Abstracts
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#2024199
"Mysteries on the Menu: A Traveller’s Health Misadventure"
Principal Presenter: Kaitlyn O'Brien
Keywords: Brucellosis, Zoonotic infection, Traveller's infectionTrack: Epidemiology & Population Health
Background: Brucellosis is a zoonotic infection, acquired by consuming unpasteurized dairy/handling animals infected with bacteria from the Brucella genus[1]. Although eradicated from Irish cattle in 2009[2], brucellosis occurs in the “Mediterranean, Middle East, Central Asia, China, Indian subcontinent, Sub-Saharan Africa, Mexico and Central and South America”.[3] In Punjab, India, a study showed 15.1% of large ruminants were seropositive for Brucella, and one-third of dairy farms had at least one infected animal.[4]
Case Presentation: A 32-year-old male presented to the hospital with over four months of fevers, myalgia, headaches, and 5kg weight loss, after travelling to India. His symptoms persisted despite receiving empiric antibiotics. He handled buffaloes and drank unpasteurised goat milk in India. Clinical examination was normal, apart from tachycardia(110bpm).
Diagnosis: Routine bloods only revealed a raised CRP (51mg/L). His CT Thorax, Abdomen, and Pelvis(CT TAP) showed mild splenomegaly and 3mm left upper and lower lobe pulmonary granulomas. HIV, syphilis, Lyme, leptospirosis IgM, hepatitis B, hepatitis C, connective tissue disease screen, and Quantiferon tests were negative. Blood cultures were sterile, but Brucella IgM and IgG serology returned positive, suggesting acute brucellosis. Subsequent Brucella PCR was positive.
Treatment: He received 6 weeks of oral rifampicin(600mg OD) and doxycycline(100mg BD), with significant clinical improvement. He remained well at follow-up.
Discussion/Conclusion: Brucellosis is rare in Ireland; five cases were reported in 2023, and one case was reported in both 2024 and 2022[5]. The 2022 case, and two 2023 cases were associated with international travel. Brucellosis has an average onset of 2-4 weeks; the incubation period is 5 days-6 months.[6] Symptoms include fever, malaise, arthralgias, hepatosplenomegaly, or lymphadenopathy. Severe, multi-systematic complications may occur, including arthritis, sacroiliitis, spondylitis, central nervous system disorders, epididymo-orchitis, endocarditis, hepatitis, respiratory disorders, and rashes.[7] Definitive diagnosis is made by culturing Brucella spp. A presumptive serological diagnosis can be made if a four-fold increase in Brucella antibody titres occurs between acute and convalescent serum specimens, or if titres are ≥ 1:160 by standard tube agglutination test/Brucella microagglutination test.[6] Treatment for brucellosis without spondylitis, neurobrucellosis, or endocarditis is 6 weeks of doxycycline, with either a parenteral aminoglycoside for 7-21 days, or oral rifampicin for 6 weeks.[8] Close clinical monitoring and serologic testing are essential, as relapse rates post-treatment are 5-15%.[9] Had brucellosis not been considered, the patient could have developed serious complications. This case emphasizes the need for awareness of zoonoses in Ireland, and the importance of careful history-taking in returning travellers.
References:
1. Brucellosis [Internet]. Factsheet- Health Protection Surveillance Centre. Health Protection Surveillance Centre; 2010 [cited 2024 Sep 18]. Available from: https://www.hpsc.ie/a-z/zoonotic/brucellosis/factsheet/
2. Animal Health Surveillance- Current News [Internet]. Animal Health Surveillance. Department of Agriculture, Food and the Marine; [cited 2024 Sep 18]. Available from: https://animalhealthsurveillance.agriculture.gov.ie/currentnews/surveillanceforbrucellosisinireland2018.html
3. Bosilkovski M. Brucellosis: Epidemiology, Microbiology, Clinical Manifestations, and Diagnosis. UpToDate [Internet]. 2023 Dec 12 [cited 2024 Sep 19]; Available from: https://www.uptodate.com/contents/brucellosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis
4. Holt HR, Bedi JS, Kaur P, Mangtani P, Sharma NS, Gill JPS, et al. Epidemiology of brucellosis in cattle and dairy farmers of rural Ludhiana, Punjab. Munoz-Zanzi C, editor. PLOS Neglected Tropical Diseases. 2021 Mar 18;15(3):e0009102.
5. Annual Infectious Diseases Notifications in Ireland 2020-2024 [Internet]. Health Protection Surveillance Centre. Health Protection Surveillance Centre; 2025 [cited 2025 Mar 7]. Available from: https://www.hpsc.ie/notifiablediseases/annualidstatistics/Annual_ID_Summary_Report_for_HPSC_Web_v10.0-2020-2024-06022025.pdf
6. Centers for Disease Control and Prevention. Brucellosis Reference Guide: Exposures, Testing and Prevention [Internet]. 2017 Feb [cited 2024 Sep 19]. Available from: https://www.cdc.gov/brucellosis/pdf/brucellosi-reference-guide.pdf
7. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. New England Journal of Medicine [Internet]. 2005 Jun 2 [cited 2024 Sep 19];352(22):2325–36. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra050570
8. Bosilkovski M. Brucellosis: Treatment and Prevention. UpToDate [Internet]. 2023 Dec 12 [cited 2024 Sep 19]; Available from: https://www.uptodate.com/contents/brucellosis-treatment-and-prevention
9. Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME, et al. Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations. PLoS Medicine [Internet]. 2007 Dec 27 [cited 2024 Sep 19];4(12):e317. Available from: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040317
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Board No: 1 #2024152
"Redefining Institutional Stigma Education (RISE) - development of an innovative learning module for healthcare professionals"
Principal Presenter: Amir Bachari
Keywords: HIV Stigma, Education, Online LearningTrack: Diversity & Inclusion
Background
HIV stigma continues to have an immense impact on the patient-provider experience and has negative health consequences on the patient. However, there is insufficient training to healthcare professionals (HCPs) in Ireland to meet such a gap in competency. Redefining Insitutuional Stigma Education (RISE) was launched with the objectives of decreasing HIV stigma, providing competency training to HCPs, and decreasing experiences of stigma for patients living with HIV in healthcare settings .Methods
A survey aimed at health sciences students and HCPs was carried out by researchers at RCSI Department of Tropical Medicine and International Health, RCSI University of Medicine and Health Sciences to inform the development of a HIV stigma module for healthcare workers and students. Filmed interviews with people living with HIV and those working in HIV care, as well as best practice roleplay videos were integrated into the module.Results
A total of 117 individuals completed the national survey that informed the module development. The online module was launched in June 2024. In the 9 months since program launch, 256 people have completed the 2.5 hour long course. The module has been integrated into RCSI Graduate Medicine Programme and University of Galway Undergraduate Medicine curricula, and has gained RCPI CPD accreditation.47% of those who completed the pre and post evaluation (n=75) indicated an increase in their understanding of HIV and its transmission; 63% indicated an increase in understanding of principles of person-centered care in the context of HIV. In addition, 52% indicated an increased comfort in being an up-stander when faced with a stigmatising situation following the module.Conclusion
Using a multidimensional approach to development of content that centres lived experiences combined with theory and practical applications is an effective means of increasing knowledge and comfort of HCPs. Upscaling of the initiative should be considered by implementation of RISE in all medical curricula and healthcare spaces in Ireland. -
Board No: 2 #2024125
"The development of a group-based psychological intervention to address HIV stigma amongst African migrant women who are HIV positive"
Principal Presenter: Austin Bayley
Track: Diversity & Inclusion
HIV stigma is a very common troubling experience by patients living with HIV (PLWH). HIV stigma can lead to diminished self-esteem, exacerbate mental health difficulties and social isolation, and complicate the treatment of HIV itself. Reducing HIV stigma can be achieved through public health campaigns, organisational considerations, and also on an individual basis. The role and contribution of psychological intervention to effectively address internalised HIV stigma and accompanying shame is becoming more recognised.
Methods
The Infectious Diseases (ID) department of the Mater Misericordiae University Hospital was successful in funding the development of a new ID psychology service. Following the appointment of a Principal Clinical Psychologist, stakeholder involvement with the ID consultant group, clinical nurse specialists, and medical social workers was used to inform service development. Outpatient clinic space, administrative support, and referral pathways were developed.
Results
In the first 6 months, X ID psychology referrals were received. These came from patient cohorts of PLWH, and general Infectious diseases (e.g. bone and joint infection, chronic aspergillosis, etc). Patients with a diagnosis of long covid were not accepted to this new service as there is separately a nationally funded long covid psychology service. A significant psychological need was identified within the patient cohort of African women living with HIV. A preliminary model of internalised HIV stigma within a female African migrant cohort is discussed. As a means of addressing this particular challenge, a group-based intervention was co-created with Akidwa and trialled. Feedback from group participants will be described and recommendations for ID service provision will be highlighted.
Conclusions
There is a need to develop psychology services amongst existing ID clinical services to fully support our patients. The development of a group based intervention for female African PLWH demonstrates the role that an embedded psychologist can have within Infectious Disease service provision.
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Board No: 3 #2024155
"People Experiencing Homelessness With COPD Are Younger And Have More Severe Disease Than Housed People With COPD"
Principal Presenter: Sophie Coalter
Keywords: Homelessness, COPD, PFTTrack: Diversity & Inclusion
Background:
Homelessness is an independent risk factor for mortality and morbidity (Fazel et al., 2014). People experiencing homelessness (PEH) have a greater prevalence of respiratory diseases such as chronic obstructuve pulmonary disease (COPD) than the housed population, while also having poorer access to healthcare diagnostics (Lewer et al., 2019). However, PEH hospitalised for COPD have not been characterised.
Aims:
To compare characteristics of PEH to housed patients admitted with COPD.
Methods:
We performed a retrospective cohort study using electronic records of patients admitted with exacerbations of COPD to St James’s Hospital, Dublin, between January 2023 and June 2024 Homelessness was defined according to FEANTSA typology, and included rough-sleeping and living in hostels. Statistical analyses were conducted in SPSS, with one-way ANOVA used to compare outcomes which were continuous variables and Fisher’s exact test used to compare categorical outcomes.
Results:
201 patients were admitted with exacerbations of COPD during the study period, of whom 24 were PEH and 177 were housed. Approximately 2,000 of 270,000 adults in the SJH catchment area have experienced homelessness. PEH admitted with COPD exacerbations were younger than their housed counterparts, 50 years (range 37-64) vs 68 years (range 18-94) respectively, (p<0.001).
Only 8/24 (33%) of PEH had pulmonary function tests on record compared to 105/177 (60%) of housed patients (p<0.05). The mean FEV1% predicted in PEH was 35% (range 17-65%), compared to 57% (13-119%) in housed patients (p 0.008). 12/24 (50%) of the PEH had a CT thorax in the past 3 years vs 141/177 (80%) of housed patients (p 0.004). Emphysema was described in 9/12 (75%) of CT reports in PEH compared with 102/141 (72%) of housed patients (ns).
Despite a younger average age in PEH, length of stay in hospital was similar in PEH and housed patients (7.9 days vs 8.0, ns). Inpatient hospital mortality was higher among PEH with 1/24 (4%) vs 5/177 (3%), (ns).
Conclusion:
PEH admitted to hospital with infective exacerbations of COPD have more severe disease and higher mortality rates despite being much younger than housed patients. PEH are less likely to have pulmonary function tests, a key investigation which guides specialist outpatient COPD management. This small cohort study suggests a need for improving access to COPD care in PEH.
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Board No: 4 #2024126
"HEALTH OUTCOMES OF UNACCOMPANIED REFUGEE MINORS - A NATIONAL REVIEW"
Principal Presenter: Deirdre Foley
Track: Diversity & Inclusion
Background
An unaccompanied minor (UAM) as a child or adolescent under the age of 18, who is separated from both parents and other relatives and is not being cared for by any other adult. The number of migrant children globally has increased by nearly 40% in the past 20 years. Data collection on this cohort is complex, due to lack of identity documents and mediums through which migration of UAMs can occur.
Method
All unaccompanied minors attending our inclusion health service were audited for demographics and health outcomes.
Results
21 UAMs were referred to our inclusion health clinic, two of whom were re-directed due to age. Of the 19 children reviewed the median age of children at time of referral to our service was 15.25 years (range 10.6 – 16.0 years).
Country of origin
Afghanistan 9
Somalia 3
Nigeria 3
Democratic Republic of Congo 2
Palestine 1
Sierra Leone 1
Time in transit ranged from 3 days to 18 months. Many had received threats from armed groups, abuse, female genital mutilation or were trafficked. Vitamin D levels were reported as adequate in eight (42.1%), high in one (5.3%), and moderate or severely low in nine (47.4%) children. 18 (94.7%) children received screening for communicable disease. All children screened negative for hepatitis B and C, HIV and urine PCR for chlamydia and gonorrhea. Quantiferon was negative in 14 (73.7%), positive in two (10.5%) children. Two children (10.5%) had symptoms of active pulmonary tuberculosis on arrival to the state both whom were immediately referred for treatment.
