 EUCAST and the UKARU reviewed the AST methodology and breakpoints for anaerobes and developed a standardised disk diffusion method. Fastidious Anaerobe Agar with horse blood (FAA-HB) was used to test the most commonly isolated anaerobic bacteria including Bacteroides spp (n=170), Prevotella spp. (n=49), Fusobacterium necrophorum (n=51), Clostridium perfringens (n=58) and Cutibacterium acnes(n=54). The antimicrobials included for the initial phase were benzylpenicillin, piperacillin-tazobactam, meropenem, metronidazole and clindamycin with vancomycin included for the Gram positive organisms. Breakpoints for additional agents have just been published on the EUCAST website.
This lecture will provide insights into the development of AMR in anaerobic bacteria, the available AST methodologies and the importance of surveillance for this important group of pathogens.
Speakers
Trefor Morris
Being Patient: Patient experiences of Clostridioides difficile infection and why we should be listening
Being Patient: Patient experiences of Clostridioides difficile infection and why we should be listening
Medical Microbiology
Abstract
Many of us have diagnosed, treated or researched Clostridiodes difficile infection (CDI) for many years and probably know the organism and the disease it produces very well indeed. But how well do we really know it? In truth, we only know this from our own perspective. What is it really like to suffer from CDI? How well do the pathways and guidance we contribute to function in the experience patients?
This talk will focus on patient experiences of CDI, what they can teach us as clinicians and researchers and why involving patients and the public in designing our research and clinical services can help everyone.
Speakers
Dr Jane Freeman
Pathogen detection & chronic lung infection underestimated in cystic fibrosis
Pathogen detection & chronic lung infection underestimated in cystic fibrosis
Medical Microbiology
Abstract
Chronic lung infection is the leading cause of morbidity and early mortality for people with cystic fibrosis (pwCF). Microbiological surveillance to detect lung pathogens is recommended as best practise in CF patient care. Here we studied pathogen detection in forty pwCF over several years. We found that microbiological culture, the diagnostic gold standard, was significantly disparate to targeted culture-independent approaches for detection and determination of chronic infection status of two important pathogens in CF. Pathogen detection was significantly lower by culture and consequently infection status was also misclassified in the majority of cases.
In particular, the extent of chronic infection by both Pseudomonas aeruginosa and Staphylococcus aureus not realised with culture was striking. Our findings have implications for the development of infection and clinical care of pwCF. Future longitudinal studies with greater patient numbers will be needed to establish the full extent of the clinical implications indicated from this study.
Speakers
Professor Chris van der Gast
Shiga toxin-producing Escherichia coli O26 (STEC O26)
Shiga toxin-producing Escherichia coli O26 (STEC O26)
Medical Microbiology
Abstract
Shiga toxin-producing Escherichia coli (STEC) O157:H7 has been the most clinically significant STEC serotype in the UK for over four decades. However, over the last 10 years we have observed a decrease in STEC O157:H7 and an increase in non-O157 STEC serotypes, such as O26:H11. Little is known about the microbiology and epidemiology of non-O157 STEC. This presentation describes the virulence, clinical outcomes and epidemiology of non-O157 STEC, focusing on the most commonly detected serotype, STEC O26:H11.
Learning outcomes
This presentation will provide an overview of the increase in STEC O26 (and other important non-O157 serotypes including STEC O145) for both outbreak and sporadic cases across the UK covering the microbiological investigation.
Speakers
Dr Claire Jenkins
Do we (k)need a hip new approach? Experience of an international trial of the Biofire Joint Infection Panel
Do we (k)need a hip new approach? Experience of an international trial of the Biofire Joint Infection Panel
Medical Microbiology
Abstract
This presentation will give delegates a:
- Real world evaluation of a syndromic panel compared to traditional Gram stain and culture
The presentation will cover:
- An outline of the trial
- A summary of findings
- The local experience of the process
- Brief local case studies that show how the multiplex PCR panel results could have positively affected patient management.
Speakers
Robert Maloney
New drugs for bad bugs: What’s in the pipeline?
New drugs for bad bugs: What’s in the pipeline?
Medical Microbiology
Learning outcomes
This presentation will:
- Provide an overview of why new antibiotics are needed
- Highlight new and emerging antibiotics and identify target pathogens
- Give the reference laboratory perspective on testing
Speakers
Dr Katie Hopkins
EUCAST – striving towards a complete system
Biomarkers, disease severity and triaging the role of mid-regional proadrenomodulin
Biomarkers, disease severity and triaging the role of mid-regional proadrenomodulin
Medical Microbiology
Abstract
There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. The aim to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) and/ or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need and recognising the “ill looking well” and the “well looking ill”. We found in patients presenting to the ED with a suspected infection, the blood biomarker MR-proADM could most accurately identify the likelihood of further disease progression.
Incorporation into an early sepsis management protocol may therefore aid rapid decision-making in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment. There is currently a randomised controlled trial to assess the accuracy of the above findings.
Learning outcomes
Delegates will:
- Learn about the challenges clinicians face when triaging patients in ED
- Understand how can biomarkers help in triaging: recognising "the ill looking well" and "the well looking ill"
- Learn about mid-regional proadrenomodulin and recent studies in triaging patients in emergency medicine.
Speakers
Dr Kordo Saeed
HSST: A Year of Interesting Cases
HSST: A Year of Interesting Cases
Medical Microbiology
Abstract
Have you ever wondered what a HSST role entails?
If you are considering entering clinical training and you are keen to see the day to day challenges of the role, this talk will provide you with an insight into the role and the opportunites that come with Consultant level training.
If you are a managing a service that is struggling to recruit medically qualified Consultant Microbiologists, this talk may persuade you that a HSST can add depth to service provision and help overcome workforce challenges.
If you are a training lead and you are keen to see the breadth of training opportunites required to develop a Biomedical Scientist and prepare them for FRCPath examinations, this talk will give some practical ideas and direction.
And lastly, if you just enjoy case presentations with unusual or unexpected pathogens, then this talk promises to provide!
Learning outcomes
Through the discussion of cases delegates will understand:
- An overview of the role, now open to Biomedical Scientists.
- The impact of a HSST within the MDT Infection Team
Speakers