Conclusions/Learning Points
UAMs represent a highly vulnerable population with significant mental health needs and at risk of serious infectious disease, child trafficking or abuse, child marriage and threats to life.
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Board No: 5 #2024161
"A Clinical Pathway for the Use of Long-Acting Injectable antiretroviral therapy (LAI-ART) in Adherence Challenged People Living with HIV"
Principal Presenter: Siobhan Quirke Niamh Allen
Track: Diversity & Inclusion
Background: Intramuscular injection of long-acting cabotegravir and rilpivirine is approved for use as a fully suppressive treatment option for HIV-1. It allows PLWH to receive two monthly treatment instead of daily tablets. [1, 2, 3] It offers a novel option for treatment, particularly for adherence challenged populations. Successful use of LAI-ART in such individuals, including those with detectable HIV viraemia has been demonstrated in clinical trials. [9 – 11] This has resulted in expansion of international guidance. [12] We implemented a clinical pathway for use of LAI in adherence challenged patients who have failed to sustain virological suppression with oral regimens. This has been introduced at St James Hospital (SJH), Dublin and Galway University Hospital (GUH).
Methods: We conducted a literature review in relation to use of LAI-ART in adherence challenged populations. We designed a clinical pathway outlining eligibility and exclusion criteria, processes of approval at each clinical site, dosing schedules and follow up requirements. We have audited implementation barriers at both clinical sites. We are prospectively collecting data and are awaiting approval of sharing agreement to allow cross-site data collation.
Results: At this time 5 patients have been commenced on this pathway; 2 in SJH and 3 in GUH. Of the 2 individuals commenced in SJH one is homeless, one is housed. Both have demonstrated an inability to adhere to oral regiments resulting in viraemia and one individual has experienced morbidity as a result of uncontrolled HIV. One has achieved a significant reduction in VL, from 2511 copies / mL to 250cpm following receipt of a single dose. Repeat VL post second dose and 3rd injection are pending. They received the second dose late but within 7 day treatment window. The second individual has received a single treatment dose to date. We will present detailed data regarding virological outcomes and patient reported outcome measures for all individuals; I cannot report this at this time pending confirmation of sharing agreement. We have identified multiple barriers to administration of LAI within the cohorts. These have included NNRTI/INSTI resistance due to previous intermittent adherence, geographical isolation requiring significant travel to hospital appointments and communication difficulties resulting in disengagement.
Conclusion: LAI-ART has the potential to be revolutionary for HIV care for individuals who have trouble taking daily medicines. This clinical pathway will add to existing observational data and further explore systems-level and individual-level barriers to implementation.
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Board No: 6 #2024187
"The Healthcare Needs and Experiences of HIV Positive Women Who Live in Irish Direct Provision System: A Mixed Method Research Study"
Principal Presenter: Nadra Nurdin
Track: Diversity & Inclusion
Introduction: Women living with HIV who are seeking asylum face intersecting challenges including social isolation, stigma and financial barriers that may compromise their linkage and retention in HIV care. Despite this, they are an under-researched group. This study aims to describe the challenges and barriers faced by these women in seeking healthcare and relate these to their HIV care outcomes.
Methods: Cis and transgender women living with HIV and who currently or previously resided in direct provision were invited to participate in this study. Participants were recruited from St James Hospital(SJH) and Mater Misericordiae University Hospital(MMUH) HIV clinics. Medical records were reviewed to assess HIV related care outcomes including viral blips, viral resistance and clinic non-attendance. A survey was performed to assess demographic factors, compliance and social support; quality of life was assessed using the WHOQOL-HIV BREF questionnaire. Semi-structed interviews and focus group sessions assessed qualitative aims.
Results: 56 women were recruited; 46 from MMUH and 10 from SJH. The mean(SD) age was 42(± 9.1), all women were born in Sub-Saharan Africa. Mean(SD) months in direct provision was 20(± 19.9). 32% had family in Ireland. 96% of participants were taking antiretroviral medication (ARV); 93% achieved viral suppression. 16% reported suboptimal ARV adherence, 10% experienced a viral blip, and 15% had less than perfect clinic attendance. Women who had suboptimal adherence, clinic non-attendance or detectable VL after suppression were more likely to be current residents in direct provision (17(94%) vs 27(71%), p=0.046]. Lower WHOQOL-HIV BREF scores in the physical health domain were independently associated with missed clinic appointments (OR=0.59, CI: 0.37-0.96, p=0.033). Non-significant trends were noted towards women with suboptimal adherence being more likely to not have family in Ireland [17(95%) vs 27(73%), p=0.062], and being current direct provision residents [11(100%) vs 33(73%), p=0.053].
Five main qualitative themes emerged: i)stigma and discrimination, ii)overall positive experiences of hospital healthcare, iii)challenges of adherence to medication due to a lack of privacy, iv)social isolation, and v)experiences of violence and abusive relationships. The women described the psychological toll of living with HIV and emphasised the benefit of peer support networks. Interestingly, participants also described marked social benefits from involvement in this study.
Discussion: Consequences of forced displacement, social isolation, and restrictive, inadequate living conditions compromise access to healthcare for women living with HIV in Irish direct provision. Future solutions that warrant exploration include advocating for improving accommodation facilities, peer support initiatives and methods to target stigma such as education through engaging community leaders.
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Board No: 7 #2024136
"A Needs Assessment for an Inclusion Health Service at Beaumont Hospital"
Principal Presenter: Caitríona O’Sullivan
Keywords: Inclusion Health, Homeless Healthcare, Public HealthTrack: Diversity & Inclusion
Background:The high burden of chronic illness and the inefficient utilisation of healthcare services by people experiencing homelessness (PEH) puts a significant financial and resource strain on Dublin hospitals. Previous inclusion health services have demonstrated success in improving both patient outcomes and reducing burdens on hospital resources and finances.
Aim:To conduct a needs assessment for the development of an inclusion healthcare initiative at Beaumont Hospital(BH).
Research Design & Setting:A 6-month retrospective observational study, analysing patient data of those who were identified as homeless, over a 5-week period in BH emergency, outpatient (OPD) and inpatient departments, using computerised health information systems.
Results:Between June 4th and July 5th 2024, 22 patients presenting to BH were identified as homeless, 16 males (72.72%) and 6 females (27.27%). 16 (72.7%) patients identified as Irish nationals. Multiple co-morbid chronic illnesses were identified among this patient cohort, of which mental health illness was the most common (31.8%). Alcohol and illicit substance use was identified in 10 (45.45%) and 8 patients (36.36%) respectively. This cohort of patients accounted for 134 ED attendances over the 6 month study period, averaging approximately 6 attendances per person, ranging 0-45. An average ED presentation costs approximately €464.36 in similar tertiary Dublin hospitals. Hence, this patient cohort amounted to am approximate total cost of €62,688.60 in BH over this 6 month period. A total of 419 bed days were accounted for among this patient cohort over the 6 month study period. The mean length of stay per patient was 19 days. 8 patients were documented to have missed OPD appointments with a total of 17 missed appointments over the 6 month study period. According to a national healthcare information system, NIMIS, this patient cohort have accumulatively presented to 15 different Irish hospitals, with an average patient presenting to approximately 5 different hospitals, demonstrating a poor continuity of care.
Conclusion:A multimorbid and socially complex group of patients in BH was identified during a short five week period. The number of patients reported by clinicians as homeless during this timeframe is likely to underrepresent the accurate sum of patients experiencing homelessness attending BH. Given the extensive healthcare needs of PEH in BH, and the previous success of inclusion health teams in Dublin hospitals with similar patient demographics, an inclusion health team at BH is likely to improve both patient outcome, in addition to improving hospital resources and cost saving measures.
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Board No: 8 #2024190
"Prevalence of HIV-Related Stigma and the Association with HIV Treatment Engagement and Antiretroviral Therapy Adherence among People with HIV."
Principal Presenter: Leigh Lehane
Keywords: STIGMA, HIV, adherenceTrack: General Infectious Diseases
HIV
Background: HIV-related stigma is multifaceted and adversely impacts mental health, treatment engagement, and antiretroviral therapy (ART) adherence among people with HIV. As part of a systematic literature review (SLR) evaluating 6 research questions on HIV-related stigma, data on prevalence and associations with treatment engagement and outcomes across the HIV care continuum are presented.
Methods: Searches were conducted in MEDLINE® and Embase® via the OVID platform from database inception (care continuum search) or May 2020 (prevalence search) to May 2023. Relevant conferences, SLR bibliographies, and websites from 2021 to 2023 were also searched. Eligibility criteria were applied using the Condition, Context, and Population framework. Records were independently screened by 2 reviewers until ≥90% inter-rater reliability was achieved. Data were extracted by a single reviewer and validated by a second.
Results: The SLR identified 15 studies reporting prevalence of HIV stigma and 29 studies reporting associations between HIV stigma and treatment outcomes, including engagement/retention in HIV care and ART adherence. The reported prevalence of HIV-related stigma was broad across multiple stigma types and geographic regions, including Brazil, China, Europe, and the United States, ranging from 10% to 94%. Among 10 studies evaluating associations between stigma and engagement/retention in care, 7 reported significant associations (P<0.05) between higher internalized, perceived, or unspecified stigma and reduced engagement/retention in HIV care. Among 20 studies evaluating associations between stigma and ART adherence, the majority reported significant associations (P<0.05) between higher internalized, enacted, personalized, anticipated, perceived, or unspecified stigma and suboptimal ART adherence.
Conclusion: This SLR found HIV-related stigma in people with HIV was broadly reported and negatively impacted engagement/retention in HIV care and ART adherence. Findings underscore the need for strategic interventions that reduce HIV-related stigma and enhance treatment outcomes for people with HIV.
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Board No: 10 #2024114
"A Retrospective Review of Children and Young People with Pertussis Positive Swabs in Southern Health and Social Care Trust from January 2024 to August 2024"
Principal Presenter: Jonathan McIntosh
Keywords: Pertussis, Vaccine, Southern trustTrack: Epidemiology & Population Health
Background
Pertussis (whooping cough) is a highly infectious disease caused by Bordetella pertussis. Malignant pertussis affects young infants, characterized by respiratory distress, perpetual tachycardia and hyperleukocytosis up to 30 G/l, leading to multiple organ failure and death in 75% of cases.
Pertussis is a vaccine preventable disease and part of the UK Immunisation schedule. It is available for infants, children and pregnant mothers. In 2024, there was a sharp increase in cases across all regions in the UK particularly in under 3 months, although this was below the 2019 peak.
The aim of our study is to analyse patient demographics including immunisation status, clinical presentation, course and outcome of children and young people with positive pertussis swabs within the Southern Health and Social Care Trust (SHSCT) area.Methods
Positive pertussis swabs from January - August 2024 were obtained and data on presentations and outcomes recorded and analysed.
Phone interviews with seven mothers whose infants presented under 3 months of age.Results
· 37 positive swabs represent 27 patients (some had repeat), 3 excluded as outside Trust, N=24
· 13 males, 11 females
· 13 under 1 year
· 7 under 3 months (none of the mothers had received pertussis vaccine)
· 6 between 4-12
· Children had received all primary immunisations
· 16 patients required hospital admission between 1-9 days, median 1-2 days
· Symptoms included spasmodic cough, colour change, feeding difficulties
· 1 had seizures but was not as a direct result of pertussis as she has epilepsy
· 11 required blood tests. No one had white cell counts over 30.
· 3 patients were readmitted all under 3 months due to ongoing spasmodic cough and maternal anxiety
· No one required admission to PICU
· We contacted seven mothers whose infants were age under 3 months on admission. All babies continued to cough for 8-12 weeks but currently well
· 3 mothers did not recall being offered the antenatal vaccine, 1 was offered it too late in pregnancy, 1 forgot to attend appointment, 1 was wrongly told that she did not require and 1 was unsure.
· All 7 mothers agreed they would take it in future pregnanciesConclusions
· We found an almost equal sex distribution
· Over half the patients were under 1 year and a third under 3 months at presentation
· We saw no malignant pertussis
· All who presented under 3 months were born to mothers did not receive antenatal pertussis vaccine -
Board No: 11 #2024135
"Annual Hepatitis C Screening in Men Who Have Sex with Men Living with HIV: An Audit of Compliance with National Guidelines"
Principal Presenter: Kieran Cooper
Keywords: Hepatitis C screening, HIV, gbMSMTrack: General Infectious Diseases
Background
Men who have sex with men (MSM) living with HIV are at increased risk of hepatitis C virus (HCV) infection, particularly via sexual transmission. National Clinical Guideline No. 15 recommends annual HCV screening for all MSM living with HIV, with more frequent testing in the presence of risk factors such as an unexplained rise in alanine aminotransferase (ALT) or a newly diagnosed sexually transmitted infection (STI). This audit evaluated adherence to these recommendations in a tertiary hospital in Ireland. The national goal is to make HCV a rare disease by 2030.Methods
A retrospective audit was conducted of 100 MSM living with HIV who attended a tertiary hospital for HIV care from 1 January to 31 December 2024. Electronic and physical medical records were reviewed to assess demographics, HCV screening status within this timeframe, ALT levels, recent STI diagnoses, and history of chemsex. Descriptive statistics and subgroup analyses were performed using Microsoft Excel.
Results
Screening rate: 27% (27/100) of eligible patients were screened for HCV.
HCV prevalence: 3.7% (1/27 screened patients tested positive).
Screening in high-risk groups:
– 40% (10/25) of patients with an unexplained rise in ALT were screened
– 29% (5/17) of patients with a newly diagnosed STI were screened
Age: mean 38.2 years; median 37
Years since HIV diagnosis: mean 7.1; median 5
Only one patient had a documented history of chemsex; this individual was not screened.
No interventions or changes in practice occurred during the audit period.Conclusion
This audit highlights poor adherence to national HCV screening guidelines for MSM living with HIV, with less than one-third screened in the past year. Even among patients with recognised risk factors, screening was inconsistent, indicating missed opportunities for early diagnosis and treatment. Targeted quality improvement measures—such as clinician education, audit feedback, and electronic prompts—are needed to align practice with national goals and help achieve the elimination of HCV as a public health threat in Ireland by 2030. -
Board No: 12 #2024168
"Testing the waters: Rates of HIV testing in an Irish Emergency Department"
Principal Presenter: Nalisu Mazubane
Track: General Infectious Diseases
Background:The CDC recommends testing patients for HIV using an “opt-out” approach–meaning that absence of dissent is taken as consent.Though there is a paucity of recent guidelines on consent for HIV testing in Ireland, Medical Council guidelines recommend that informed consent be taken prior to doing an HIV test. This service evaluation assessed HIV testing at a major teaching hospital Emergency Department (ED),as well as knowledge, attitudes and practices of healthcare workers (HCW) around it.
Methodology:The project was commenced after approval by our institution’s Quality Improvement office. It aimed to review the number and results of HIV tests carried out via the ED of our institution over one year from 01 June 2023 to 01 June 2024, sourcing the data from the microbiology labWe also evaluated the knowledge and attitudes of HCW about HIV testing and barriers, if any, to the testing. Accordingly, 25 HCW completed a questionnaire consisting of ten questions to be rated on a five point Likert scale. Healthcare workers on duty in the Emergency Department were randomly selected and approached to complete the questionnaires.
Results:7 090 patients were seen from 01 June 2023 until 01 June 2024, and of these 195 (1.14%) were tested for HIV.Of these, 2.05% (n=4) were positive and 0.5% (n=1) were equivocal. It was uncertain whether these were previously known positive cases or first-time diagnosis. Comparing this to national figures, in 2023 there were 911 total HIV diagnoses in Ireland, giving a rate of 17.7 per 100,000 population according to the Health Protection Surveillance Centre.Regarding the attitudes surrounding HIV tests in ED, 60% (n=15) agreed that the ED should offer HIV testing. 56% (n=14) agreed that written consent should be taken before doing an HIV test, while 28% (n=7) disagreed. 48% (n=12) felt verbal consent was sufficient for HIV testing, while 36% disagreed and 12% voted neutral
Conclusion:After the 2021 United Nations (UN) General Assembly, the UN set a 2025 goal that 95% of people with HIV should know their status in our aim to eradicate AIDS by 2030. Adopting the opt-out approach as the general culture is conducive to making progress towards this.This project highlighted an opportunity to educate staff on the opt-out approach to HIV testing.The study can then be repeated after this educational intervention, to assess the efficacy of the same.
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Board No: 13 #2024209
"Mpox Vaccine Readiness in High-Risk Healthcare Workers: an Institutional Analysis"
Principal Presenter: Seán Brennan
Keywords: vaccine, mpoxTrack: Epidemiology & Population Health
Background
There is a recommendation from the National Immunisation Advisory Committee that vaccination be offered as pre-exposure prophylaxis for healthcare or laboratory workers involved in the management of patients with mpox or their samples. In light of the clade Ib epidemic in Central and Eastern Africa there is an increasing risk of occupational exposure. We have conducted a local analysis of vaccine attitudes amongst high-risk staff in regard to mpox vaccination in St. James Hospital. Our intention is to identify barriers to vaccination and improve vaccine uptake. We have used an adapted version of the shortened scale 7Cs of vaccination readiness model.
Methods
Survey responses were collected from 52 patient-facing staff in the emergency department, infectious diseases and genitourinary medicine departments and laboratory. The survey included questions on vaccine intentionality, department, profession and 7 questions relating to vaccine readiness. These were scored on a 7 point Likert scale with higher scores equating with a higher readiness to accept the vaccine (minimum score 1 maximum score 7). Scores above 4 indicated vaccine readiness. Certain items were reverse coded (i.e. calculation, constraint) in order to achieve this. Data was analysed with appropriate statistical tests using SPSS.
Results
24 participants (46.2%) of all groups reported they would take a vaccine today. Participants who would not receive a vaccine displayed an overall median score of 4.6 (mean 4.5) versus a median of 5.5 (mean 5.3) in those who would receive a vaccine. There was a significant difference in complacency scores (median 3 vs 6) between these groups (p=0.001). Complacency scores had an median of 3.5 amongst GUM/ID staff compared to ED staff who displayed a median score of 6, and were lower amongst pharmacy staff, but these differences did not reach statistical significance. Compliance scores were highest in laboratory staff with a median of 7 (non-significant). 9.6% of participants had scores < 4 indicating vaccine hesitancy.
Conclusion
Median scores were overall similar between departments and professional roles. Although vaccine readiness scores were negatively associated with intentionality, both groups scored a median above 4 indicating vaccine readiness. Complacency scores reached significant difference when compared across vaccine intentionality groups. Pharmacy staff displayed lower complacency scores. This may reflect lower levels of patient contact. Overall scores indicate readiness to be vaccinated however vaccine intentionality remained low. This may be driven by complacency scores indicating a lower perceived risk of exposure.
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Board No: 14 #2024173
"Barriers to completing the Mpox vaccination series among attendees of The Mater Misericordiae University Hospital vaccination service"
Principal Presenter: Luzviminda Magalona
Keywords: #mpox, #vaccines, #immunisationTrack: Other
Barriers to completing the Mpox vaccination series among attendees of The Mater Misericordiae University Hospital vaccination service
Authors: Luzviminda Magalona, Mairead O’Connor, Aoife Heeney, Padraig McGettrick, Tara McGinty, Christine Kelly, Eavan Muldoon, John Lambert, Carlos Mejia-Chew.
Background: Mpox Vaccination is a crucial public health initiative to reduce the spread and severity of Mpox infection. In August 2024, the Mater Misericordiae University Hospital (MMUH) Infectious Diseases Clinic incorporated routine Mpox vaccination into their standard of care for anyone attending the clinic and eligible as per current National Immunisation Advisory Committee guidelines. Anecdotally, some who receive the first vaccine dose do not return for the second one, which is necessary for an optimal immune response. We conducted a survey to explore potential barriers to completion of the vaccination schedule.
Methods: We designed an online 20 multiple-choice question survey using SurveyMonkey. To explore possible barriers to completing the vaccination schedule we focused on three key areas of interest: knowledge gaps, service complexities, and stigma. The survey was distributed via email to all clinic users who received at least one Mpox vaccine dose between August 1, 2024, and March 13, 2025, and provided their email to be contacted by the service. Those who had received a second dose were excluded from the questions addressing barriers and potential facilitators to complete the vaccination series. All data collected were de-identified and compliant with General Data Protection Regulations.
Results: Out of 191 people contacted, 66 (34.5%) responded to the survey. Most respondents were aged 25-44 years (72%) and 19 (29%) were people living with HIV. Thirty-one (48.4%) self-identified as White/Caucasian, 25% as Asian, and 25% as Hispanic/Latino. Most (45%) had heard about the Mpox vaccine from their healthcare providers, followed by social media (17%), community organizations (13%), news articles (13%), and friends/word of mouth (9%). Twenty-one (33%) respondents had not received the second vaccine dose. The main reasons for non-completion included awaiting scheduling of the second dose (72%), followed by unawareness of the need for a second dose (11%), forgetting, not thinking a second dose was necessary, and side effects after the first dose (5.5% each). Although 94% received sufficient information about the need for the second dose, potential facilitators to receive a second dose included more flexible appointment options (66.7%), such as walk-ins, and text/email reminders (55%). Overall, 94% were very satisfied with the service.
Conclusion: Despite high satisfaction with the service, significant barriers exist to completing the Mpox vaccination series. These include a lack of awareness of the second dose and forgetfulness. Addressing these issues by improving communication and offering more accessible appointment options could help increase vaccine completion rates.
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Board No: 15 #2024158
"A Retrospective Examination of the Effect of RSV Immunisation on Hospitalisation Rates Among Irish Infants Over Two Seasons"
Principal Presenter: Sean Brennan
Track: Epidemiology & Population Health
RSV is a leading cause of hospitalisation among children and infants. From 2013-2023, infants <1 year accounted for ~67% of notified cases, ~64% of RSV-related emergency department visits, and ~69% of RSV-related hospital admissions, among children 0-4 years in Ireland. Seasonal variations in RSV incidence impact healthcare preparedness and public health measures. This exploration aims to examine RSV hospitalisation and case trends for 2024/25 and 2023/24 using HPSC data. Understanding these trends is crucial for anticipating healthcare demand and guiding policy decisions.
Data on confirmed cases and hospitalisation incidence were extracted from the HPSC public database for the above seasons. Weekly caseload data were compiled for the 0-4 years age group from Week 40 to Week 8 (October-February), while RSV and hospitalisation incidence were compiled for the <1 year group. Data were retrospectively analysed to identify variations in mean incidence, hospitalisation impact and disease burden.
RSV seasonality varied across the two seasons, with a later start to the season in 2024/25 observed. The 2024/25 season displayed a substantial reduction in RSV burden for infants as compared to the 2023/24 season. RSV cases and hospital admissions in the 0-4 years age group were reduced by 28% (4950 to 3565) and 30% (3270 to 2279), respectively. The mean incidence of RSV and RSV-related hospitalisations per 100,000 in the <1 year group were reduced by 45.6% (232.4 to 126.5) and 60.7% (116.3 to 45.7), respectively.
Notable differences in timing, circulation and intensity trends were observed between seasons. RSV cases and hospital admissions in 0-4 group were substantially reduced during the 2024/25 season, following the introduction of a passive immunisation program to babies born between September 2024 and February 2025. RSV and related hospitalisation incidence in infants <1 also saw a considerable reduction, highlighting the impact of the infant immunisation program. Additional research needed on contributing factors such as viral evolution, environmental influences, and population immunity. Data on infants under six months are required to provide more accurate insights into immunised versus non-immunised comparisons. As retrospective examination, this work is limited by availability of historical data and absence of publicly disclosed coverage rate for the 2024/25 infant immunisation programme. Consequently, it is challenging to establish definitive causality or correlation regarding its impact on RSV incidence and hospitalisation rates across Ireland.
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Board No: 16 #2024134
"Factors Affecting Vaccine Uptake in Renal Transplant Patients in Ireland"
Principal Presenter: Gavan Duffy
Keywords: Vaccine, Transplant, HesitancyTrack: Epidemiology & Population Health
Background
Renal transplant recipients require lifelong immunosuppressive therapy, increasing their susceptibility to infections. Despite the clear benefits of immunisation, vaccine uptake remains suboptimal in this population. This scoping review explores the factors influencing vaccine acceptance among renal transplant patients in Ireland, identifying key barriers and facilitators to inform healthcare policy and clinical practice.Methods
A scoping review was conducted following the PRISMA-ScR framework. A systematic literature search was performed across PubMed, Scopus, Embase, and Google Scholar for studies published from 2015 onward, focusing on vaccine uptake among renal transplant recipients and other relevant immunocompromised or socioeconomically disadvantaged populations. Inclusion criteria encompassed studies assessing patient-specific, healthcare system-related, socioeconomic, and cultural influences on vaccination. Data were extracted and analysed using thematic synthesis to categorise key factors affecting vaccine acceptance.Results
Seventeen studies met the inclusion criteria, revealing several recurrent themes. Safety concerns were the most frequently cited barrier, with renal transplant patients expressing fears regarding vaccine side effects and efficacy in immunocompromised individuals. Mistrust in healthcare providers was another significant obstacle, often influenced by prior negative experiences or systemic healthcare disparities. Socioeconomic status strongly impacted vaccine uptake, with lower-income individuals facing barriers such as limited healthcare access and increased exposure to misinformation. Cultural influences, particularly in minority populations, played a substantial role, with vaccine hesitancy linked to community beliefs and historical distrust of medical institutions. Healthcare provider recommendations were identified as a key facilitator, with strong endorsements significantly improving vaccine acceptance.Conclusion
Vaccine hesitancy among renal transplant patients is multifaceted, driven by concerns over safety, mistrust in healthcare providers, socioeconomic disparities, and cultural influences. Addressing these barriers requires targeted interventions, including patient-centred education, trust-building initiatives, and improved healthcare accessibility. Public health strategies should prioritise culturally tailored communication and enhance provider-patient discussions on vaccine safety and efficacy. Further research is needed to explore long-term interventions and the impact of misinformation on vaccine uptake within this vulnerable population. -
Board No: 17 #2024198
"Vaccination, Screening and Prophylaxis of Chronic and Opportunistic Infections in The Mater Rheumatology Cohort"
Principal Presenter: Bearach Reynolds
Keywords: Immunosuppression, Vaccination, ScreeningTrack: General Infectious Diseases
Background
Biologic agents are being used increasingly across many medical specialities. While these medications offer significant benefit, there are well established risks including opportunistic infections. There are clear guidelines, specific to the rheumatology population, which set out how to protect patients through appropriate screening, prophylaxis and vaccination. We audited practice in the rheumatology population in Mater University Hospital.
Methods
An audit form was made based on ‘The 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases’ and ‘The 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections’. These focus on patient screening of infection and vaccination. We reviewed the last 51 patients who were referred for pre-biologic counselling to the rheumatology specialist nurses and were either starting on biologics or due to change from one biologic to another. Electronic records correspondence with GPs were reviewed. Vaccines were marked as included if they were mentioned in correspondence to the GPs at the time of biologic screening or in the last two years.
Results
51 patients referred for nurse review were included. The median age was 53 (IQR) years and 58% of patients were male (n=33). 49 (86%) were of Irish ethnicity. The most common indication for biologics was Rheumatoid arthritis (n=22 , 38.5%) with tocilizumab (n=10, 17.5%) and adalimumab (n= 8, 14%) being the 2 most common agents.
In terms of pre-biologic screen, VZV IgG was sent in 72.5% of patients and HIV serology was requested in 78.4% of patients. 86.2% had a Tuberculosis IGRA and 84.1% had a chest x-ray. Hepatitis A IgG in was checked 86.2%. With regards to Hepatitis B, 94.1% of patients had a surface antigen checked with only 43.1% of patients having a core antibody result available. 92.2% of patients had hepatitis C antibody results available.
In terms of vaccination, less than 10% of patients had Covid, influenza or pneumococcal vaccine mentioned to their GP in correspondence. From a nursing education point of view, 97% of patients had documentation of nurse led education around vaccination.
Conclusions and recommendations
Within the cohort commencing biologics in the rheumatology department of MMUH, there is scope to increase compliance with the EULAR guidelines specifically improving pre-biologic serology testing and improved communication with GP regarding vaccinations. We suggest increased collaboration between specialities to optimise pre-biologic screening for chronic/latent infections and identify high risk patients for further evaluation by Infection specialists.
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Board No: 18 #2024120
"HBV vaccination in HIV patients in Beaumont Hospital: how often is HBsAb repeated post vaccination."
Principal Presenter: Ayat Alharbi
Keywords: HBV, Vaccination, HIVTrack: Virology
Background: HBV vaccine is a yeast derived vaccine which is prepared with biosynthetic surface antigen made using recombinant technology.
Approximately 80–90% of healthy young adults achieve HBV surface antibody (HBsAb) levels >10 IU/L after a complete vaccine course. Antibody levels >100 IU/L are regarded as ideal whereas a level <10 IU/L is classified as non-response.
As per BHIVA guidelines, it is recommended that HIV-positive adults be screened for evidence of HBV infection or immunity, and that non-immune individuals (HBsAg negative, HBcAb negative, HBsAb negative) be offered HBV vaccination.
Aim: This audit aims to explore the effectiveness and guidelines adherence of HBV vaccination of HIV patients in Beaumont Hospital who are found to be non-immune and specifically to look at the rate of repeating HBsAb level after receiving hepatitis B vaccine.
Methods: 50 medical charts were retrospectively reviewed for patients attending HIV clinic in Beaumont Hospital between 2019-2024.
Results:
1) Out of 50 patients that were audited, 23 patients (46%) showed evidence HBsAb to be less than 10.
2) Out of the 23 patients who had HBsAb <10, 4 patients had positive HbcAb (evidence of immunity from previous infection) and didn't require hepatitis B vaccination.
3) All of the remainder 19 patients who had evidence of non-immunity (HBcAb negative and HBsAb less than 10) received the typical course of hepatitis B vaccination.
3 patient received Twinrix vaccine (combined hepatitis A and B vaccine) and 16 patients received Engerix-B vaccine.
4) Out of the 19 patients who received Hepatitis B vaccine whether in the form on Twinrix or Engerix-B, 9 patients (47.3%) didn't have a repeated HBsAb test.
5)Out of the 10 patients who had repeated HBsAb test after hepatitis B vaccination, 4 patients showed evidence of no response (HBsAb <10) and three of these received a booster dose of hepatitis B vaccine.
Conclusion:
Adherence to guidelines is encouraged regarding repeating HBsAb level after receiving three doses course of hepatitis B vaccine.
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Board No: 19 #2024220
"Immunogenicity of Respiratory Syncytial Virus and Influenza Vaccinations in Allogeneic Haematopoietic Stem Cell Transplant Recipients"
Principal Presenter: Ellen walsh
Track: Virology
Background:
Respiratory viruses are a significant cause of morbidity and mortality among allogeneic haematopoietic stem cell transplant
recipients (HSCT), particularly early post-transplant. Vaccination is one of the most important and cost-effective public health
interventions available. There is a lack of information on vaccine immunogenicity in immunocompromised patients due to exclusion
from clinical trials assessing vaccine effectivenes. Particularly, there is a lack of research on cellular immune responses to
vaccination in this patient cohort. Two vaccines were licensed against respiratory syncytial virus (RSV) in 2023. There is no published data to date evaluating the cellular immune response to these licensed vaccines in any cohort.
Methods
A prospective observational study is being conducted through the 2024/2025 winter season. Allogeneic HSCT recipients and
control volunteers without immunocompromising conditions were vaccinated with quadrivalent inactivated seasonal influenza
vaccine and an AS01E – adjuvanted RSVPreF3 vaccine per European licensing criteria. Peripheral blood was drawn at baseline and
post-vaccination. A whole blood multiplex cytokine release assay was performed following overnight stimulation with inactivated
influenza A/H1N, A/H3N2 reference antigens, RSV, and phorbol myristate acetate and ionomycin positive control at 37oC. Antibodies against RSV were quantified by ELISA.
Results
15 HSCT recipients and 15 control volunteers were vaccinated against RSV. Preliminary cellular immune response data are described. Median time from HSCT was 9 months (range 4-12 months). 50% remained on low-dose immunosuppression. 83% had a CD4+ T-cell count of<400/mm3. 86.6% were vaccine-naïve post-transplant. Follow-up samples were taken at median of 4 weeks post-vaccination. IFNγ and IL-2 production was measured and 5-95th percentile ranges were calculated. HSCT recipients had lower cytokine production than controls, with the exception of one. They were also more likely to have a fold increase of >1 to A/H1N1 and A/H3N2 despite lower absolute cytokine levels. Production of IFNγ in response to RSV was significantly increased in the HSCT group post-vaccination and IL-2 significantly increased in both groups post-vaccination.
Conclusions
This preliminary data supports immunogenicity of the cellular immune response to RSV vaccination in both control subject and
HSCT recipients in the early post-transplant period. Higher fold increases in response to antigens in the post-transplant group
may reflect prior vaccination in the control group.
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Board No: 20 #2024153
"How do Risk Assessment Models impact 30-day Unplanned Hospital Readmissions in Adult Patients receiving Outpatient Parenteral Antimicrobial Therapy (OPAT)?: A Systematic Review."
Principal Presenter: Tracy Finnegan
Keywords: Predictive models, OPAT, ReadmissionTrack: General Infectious Diseases
Background:Outpatient Parenteral Antimicrobial Therapy (OPAT) enhances health-related quality of life; however, unplanned readmissions may reduce patient satisfaction and the cost-effectiveness of the treatment. By predicting and minimizing these unplanned readmissions, patient outcomes can be significantly improved. Predictive models for unplanned OPAT readmissions can help identify high-risk patients, enabling tailored care and support. However, data on the effectiveness of OPAT-specific models is limited.This systematic review assessed the impact of risk assessment models on 30-day unplanned hospital readmissions among adult patients receiving OPAT.
Methods:A systematic review aiming to measure the impact of readmission risk models on 30-day unplanned hospital readmissions in adult OPAT patients. Searching electronic databases identified 435 potential articles. Independent selection, data extraction, tabulation of findings, and analysis were completed. Meta-analysis was conducted using JBI Sumari. When a meta-analysis was not feasible, the results were reported narratively.
Results:Three studies met the inclusion criteria. The primary outcome of the review was to measure the impact of OPAT readmission risk models on 30-day hospital readmissions by evaluating their ability to accurately predict readmissions within 30 days. Two studies reported low c-statistics, indicating poor discriminative capability, while one study showed a c-statistic of 0.75 in a temporal validation cohort, suggesting modest discriminative ability but lower accuracy in a broader group.
A meta-analysis of the likelihood of unplanned readmissions in OPAT patients' found no significant differences in unplanned readmissions. Across the studies, the most common reason for readmission was infection-related, followed by adverse drug events, and complications from vascular devices. There were few reported readmissions for diarrhoea.
The studies identified different risk factors for readmission depending on the patient case mix, the structure of the OPAT service and the methods of OPAT delivery. Aminoglycosides and daptomycin were linked to a lower likelihood of readmissions, while other factors showed no clear trends. Results on endovascular infections and concurrent antimicrobial use had low heterogeneity indicating that the results can be trusted, but findings regarding drug-resistant organisms, age, the Charlson Comorbidity Index, and previous admissions should be interpreted with caution due to high heterogeneity.
Conclusion:The limited studies in the review hindered data synthesis. It found insufficient data on the efficacy and transportability of current OPAT readmission risk models. Further research is needed to enhance the transportability of these models and develop site-specific versions for different settings
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Board No: 22 #2024208
"OPAT in Sligo University Hospital"
Principal Presenter: Elaine Casserly
Keywords: OPAT, Sligo University Hospital, Infectious Disease SUHTrack: General Infectious Diseases
Background
Sligo University Hospital (SUH) is a 307 Bed hospital providing acute hospital services to Sligo/Leitrim/West Cavan and South Donegal. Over the last year efforts have been made to formalise the delivery of OPAT with the hiring of an Infectious Diseases (ID) consultant in early 2024 supported by a Community Intervention Team (CIT) liaison nurse. This has resulted in an increase in OPAT referrals as well as hospital bed days saved.
Methods:
Patient data was reviewed and collated from the OPAT portal as well as local database records. Patients who were discharged on OPAT in 2024 were included in the review.
Results
Twenty one patients received antibiotics through the OPAT programme from January 2024 to December 2024 compared to three patients in 2023. Eleven patients were male, ten were female. Patients were aged between 33 to 81 years. S-OPAT was used in the majority of cases at 81% (17/21). The most common indication for therapy was bone and joint infections 28% (6/21), bacteraemia 19% (4/21), empyema 9% (2/21), intra-abdominal abscess 9% (2/21) , skin and soft tissue infections 9% (2/21), infective endocarditis 9% (2/21), there was one case of pyelonephritis, meningitis and neurolyme. The most commonly prescribed antimicrobial was Ceftriaxone 42% (9/21), followed by Flucloxacillin 29% (6/21), Daptomycin in 19% (4/21) and Ertapenem in one case. Antimicrobial duration ranged from 6- 48 days with the average duration of 15 days. There were 321 bed days saved. There were no recorded line complications in this cohort. Two patients were readmitted to hospital while on the programme, one with acute kidney injury and another with increasing pain. In one of these patients antibiotics were changed and treatment failure evident. Otherwise cure was achieved in all other patients.
Conclusion
OPAT activity has increased seven fold in SUH from three to twenty one patients from 2023 to 2024. There was an increase in bed days saved from 73 to 321. As of March 2025 there have been six patients referred onto the OPAT programme, a further increase from last year. The recruitment of an ID consultant and CIT liaison nurse has allowed for specialised outpatient surveillance in line with national OPAT guidelines. Challenges still remain. Further work is needed in the area of early patient identification, staff education, recruitment of staff in hospital and the community to allow for service flexibility and expansion.
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Board No: 23 #2024225
"Outpatient Parenteral Antimicrobial Therapy (OPAT) Outcomes and Supply Chain Contingency Planning at Cork University Hospital: 2024"
Principal Presenter: Cian Lenihan
Keywords: OPAT, Quality Improvement, Antimicrobial StewardshipTrack: General Infectious Diseases
Background
Outpatient Parenteral Antimicrobial Therapy (OPAT) at Cork University Hospital (CUH) allows patients requiring intravenous antibiotics to be safely managed at home following clinical stabilisation. CUH’s OPAT service aligns with the National Irish OPAT Guidelines [1], prioritising self-administered OPAT (S-OPAT) and maintaining a target readmission rate below 5%. This study aimed to summarise OPAT outcomes at CUH for 2024, compare these with prior year performance, and highlight barriers encountered—specifically, recent antibiotic supply delays from the designated manufacturing company and subsequent local contingency strategies implemented.Methods
All OPAT referrals at CUH during 2024 (n=279) were retrospectively reviewed, yielding 173 unique patients who were accepted by the service. Data collected included referral specialty, microbiological results, antibiotic regimens, intravenous catheter complications, readmissions, and bed-days saved. Comparisons were made with 2023 performance data, and adherence to the National Irish OPAT guidelines was assessed.Results
Of 279 OPAT referrals in 2024, 173 unique patients (average age: 60 years; male 60.7%) were enrolled in the service. Orthopaedics was the predominant referring specialty (31.8%), followed by Infectious Diseases (17.3%), Plastic Surgery (8.1%), and Endocrinology (7.5%). Ceftriaxone, flucloxacillin, and daptomycin were the antibiotics most frequently used. One catheter-related bloodstream infection was recorded during the year, and vascular access issues remained minimal (~2%). Overall, OPAT contributed significantly to hospital capacity, saving approximately 3,389 inpatient bed-days.However, significant external supply delays were encountered. Throughout 2024, intermittent shortages of compounded antibiotics from the supplying company delayed some discharges necessitating a contingency plan approved by the CUH Drugs and Therapeutics Committee. Interim bridging antibiotics were provided by CUH pharmacy to ensure continuity of care. Implementation of this contingency saved an additional 10 bed-days (cost saving of €8,970); however, despite this strategy, 67 bed-days were lost due to these delays, with an additional 9 bed-days lost due to OPAT staffing constraints.
Conclusion
The 2024 CUH OPAT outcomes underline continued success in effectively managing suitable patients in the community, saving substantial hospital bed-days and aligning with National Irish OPAT guidelines. The emergence of supply chain delays highlights a critical vulnerability in the OPAT service. CUH’s proactive implementation of a bridging antibiotic contingency plan provided an effective short-term solution, demonstrating a replicable model for national adoption. Future recommendations include fortifying supplier agreements, enhanced forecasting of antibiotic requirements, and robust contingency frameworks to ensure sustained OPAT service efficiency.
Reference
1. Health Service Executive (HSE). National Clinical Programme for Infectious Diseases and Antimicrobial Resistance. National Guidelines for the Provision of Outpatient Parenteral Antimicrobial Therapy (OPAT) [Internet]. Dublin: Health Service Executive (HSE); 2019 [cited 2025 Mar 17]. Available from: https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/national-guidelines-for-opat.pdf -
Board No: 24 #2024113
"Nocardia Osteomyelitis treatment on OPAT"
Principal Presenter: Mustapha Kamal Aziz
Keywords: Nocardia, Osteomyelitis, OPATTrack: General Infectious Diseases
Nocardia Farcinica is widely known to be a causative agent to cause infection in humans particularly in immunocompromised host.1 However, it is an uncommon infection especially in immunocompetent people. Nocardia infection is much related with soil as it part of the organisms in soil.2 In this case, we are reporting a 73 year old gentleman who is immunocompetent but developed Nocardia Farcinica osteomyelitis after cutting grass and sustained injury over right proximal tibial area while at home. Initial MRI of right tibia showed evidence of osteomyelitis. Gram stain , Culture and Sensitivity came back negative but samples grew from enrichment broth. Patient was then sent to theatre for surgical intervention and was then discharged under for prolonged treatment of antibiotics under Infectious Diseases team for Outpatient Antimicrobial Therapy (OPAT).
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Board No: 25 #2024186
"Proclamation of OPAT, medium for treatment revelation"
Principal Presenter: Mustapha Kamal Aziz
Keywords: OPAT, Patient SatisfactionTrack: General Infectious Diseases
Outpatient Antimicrobial Therapy (OPAT) has been an essential part of treatment in the Infectious Diseases (ID) team since its introduction in 2011 for patients requiring prolonged antibiotics. OPAT has allowed patients to receive hospital standard treatment while being at home. Most patients who are on OPAT are patient who receives antibiotics from days,weeks to months. As for most services, the main stakeholders in this are always the patients and it is vital that their feedback is heard as it will be the pillar for improving a service. We have conducted an audit to see how does the ID OPAT service in Our Lady of Lourdes Hospital, Drogheda faired from July 2023 to June 2024 through feedback questionnaire. These are patients who are on regular follow up and had their treatment course throughout in Drogheda Hospital. We designated a questionnaire and asked patients by the end of their treatment to see and gauge patient's satisfaction with the OPAT service from North East region (Louth, Meath, Cavan, Monaghan). Our feedback showed that majority of the patients had good experience with the OPAT service provided by ID team in Drogheda hospital. The downside of the study is that it needs a larger sample size to match the counties that OLOL Hospital is covering as we only had 70 patients who were on OPAT based from the Management Control Centre's data. There is always room for improvement for the service in terms of patient education and waste disposal being the main issue. In conclusion, the OPAT service in Drogheda hospital showed remarkable promise but obviously still needs more improvement to ensure the service is run better in the future.
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Board No: 26 #2024222
"The experiences of patients in the community following discharge on Outpatient Parenteral Antimicrobial Therapy (OPAT), a systematic review."
Principal Presenter: Aarti Gupta Michael Nash
Track: General Infectious Diseases
Background: OPAT, or Outpatient Parenteral Antimicrobial Therapy is referred to as treatment with intravenous antimicrobial administration in the community. This systematic review aims to evaluate the experiences of the patients discharged on OPAT.
Aim: To examine the experiences of patients treated on OPAT in the community
Methods: The author conducted a comprehensive review using MEDLINE, CINAHL, and EMBASE databases. Keywords such as outpatient parenteral antibiotic therapy, outpatient treatment, community antimicrobial treatment, and infection, were looked up on the databases in addition to usage of Boolean operators like ‘AND’ and ‘OR’. This search was limited to papers published during the past 15 years and only peer review articles solely in English language were included. The gender of the sample population of the studies didn’t affect the inclusion but age limiter (age>19yrs) was applied.
Results: Seven papers which fulfilled the predetermined inclusion criteria were found using the searching and selecting approach, and were subjected to methodological and critical appraisal. Four of the seven studies were deemed to be of good quality and were subsequently incorporated into the theme analysis procedure. Two major themes about the real-life experiences of patients receiving OPAT in the community emerged as a consequence of analysis and synthesis. Themes: 1) Triumphs in Home Healing 2) Complexities of Home-Healing. Three further subthemes were [AD1] created for each category under the two main themes. The study highlighted overall satisfaction and acceptance of OPAT, while also stressing the importance of comprehending patients' viewpoints and the nurses' role in providing comprehensive care. Nurses foster robust relationships with patients by offering comfort, empathy, and emotional support in community settings, hence improving treatment adherence and patient satisfaction. Alongside the anxiety and concern experienced by patient’s post-implantation of a long-line device, some individuals perceived their routines as too hectic, while a minority expressed frustration that frequent nursing visits encroached upon their privacy. These findings underscore the necessity for enhanced communication and care protocols customized to patients' needs and choices.
Conclusion: This Qualitative systematic review (QSR) emphasized the significance of patients' experiences with OPAT, identifying shortcomings that must be resolved to enhance community care. The study highlights the need of efficient communication, cultivating interpersonal connections, and patient centered care to alleviate anxiety and stress. Although there were differences among patients, a prevailing inclination towards receiving treatment at home was noted.
[AD1]Consider saying what they are, depends on word count -
Board No: 27 #2024143
"Assessing the Effectiveness of OPAT at a University Teaching Irish Hospital: A Patient-Centred Evaluation"
Principal Presenter: Areej Elzubair
Track: General Infectious Diseases
Assessing the Effectiveness of OPAT at a University Teaching Irish Hospital: A Patient-Centred Evaluatio
Aarti Gupta1,2, Mubashir Habib2, Areej Elzubair2, Ashwin Delmonte Sen2, Aoife Pearson2, Sinead Fenlon2, Ciara Parthiban1,2, Andrea Doyle2, Eavan Muldoon1, Fionnuala O'Connor1; Sarmad Waqas2,3
1. Health Service Executive 2. Tallaght University Hospital, Dublin 3. Trinity College Dublin
Background: To assess the OPAT service’s effectiveness and patient satisfaction, a series of surveys have been conducted previously since the OPAT governance was commenced by the infectious diseases department in Tallaght Hospital Dublin in May 2022.
The first survey evaluated the OPAT service from its inception until March 31, 2023, while a second survey covered the period from April 2023 to February 2024. This third follow up survey was recently conducted covering the period from March 2024 to February 2025, allowing for continued analysis of patient experiences and service outcomes.
Methodology: A sixteen-question survey was distributed to patients to gather insights on key aspects of their OPAT experience, including demographics, patient satisfaction, communication with the Infectious Diseases (ID) Team, and clinical waste management during treatment. The survey was commenced followin approval from the Quality Improvement (QI) department.
Results: During the latest survey period, 103 patients were enrolled in the OPAT program, with 56 individuals (55%) successfully completing the questionnaire. The patients were either contacted by phone or asked to fill the Performa while attending follow up appointment. Some patients could not be reached or had other commitments, while, unfortunately, one patient had passed away before participation was possible. The respondent group was evenly split between male and female patients (male n=31).
The majority of participants 95%(n-53) received OPAT through healthcare providers (H-OPAT), whereas a smaller fraction 5 %(n-55)opted for self-administered treatment (S-OPAT). When asked about side effects, 70%(n-39) reported no issues, while 29%(n-15) experienced mild symptoms such as nausea, vomiting, and indigestion. Notably, no severe adverse medication reactions were reported. Patients expressed high satisfaction with key aspects of the OPAT service, including communication with the Infectious Diseases Team, their clinic experience, and their willingness to recommend the service to others. Notably, concerns about clinical waste collection delays, which affected nearly 50% of respondents in the past two surveys, saw a significant improvement this year, with only 14% (n-8) reporting issues.Conclusion: The results demonstrated patient satisfaction and notable improvements in service delivery, particularly in waste management. While progress has been made, refining logistical aspects such as clinical waste collection will further enhance the overall OPAT experience. . The results have been disseminated to stake holders and we will continue the patient satisfaction surveys in future also to ensure ongoing improvement and maintenance of quality patient care.
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Board No: 28 #2024221
"A Descriptive Analysis of Management of Prosthetic Joint Infections and Fracture-Related Infections at University Hospital Waterford during 2024"
Principal Presenter: Stefania Stroiescu
Keywords: Prosthetic joint infections, Fracture-related infections, Bone and joint infectionsTrack: General Infectious Diseases
Background:
Bone and joint infections, including prosthetic joint infections (PJIs) and fracture-related infections (FRIs), often require prolonged treatment with intravenous antibiotics, leading to extended hospital stays and inconvenience for patients. The OVIVA study (2019) demonstrated that an early switch to highly bioavailable oral antibiotics is non-inferior to intravenous treatment in appropriately selected patients. To date, there has been no implementation of these findings in international guidelines. With a large orthopaedic department in University Hospital Waterford, a substantial number of Infectious Diseases consultation requests concern management of PJIs and FRIs.Methods:
A retrospective review of PJIs and FRIs treated at University Hospital Waterford in 2024 was conducted. Data collected included patient gender, infected joint/bone, surgical procedure performed, organism isolated, if an early oral switch was implemented and outcomes of same.Results:
In total, 85 PJIs or FRIs were included. 55 patients were male (64.7%), while 30 were female (35.3%). 60 infections were monomicrobial (70.6%), 9 were polymicrobial (10.6%), and 16 were culture-negative (18.8%). Affected joints were primarily hips (29; 34.1%), followed by knees (27; 31.8%) and tibia/fibula fracture-related infections (17; 20.0%).Surgical management included 27 DAIR procedures (31.8%), 32 exchange arthroplasties (37.7%), 4 excision arthroplasties (4.7%), and 22 removal of metalwork (25.9%).
Staphylococcus aureus (39/85; 45.9%) was the most common pathogen, followed by Coagulase-negative staphylococci (17/85; 20.0%), Streptococcus spp. (10/85; 11.8%) and Pseudomonas spp. (4/85; 4.7%).
An early oral switch (within 7 days) was implemented in 12 patients (14.1%), while 12 further patients were switched to oral antibiotics within 2 weeks. One remains on long-term suppression, one remains on antibiotics while awaiting metalwork removal and there is no evidence of infection recrudescence in the others to date. Among the 61 patients who did not undergo an early oral switch, 36 (59.0%) had no infection recrudescence, 14 (22.9%) remain on long-term suppression, 4 (6.6%) have ongoing infection, 2 (3.3%) died, while follow-up data was unavailable for 2 individuals (3.3%).
Conclusion:
An early oral switch was successfully implemented in appropriate patients with no evidence of infection recrudescence. These findings support the use of highly bioavailable oral antibiotics in managing PJIs and FRIs, potentially reducing costs and improving patient quality of life. While our analysis is limited by a small sample size, ongoing review of the management of PJIs and FRIs in subsequent years is warranted to gather further data.
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Board No: 29 #2024213
"Multidrug resistant prosthetic Hip joint infection managed via OPAT complicated by an unusual sarcoid-like reaction to Daptomycin."
Principal Presenter: Ahmed Isack
Track: General Infectious Diseases
Background:
A 55-year-old man with a history of total knee replacement (2010), total hip replacement (2018), and femoral plate placement for a periprosthetic fracture (2020) was admitted for a complex orthopaedic infection. Eight to ten weeks prior, he developed swelling in his right hip, initially diagnosed as trochanteric bursitis. A steroid injection was given, but the swelling ruptured four weeks later, resulting in purulent discharge. The patient underwent debridement, but the infection required a two-stage revision surgery for a polymicrobial, multidrug-resistant prosthetic joint infection.
Methods:
Microbiological analysis from the first debridement identified methicillin-sensitive Staphylococcus aureus (MSSA) and coagulase-negative Staphylococci. The first stage of revision surgery also grew vancomycin-resistant Enterococcus (VRE) with high daptomycin minimum inhibitory concentration (MIC), Pseudomonas aeruginosa, and coagulase-negative Staphylococci.
Results:
After the first-stage revision, the patient was started on oral linezolid and intravenous Piperacillin/Tazobactam. As the bacterial load decreased, oral rifampicin was added. However, the patient developed acute renal injury attributed to Piperacillin/Tazobactam, leading to a switch to intravenous Meropenem. His renal function improved without the need for dialysis or steroids. For discharge, to reduce prolonged exposure to linezolid, the patient was transitioned to self-administered outpatient parenteral antimicrobial therapy (Self-OPAT) with IV Daptomycin, IV Tigecycline, IV Meropenem, and oral rifampicin for six more weeks, totalling 12 weeks of antimicrobial therapy.
Three weeks into the OPAT regimen, the patient developed pleuritic chest pain. A CT pulmonary angiogram (CTPA) ruled out pulmonary embolism but revealed mediastinal lymphadenopathy and ground-glass opacities. An urgent endobronchial ultrasound (EBUS) biopsy showed non-necrotizing granulomas, and bronchoalveolar lavage (BAL) excluded eosinophilic pneumonitis. A rare sarcoid-like reaction to daptomycin was diagnosed. Daptomycin and tigecycline were discontinued, and oral linezolid was resumed, while meropenem and rifampicin continued. The patient’s symptoms improved after discontinuation of daptomycin.
After completing 12 weeks of antibiotics, the patient underwent a diagnostic hip aspirate, which was negative. Four weeks later, the second stage of hip revision surgery was performed. As of 20 months post-surgery, the patient is doing well.
Conclusion:
This case underscores the challenges of managing multidrug-resistant polymicrobial infections in patients with extensive orthopaedic hardware. Complications such as drug-induced renal injury and a sarcoid-like reaction were managed successfully, and the patient remains stable with no further respiratory issues.
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Board No: 30 #2024219
"Audit and outcomes of Prosthetic joint infections at an academic centre, insights from a prospective database."
Principal Presenter: Shaini Gangadharan
Track: General Infectious Diseases
Audit and outcomes of Prosthetic joint infections at an academic centre, insights from a prospective database.
Authors: S. Gangadharan1,2 , Kyle Gormley1, Cora McNally1, Peter Coakley1, Ksenia Davenport1, Sam McConkey1,2, Ann Platts1, Lorraine Myler1, Eoghan de Barra1,2
1. Dept. Infectious Diseases, Beaumont Hospital
2. Dept. International Health and Tropical Medicine, RCSI University of Medicine and Health Sciences.
Background
The management of Prosthetic Joint Infections (PJI) usually involves surgical intervention, a prolonged course of antimicrobial therapy, and follow-up (IDSA guidelines, 2013). We performed a follow-up of the treatment outcomes of patients with a PJI between 1st July 2023 and 31st July 2024 at our centre.
Methods
The recently established prospective database of PJIs was interrogated, and additional data points from laboratory systems and chart reviews were added as required. Variables included demographics, joints involved, type and timing of surgeries, microbiological results, and antimicrobial therapies. The outcome measures at six months post-infection diagnosis were clinical cure (alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antimicrobial therapy) and treatment success (clinical cure plus index prosthesis in situ) (Davis et al., 2022). A descriptive analysis will be presented.
Results
There were 12 patients with PJI identified in the study period. Of the patients reviewed, 41% were female. The most common treatment strategy was DAIR (Debridement, Antibiotics, and Implant Pretension) 58%. Of the joints involved, 75% underwent total hip replacements and 25% total knee replacements. PJI was early (< 30 days of initial surgery) in 25% of cases and late (> 30 days) in 75%. Among patients who underwent DAIR, 70% received Daptomycin as first-line therapy, with no reported adverse reactions. 57% received adjunctive rifampicin. When looking at rifampicin use among DAIR, 57% received it, however, MSSA was only found in one. 25% of patients underwent two-stage revision from PJI diagnosis.
Overall, 83% of the patients had a clinical cure, 85% with DAIR, and 100% with two-stage. Two patients initially treated with DAIR were subsequently converted to two-stage. Both had clinical cures at 6 months.
Conclusion
This dataset shows excellent 6-month outcomes. The relatively high frequency of DAIR and the success rates are above what has been reported elsewhere. Close interdisciplinary working is needed to choose the most appropriate therapies for PJI patients. The use of a prospective dataset should allow ongoing review of strategies and better inform patient selection and, ultimately, outcomes.
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Board No: 31 #2024177
"Optimising Outcomes in Foot Infections: A Collaborative Model for Rapid Infectious Diseases Assessment and Care"
Principal Presenter: Michelle Hooban
Track: General Infectious Diseases
Background:
Diabetic foot infections (DFIs) and osteomyelitis are leading causes of hospitalisation and limb loss. Timely, coordinated care is essential for improving outcomes.
Methods:
Our rapid-access infectious diseases (ID) clinic facilitates podiatry patients' swift access to a multidisciplinary team, including physicians, HSCPs, and advanced and specialist nursing care. Patients with DFIs and suspected osteomyelitis are triaged and jointly assessed by podiatrists and the ID team in a structured clinic setting.
Podiatry triages and refers DFIs and suspected osteomyelitis cases to the ID clinic. Early diagnostics: Probe-to-bone, bedside Doppler and microbiological sampling.
Rapid access to ID Physicians enables full medical review and clinical investigations.
The team assesses patient safety and eligibility for OPAT services, ensuring suitability for outpatient management.
Results:This approach has been evolving over the past few years, with 325 joint Infectious Disease- podiatry reviews conducted in 2024.
Benefits in Practice:
Increased care efficiency with timely antimicrobial therapy based on infection severity.
Podiatry’s role optimises wound assessment and infection management, including deep swab cultures and debridement (Lipsky et al., 2020).
Targeted therapy and comprehensive treatment planning. More effective antibiotic stewardship and streamlined patient-centred care.
Integrated expertise from multiple specialties to address complex needs.
Reduced admissions and early discharges through early outpatient intervention.
2024 Developments:Complex foot multidisciplinary meetings with attendance from ID, Endocrinology, Renal, Podiatry, Orthotist/Prosthetist specialties and surgical input from Orthopaedics and Vascular.
Expansion: 1.5 WTE ID-senior podiatrists recruited and a new ANP post for integrated community care.
An additional ANP-led podiatry clinic.
Conclusions:The rapid-access ID clinic, enhanced by new ID-podiatry posts, continues to improve care. The complex foot meetings introduced in April 2024 have highlighted challenges in limb salvage and clinical decision-making. With the addition of 1.5 WTE new posts, the ID-podiatry activity will expand, improving infection control, limb salvage, and patient outcomes.
References:
Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Journal of the American Podiatric Medical Association, 107(5), 387-394.
Lipsky, B. A., Berendt, A. R., & Cornia, P. B. (2020). Clinical Infectious Diseases, 68(8), e1-e88. -
Board No: 32 #2024218
"The Combined Orthopaedic Infection Clinic: Results from a novel clinic for patients with bone and joint infection at St. James’ Hospital"
Principal Presenter: Adam Adnan
Track: General Infectious Diseases
Background:
Orthopaedic infections impose a tremendous burden on patients and clinicians while posing significant challenges in treatment and management. Generally, orthopaedic infections are managed between Orthopaedic and Infectious Diseases services, which contributes to fragmented care, delayed treatment, and potential inconsistencies in clinical decision-making. The adoption of combined clinics has been recognised in some countries; however, they are not widespread and this integrative approach is yet to become standard practice in many healthcare systems. This paper evaluates the experience and potential benefits of a newly established Combined Orthopaedic and Infectious Diseases clinic in St James’s Hospital. We expect that a combined clinic will care for patients with complex bone and joint infections. Patients are seen once a month, concurrently by an Infectious Diseases and an Orthopaedic consultant. Preliminary observations from established clinics have shown this model improves communication between the specialties, minimises hospital stays, and reduces missed appointments, ultimately leading towards better patient care and clinical outcomes.
Methods:
We performed a service evaluation of patients attending the Complex Bone Infection clinic in St. James’ Hospital. Patients were included in study if they had attended (Nov – March). Patients’ medical background, surgical history, microbiology and outcomes were collected from the electronic medical system.
Results:
Fifteen patients attended the clinic over the 4 month period (median age 64, 50% male). The most common diagnosis was prosthetic joint infection (n=9, 64%). Other conditions included fracture-related infection (n=2), osteomyelitis (n=2) and septic arthritis (n=1). The median number of previous interventions was 2.5 (range 0 – 7). Obesity (42%) and diabetes (21%) were the most common co-morbidities. The most common pathogen was Staphylococcus aureus (n=4, 21%). Polymicrobial infections represented half (50%) of cases and only 1 case was culture-negative. At the clinic visit, 6 (42%) patients were planned for surgery, 2 were referred for joint aspiration and 2 were referred for further advanced imaging. In a small number of patients (n=2), there was no immediate plan for further surgery and antibiotic suppression was recommended.
Conclusion:
To our knowledge, this is the first report of a dual-specialty outpatient clinic for orthopaedic infection in Ireland. We have secured HRB funding to further analyse the processes of multidisciplinary care for orthopaedic infection in St. James’ Hospital. Further analyses are planned at one year post clinic inception to evaluate outcomes to date.
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Board No: 33 #2024214
"Hand and Wrist Trauma: Antimicrobials and Infection - Audit of Clinical Practic"
Principal Presenter: Jennifer McGarry
Track: General Infectious Diseases
Background: Hand traumas are the most common injuries treated in emergency departments, accounting for 20% of attendances. Surgical site infections (SSIs) affect 5% of surgical patients. The World Health Organization (WHO) has established guidelines to prevent SSIs, but their application in hand trauma surgery remains unclear. This study aimed to assess adherence to WHO guidelines for SSI prevention in hand trauma surgery at Mater Misericordiae University Hospital (MMUH).
Methods: Data collection occurred over a 2-month period. All patients requiring surgery for hand trauma were included. Patients with infected wounds were excluded. Data analysis was conducted using R statistical software (version 4.3.3). Descriptive statistics were used to summarise all captured data. Dichotomous, categorical, was reported as counts and percentages.
Results: Between 1/4/2024 and 1/5/2024 44 patients were treated for hand injuries at MMUH. Type of injury included, skin only (n=18), fracture (n=4), tendon (n=14), joint (n=2), and digital nerve (n=6). Prophylactic antibiotics were given in 41/42 (98%) of patients. The average length of antibiotics was 4.6 days. The average time to operation was 41.7 hours. Antimicrobial sutures were not used in any cases.
Conclusions: The WHO advise against extending surgical antibiotic prophylaxis (SAP) postoperatively to reduce the risk of surgical site infections (SSIs). The WHO guidelines represent the most comprehensive resource available however, they do not specifically address hand trauma. In contrast, our centre's practices significantly diverge from these recommendations. This discrepancy highlights a gap between established guidelines and clinical practice. High-quality studies focused on hand trauma and the use of antimicrobials are needed.
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Board No: 34 #2024217
"Re-audit: Development of local antimicrobial guidelines for surgical prophylaxis in open long bone fractures presenting to an evolving major trauma centre"
Principal Presenter: Shane O'Neill
Track: General Infectious Diseases
Purpose
Open long bone fractures require complex multidisciplinary care and antibiotic prophylaxis to avoid the risk of deep-seated infection. A previous audit at the Mater Misericordiae University Hospital (MMUH) revealed poor compliance with BOA-BAPRAS recommendations. In response, local antimicrobial guidelines based on BOA-BAPRAS standards were implemented in May 2024. This re-audit assessed compliance with these guidelines, and specifically investigated whether non-compliance was more likely outside usual working hours.
Methods
A retrospective audit was conducted comprising 55 cases of open long bone fractures from May 2024 to January 2025. Antibiotic prescribing patterns at initial debridement and definitive soft tissue cover were examined. Cases were categorised as fully compliant with local guidelines, compliant with BOA-BAPRAS but not local guidelines, or non-compliant with either. The relationship between non-adherence to local guidelines and cases that occurred outside of usual working hours was examined.
Results
At initial debridement local guidelines were adhered to in 49.1% of cases, complied with BOA-BAPRAS in 23.6% of cases, and followed neither in 27.3% of cases. Of non-compliant cases, 60% occurred outside usual working hours.
At soft tissue cover, local guidelines were adhered to in 77% of cases, complied with BOA-BAPRAS in 11.5% of cases, and followed neither in 11.5% of cases. Of non-compliant cases, 67% occurred outside usual working hours.
Conclusions
Formalising guidelines and introducing visual cues in clinical areas can improve prescribing practices in this patient cohort. Non-compliance was more frequent outside usual working hours, potentially due to reduced awareness of the guidelines or the staging of surgery.
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Board No: 36 #2024142
"Establishing a Maxillofacial Surgery/Infectious Diseases/Dental Multidisciplinary Meeting at St James's Hospital"
Principal Presenter: Fergal Howley
Keywords: Maxillofacial, Dental, MultidisciplinaryTrack: Other
Background:
Infections involving the maxillofacial bones and adjacent structures can be severe, and
their diagnosis and management challenging. This anatomical area is prone to micro-
injuries and abrasions through routine daily activities, as well as myriad non-infectious
pathologies including malignancy, trauma, dental disease, and iatrogenic complications
of treatments such as anti-resorptive and radiotherapy. This, coupled with the diverse
microbiota of the oral cavity, can result in a wide range of complex and severe infection.
St James’s hospital has a busy maxillofacial services providing 24-hour care to a wide
catchment area and a population of 3 million.
Patients with infectious complications are often referred to the Infectious Diseases
services.
Methods:
In the absence of a formal pathway for in-person discussion of patients under the shared
care of maxillofacial, dental and infection services, we established the maxillofacial, infectious diseases, and dental multidisciplinary meeting (MFIDD-MDM).
The aim was to provide a platform to discuss complex cases of maxillofacial infections in
order to seek specialist input and consensus.
These hybrid meeting are held quarterly, in person and via video-conference. Members
of the maxillofacial and infectious diseases services in SJH, and practitioners from the
Dublin Dental University Hospital, are invited to attend.
Results:
To date, 13 patients have been discussed, 8 females, with a median age of 58 (range 43
– 88 years).
Underlying diseases included osteoporosis (2), osteopetrosis (2), primary malignancy of
the maxillofacial region (4), metastatic malignancy to the mandible (1), osteonecrosis of
the jaw (2), osteoradionecrosis (2), and dental extraction (5).
Infectious presentations included orocutanous or oroantral fistulae (8), osteomyelitis
(10), and metalwork dehiscence (1).
10/13 patients had previously undergone surgery, four of whom had prosthetic material
in situ. Two had received bisphosphonate therapy, and four had received local
radiotherapy. Infectious pathogens had been identified on bone or tissue culture in 10/13 cases.
Conclusions:
The establishment of this MDM has provided a pathway for discussion of complex cases
of maxillofacial and dental infection. With an ageing population, increased use of anti-
resorptive therapies, and improving treatments for maxillofacial malignancies, the
number of patients presenting with complex infections is likely to increase.Given the high rate of engagement, we anticipate that this meeting will expand and frequency of meetings may need to increase to meet demand.
Future developments will include developing a Standard Operating Procedure, regular
audit and service evaluation, and potentially establishing a patient registry. -
Board No: 37 #2024150
"Operative Management of Spinal Wound Complications Over a 3 Year Period at the National Spinal Injuries Unit"
Principal Presenter: Heather Croghan-Miksch
Keywords: Spine, Wound, InfectionTrack: Epidemiology & Population Health
Background: Wound breakdown and infection after spinal surgery can cause significant morbidity, often requiring multidisciplinary management and prolonged hospitalization.
Aims: This study aims to quantify and characterise all operatively managed wound issues managed at the National Spinal Injuries Unit for Ireland, over a 3-year period, and identify factors which predicted Plastic Surgery involvement.
Methods: Data was collected relating to operatively managed spinal wound complications in a tertiary referral centre for spinal surgery between 2022 and 2024 inclusive. Patient demographics, comorbidity, operative factors, antibiotic use, microbiological cultures, and outcomes were examined. Univariate and multivariate logistic regression was used to model the likelihood of Plastic Surgery involvement.
Results: In total, 101 patients had 156 procedures for wound breakdown. Most patients had an initial spinal instrumentation for degenerative disease (n=65, 69.9%). The mean time from the index spinal procedure to the first wound washout was 7.32 weeks (SD = 19.10 weeks), with the range varying between 0 to 156 weeks. Most spinal washouts were for wound dehiscence (n=67), followed by a dural tear/CSF leak in 17 patients. Microorganisms were cultured in 71 cases, but the number and sample types varied. Of these, 41 patients (56.9%) grew a single organism, and 30 patients (42.2%) grew multiple organisms. Plastic Surgery was consulted in 8.9% of all cases (n=9). A flap reconstruction was used in all of these cases. The involvement of Plastic Surgery was associated with peripheral vascular disease (p=0.016), longer operative time of the index case (p=0.019) and an increased number of wound washouts (p=0.001).
Conclusions: The management of spinal wound breakdowns is complex and multidisciplinary. This study furthers our understanding of which patients may benefit from early Plastic Surgery input and flap reconstruction.
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Board No: 38 #2024149
"The roll out a penicillin allergy de labelling programme"
Principal Presenter: Peter Conlon
Keywords: Penicillin allergy, Antimicrobial stewardship, ImmunologyTrack: Epidemiology & Population Health
Background
10% of hospitalized patients report an allergy to penicillin. However only 1% of patients truly have a form of penicillin allergy, only 0.01% of patients have anaphylaxis to penicillin. Having a penicillin allergy label is associated with increased rates of multi drug resistant organism (MDRO) colonization, longer hospital length of stay, greater morbidity and mortality.
There is also an important economic consideration as penicillin allergy is associated with increased health care costs.
International best practice is question all penicillin allergies and to consider de labelling.
Methods
Following approval from the Drugs and Therapeutics (D&T) Committee in March 2025, we prospectively enrolled patients, who reported a penicillin allergy, admitted to Midlands Regional Hospital Mullingar.The inclusion criteria were:
- >18 years of age
Exclusion criteria were:
- History of anaphylaxis or severe cutaneous drug reaction
- Acute coronary syndrome
- Severe exacerbation of asthma or COPD
- Pregnant
- Regular use of beta blocker or anti histamine
Patients were either considered for direct de labeling based on history alone (without oral challenge) or for an oral challenge with 500mg of amoxicillin.
Direct de labelling was considered appropriate if the following criteria were met:
- No documented reaction. Eg – family history of allergy, thrush.
- Non allergic symptom eg nausea
- Delayed non severe rash (>72 hours after exposure).
- Tolerated penicillin since allergy label was initially established.
Patients were considered suitable for direct oral challenge (DOT)
- Unclear history of reaction.
- Rash occurring within 72 hours.
All enrolled patients are given a patient information leaflet. Prior to DOT patients signed a consent form. All patients who are de labelled are given written information explaining that they can safely take penicillin. A letter is sent to the GP of patients who are de labelled to remove the allergy label from their records.
Results
(at time of writing)Eight patients have been screened for penicillin allergy de labelling.
4 patients have been successfully de labeled. 3 patients were de labelled based on history. 1 patient had received penicillin intravenous during the admission. 4 patients were deemed inappropriate for de labelled due to a contraindication. (table 1).
Discussion
Thus far there has been excellent engagement from physicians and patients. All patients recognized that their penicillin allergy label was dubious and were willing to participate in the initiative. Going forward we plan to engage surgical and gynecology specialties.
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Board No: 39 #2024144
"Understanding what matters to patients in antimicrobial stewardship in hospital. PERSPEcT study update"
Principal Presenter: Benson Jacob
Keywords: Antimicrobial stewardship, Hospitalised patients, Patient perspectivesTrack: Epidemiology & Population Health
Background
There is a growing consensus that involvement of patients in healthcare-based research and as equal partners in healthcare decision-making enhances their opportunity to improve service and outcomes. Our research is focused on the patient perspective in the successful implementation of antimicrobial stewardship in a hospital setup with the following objectives.
To explore patient knowledge, understanding and perceptions of antimicrobial resistance and the role of patients in AMS (Antimicrobial Stewardship)
To identify barriers and facilitators of patient engagement in AMS programs.
Methods
A questionnaire survey using previously validated questions on antimicrobial resistance and stewardship was conducted among 360 hospitalised patients from six patient groups (cystic fibrosis, hematology/oncology, bone and joint infection, renal, outpatient parenteral antibiotic therapy (OPAT), general infectious disease). Sixty patients from each group were recruited using purposive sampling. Quantitative data were analysed using descriptive analysis.
Results
Male participants made up 56% (n=202), female participants made up 43% (n=156), and 1% (n=3) chose not to respond. Most respondents were from the 20-55 age group (84%).
93% had never heard the term "antimicrobial stewardship" but showed an understanding and awareness of antimicrobial resistance. 56% reported receiving advice from the doctor when prescribed antibiotics. Preference for approaching healthcare professionals with antibiotic treatment questions was doctors 67%, nurses 21%, and pharmacists 12%. Overall, 87% responded that they would complete the entire prescribed course of antibiotics even if they felt better after taking 2-3 doses; this figure rose to 94% among the cystic fibrosis group. Overall, 77% of the respondents were not happy to use leftover antibiotics for an infection in the future without seeing a doctor.
68% of respondents were happy to ask the doctor questions about the type of infection they were being treated for and the risk involved in receiving antibiotics, with the cystic fibrosis and OPAT groups leading this list with 83% and 82%, respectively.Conclusion
Patients appear to have a good understanding of AMR and are open to discussing infection treatment plans with healthcare professionals, though they may not be familiar with the terminology used. Poor patients’ knowledge of the AMS program and patients’ trust in their healthcare team are perceived barriers to questioning the antimicrobial prescription. The next phase of our study will use qualitative methods to explore how patients might have a role to play in AMS. -
Board No: 40 #2024180
"A review of the Mater Misericordiae University Hospital’s infectious diseases consult service"
Principal Presenter: Aoife Heeney
Track: General Infectious Diseases
Background
Infectious Diseases (ID) is an ever evolving specialty facing challenges such as increasing antimicrobial resistance, increasing cohorts of immunocompromised patients receiving immunomodulatory therapy, outbreaks of emerging infectious diseases, and an ageing, comorbid population with increasing rates of healthcare acquired and device related infections. As such the patients that require specialist ID input are becoming more diverse and heterogenous. The role of an inpatient ID consult service is central to the management of these patients, and has been shown to improve patient outcomes.
The Mater Misericordiae University Hospital (MMUH) is a large tertiary referral hospital and the MMUH ID team provides a comprehensive inpatient consultation service to all specialties. We aim to determine the characteristics of these consultations over a 2 year period.
Methods
All ID consults are requested electronically through the electronic medical record. We obtained 2 years of data from the Information Management System team. A descriptive analysis was performed.
Results
A total of 816 consults were requested in 2023, increasing to 957 in 2024. Requests came from 24 different specialities. The median length of consult (from order to sign off) was 8 days (IQR 6.175-8.925) in 2023 and 10.4 days (IQR 9.9-13.2) in 2024. Medical teams requested 389 (48%) consults in 2023, rising to 496 (52%) in 2024. The proportion of consults ordered by surgical teams fell from 392 (48%) in 2023 to 424 (44%) in 2024.
Looking at each specialty individually, orthopaedics requested the most consults each year; 208 (26% of all consults) in 2023 and 222 (23%) in 2024. Other specialties requesting a significant proportion of ID consults in 2023 were nephrology (86, 11%), endocrine (55, 7%), respiratory (54, 7%) and neurology (50, 6%). In 2024, after orthopaedics, the most consults were requested by nephrology (103, 11%), neurology (61, 6%), endocrine (58, 6%), and acute medicine (57, 6%).
Conclusion
The number of ID consult requests is rising, reflecting the increasing prevalence of complex infections. The median length of consultation has also increased, possibly related to increased demand or potentially reflective of increasing case complexity.
Although orthopaedic related infections still make up a significant proportion of referrals it is interesting to note that the majority of consultation requests are now coming from other medical specialities, reflecting the increasing heterogeneity of patients requiring specialist ID input. This highlights the evolving challenges facing ID and the need to incorporate these trends into future service development planning.
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Board No: 41 #2024131
"Assessment and treatment of latent tuberculosis infection in high-priority healthcare workers across four tertiary centres"
Principal Presenter: Zainab Albaggal
Track: Epidemiology & Population Health
Background
The HPSC recommends that HCWs arriving in Ireland from countries with a high incidence of TB should undergo LTBI screening with interferon-gamma release assay (IGRA). There is no national referral pathway for the management of positive HCW IGRAs. We evaluated the characteristics of HCWs undergoing LTBI screening at two hospital sites (St James’s Hospital Dublin (SJH) and University Hospital Galway (UHG)) as well as treatment outcomes for HCWs with positive IGRAs at four hospital sites (Mater Misericordiae University Hospital Dublin (MMUH), and St Vincent’s Hospital, Dublin (SVUH)) over a 12-month period.
Methods
HCWs undergoing pre-employment TB IGRAs at SJH and UHG in 2023 were identified using Occupational Health records. HCWs with positive IGRAs were identified at SJH, UHG, MMUH and SVUH. SJH treatment numbers included positive IGRAs from other centres within the catchment area. Demographic (age, sex, country of birth) and occupational (job role) factors were recorded, as well as treatment characteristics of those offered therapy. Univariate analysis and subsequent multivariable logistic regression assessed factors associated with IGRA positivity, treatment initiation and treatment outcome.
Results
LTBI screening was conducted in n=885 HCWs (SJH n=468/53%, UHG n=417/47%). IGRA positivity was 17% (n=146), with significant between-site differences (12% SJH, 22% UHG, Χ2=14.63, p<0.0001). On multivariate analysis, IGRA positivity was associated with site of work (p<0.0001), increasing age (p=0.03), and being from Sub-Saharan Africa (p=0.03). N=288 IGRA-positive HCWs were assessed for treatment (SJH n=110, UHG n=92, MMUH=16, SVUH=70) by Infectious Diseases services (UHG, MMUH) and respiratory services (SJH, SVUH). Treatment initiation varied significantly across sites (27% SJH, 70% UHG, 88% MMUH, 32% SVUH, p<0.0001). The commonest reason for not initiating treatment was patient preference. On multivariate analysis, patient sex, age, ethnicity and clinical role were not associated with treatment initiation, with site of attendance associated with commencing treatment (p=0.007). Rifampicin was the commonest treatment choice (96%). Treatment was completed by 82% of HCWs, with no significant differences in completion rates across sites. On multivariate analysis, none of the recorded variables were associated with increased likelihood to complete treatment.
Conclusions
LTBI is common in high priority HCWs, with 17% having a positive IGRA. The absence of a defined national clinical pathway from screening to treatment completion, as well as absence of minimum recorded datasets, is associated with diversity in treatment initiation rates. A national approach may improve standardisation and treatment outcomes.
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Board No: 42 #2024169
"QuantiFERON-TB Gold Plus (QFT-Plus) testing in Ireland 2020-2024."
Principal Presenter: Katerina Hutchinson
Keywords: Quantiferon, Tuberculosis, IrIelandTrack: Epidemiology & Population Health
Background
Tuberculosis (TB) is a global health challenge, with a quarter of the world’s population latently infected with Mycobacterium tuberculosis. Around 5 to 15% of these individuals may develop active TB in their lifetime. Timely diagnosis is key to controlling TB. The QuantiFERON-TB Gold Plus (QFT-Plus) test is a major tool for diagnosing both latent and active TB. This study is particularly relevant in the context of increased migration to Ireland, underscoring the need to monitor TB prevalence in diverse populations.Methods
We conducted a retrospective audit of QFT-Plus test results from Irish patients between 2020 and 2024, gathered from hospitals and GP practices. Data were analysed to assess TB positivity trends, focusing on age groups (<18, 18-39, 40-59, 60-74, and >75) and sex, using Microsoft Excel. The study aimed to evaluate if migration influenced TB prevalence in the tested population.Results
The number of QFT-Plus tests increased from 9,276 in 2020 to 26,581 in 2022, with a slight decline to 24,093 in 2024. Despite fluctuations in testing volume, positivity rates show statistically significant downward trend from 5.1% in 2020 to 3.8%-3.9% in subsequent years (p<0.05). Males showed significantly higher positivity rates compared to females (p<0.05), despite lower number of tests performed in this group. In 2024, the highest positivity rates were seen in individuals aged >75 years, with males at 7.26%. Elevated rates were also observed in working-age adults (18-39 and 40-59 years), particularly in males (6.70% and 6.55%, respectively). The lowest rates were in individuals under 18 years, with 1.48% in females and 2.83% in males. These trends were consistent in 2020.Conclusion
Although the volume of TB testing increased from 2020 to 2024, the percentage of positive results declined significantly. Elderly males (>75 years) showed the highest positivity rates, likely due to immune decline and pre-existing conditions. Higher positivity in working-age adults may reflect increased exposure risks. Additionally, males had significantly higher QFT-Plus positivity rates than females, despite fewer tests being conducted in males. These findings highlight the need for continued TB surveillance and targeted public health interventions to address health disparities. -
Board No: 43 #2024211
"An Audit of Latent Tuberculosis Treatment Over a One-Year Period in the Infectious Diseases Department at Beaumont Hospital"
Principal Presenter: Gavin Francis Kelly
Keywords: Tuberculosis, Latent, MycobacteriumTrack: Epidemiology & Population Health
Aim
The aim of this audit was to assess compliance with international standards of care for the management of latent tuberculosis infection (LTBI) and compare this data to previous audits.
Methods
We performed a retrospective analysis of all patients assessed for LTBI through the Infectious Diseases Clinic at Beaumont Hospital between 01.01.2023 and 31.12.2023. Patients were identified via the LTBI hospital database, and clinical details were reviewed using the electronic patient record.
Results
· 47 patients were identified.
· 42.6% were Healthcare workers; 23.4% were people living with HIV; 25.5% were screened prior to commencement of immunosuppression; 2.1% were close contacts of a person with active TB; 2.1% were emigrating from a country with high TB endemicity; 4.3% did not have a reason available.
· 10.6% did not have associated blood-borne viral (BBV) screening.
· 56.8% commenced combination Rifampicin and Isoniazid; 43.2% commenced Isoniazid monotherapy (in all of whom Rifampicin was contraindicated).
· 79.5% completed treatment; 11.4% are continuing treatment and are expected to complete without issue; 9.1% did not complete treatment, 1 becoming pregnant, and 3 due to a non-serious adverse drug event.
· 61.5% had liver function tests (LFTs) monitored at the clinic standard of 0, 2, and 4 weeks.
· 94.3% had a Completion-of-Treatment Letter sent to their referrer/GP, but only 60% had a similar letter copied to the patient themselves.
Conclusion
This audit showed strong adherence to international guidance for LTBI treatment where Rifamycin-based regimens are preferred: Rifampicin/Isoniazid remained the treatment of choice, though slightly less than 2021-2022 figures (56.8% vs 62%). Where Rifampicin-based regimens were not used, there was a valid reason for alternative therapy. The expected total completion rate of this cohort is 90.9%, comparing favourably with 2021-2022 (85.9%) and 2018 (81%).
All patients diagnosed with LTBI for whom data was available had a valid diagnosis for screening as per international guidelines. Unfortunately, there were several patients where a BBV screen was not performed, and many patients where the clinic standard of LFTs at 0, 2 and 4 weeks was not conformed to. This should be improved in future assessments.
While most patients had a Completion-of-Treatment Letter sent to their referrer/GP, only 60% had a similar letter copied to themselves. While this is not a necessity as per any guideline, good practice would suggest notifying all relevant stakeholders, including the patient themselves, on completion of treatment for LTBI.
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Board No: 44 #2024146
"The Outcome of Tuberculosis Screening Using Interferon-Gamma Release Assay (IGRA) in the Irish Prison setting."
Principal Presenter: Sivasankari Manickam
Keywords: Tuberculosis, IGRA, PrisonTrack: General Infectious Diseases
Effective and timely Tuberculosis (TB) screening in congregated settings is crucial for early detection and prevention of outbreaks. Prisoners exposed to infectious TB cases have higher risk of developing TB and of having poorer TB treatment outcomes than the general population, making them a vulnerable group in the context of TB. The burden of TB disease (TBD) in prison populations is about 10 times higher than in the general population1. Tackling barriers during screening significantly improve outcomes.
The Department of Public Health Dublin and Midlands (PHDM) were notified of an infectious pulmonary TB case in a prisoner. The sputum cultured mycobacterium tuberculosis after 3 days. In total, 38 prison officers and 34 cellmates were identified as contacts, and were screened using a symptom questionnaire and IGRA testing.
The aim of this study is to describe the outcome of TB screening using IGRA in a prison setting. Prior to this, all of our on-site TB screening are performed with Tuberculin Skin Test (TST). This requires contacts to be seen on the day the test is administered and 48 to 72 hours after to read the results. The IGRA method which requires only a single blood draw, eliminates the need for the return visit, substantially improving test attendance, reducing risk of loss to follow-up, interpretation variability and increasing completion rates in settings with high turnover.
All prisoner and prison officer contacts were screened. Three prisoners (8.8%) and three (7.9%) prison officers tested positive for TB infection (TBI) from IGRA, with one prisoner diagnosed with active TBD. All of the contacts with TBI were commenced on TB treatment.
This operational efficiency with IGRA enabled early detection of TBI and prompt initiation of TB preventive treatment.
The Laboratory provided robust support during the implementation of IGRA as the screening tool in the prison setting. Notably all collected samples were suitable for testing.
Our screening results highlight the operational advantages of IGRA in the prison service. The single visit blood draw and rapid turnaround time for IGRA contributed to the high screening uptake and diagnostic efficiency in such high-risk settings. And further facilitated the timely identification of new TBI and active TBD among the contacts.
The positive outcome supports the integration of IGRA into TB control strategies to reduce TB transmission in similar high risk settings, ultimately contributing to more effective TB prevention and management.
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Board No: 45 #2024121
"Predictors for adverse events in patients with MDR-TB, HIV and viral hepatitis C"
Principal Presenter: Anastasiia Kukurika
Track: General Infectious Diseases
Multidrug-resistant tuberculosis (MDR-TB) treatment is associated with a high rate of adverse events (AEs), especially during HIV and hepatitis C virus (HCV) co-infection. There is little agreement on whether HIV and HCV increase the risk and severity of AEs that contribute to chemotherapy stoppage and poor prognosis and outcome in tuberculosis
Objective of the study to analyze the incidence and risk factors for the development of AEs in MDR-TB/HIV/HCV patients receiving anti-TB and antiretroviral therapy (ART).
Methods: In an observational retrospective cohort study evaluated 104 patients who were treated between 2019 and 2023 in Russia Federation. All patients had an infection with MDR-TB, HIV and HCV, received anti-TB and ART. Participants were monitored for AEs on a monthly basis during the MDR-TB treatment duration.
Results: Overall, 67.5% of patients in this group experienced one or more adverse events, for a total of 96 AEs. Severe adverse events (AEs) occurred in 11.5% of patients, resulting in withdrawal of 1 anti-TB drug (25%), all TB regimen (55%), or TB and antiretroviral regimen (20%). The most frequently canceled TB drugs were pyrazinamide (17.3%) and kanamycin (14.6%). Alcoholism, drug addiction, comorbidity and anti-TB drug intake all have a direct link with the chance of getting AEs, according to the regression coefficient values. Liver disease increases the odds of developing AEs 3.37 times (95% CI: 0.79-14.33), genitourinary system 3.32 times (95% CI: 0.99-13.7), pyrazinamide intake 13.95 times (95% CI: 2.8-69.4), kanamycin intake 6.06 times (95% CI: 1.68-21.95). The development of severe AEs was not significantly influenced by alcoholism OR=0.12 (95% CI: 0.02-1.04) and drug addiction OR=0.2 (95% CI: 0.03-0.99).
Conclusions: As a result, the prevalence of adverse events (AEs) among patients with triple infection remains high (67.5%). Pyrazinamide and kanamycin have the worst safety profiles. Liver and kidney illness, pyrazinamide and kanamycin use, alcoholism and drug addiction were all risk factors for AEs development.
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Board No: 46 #2024184
"Availability of drug susceptibility testing results for Mycobacterium tuberculosis culture-positive patients at a tertiary Hospital with a dedicated Tuberculosis clinic"
Principal Presenter: Kieran Cooper
Keywords: Tuberculosis, Drug susceptibility testing, Culture positiveTrack: General Infectious Diseases
Background:
Prompt availability of drug susceptibility testing (DST) results for Mycobacterium tuberculosis (Mtb) is critical for effective clinical management and patient safety. Where DST results are authorised but not visible, delays in treatment modification can introduce unnecessary clinical risk. Significant clinician time is used telephoning laboratories, often without answer, to obtain DST results, which may be subject to error and are not visible to the multidisciplinary team.
Methods:
A retrospective audit (Dec 2023-Dec 2024) was conducted using the in-house TB database, to assess DST result visibility and compliance with national and international reporting guidelines before and after the implementation of a new hospital-wide laboratory reporting system.
Results:
DST results were electronically visible in 12/13 (92%) cases. Mean time from hospital receipt of specimen to DST visibility was 99 days (target ≤30 days). Mean time from culture positivity to DST result was 77 days for both systems combined. Median time from DST reference laboratory authorisation to uploading to patient record was 13 days. DST results from the reference laboratory were visible in only 31% of cases where results had been authorised, with a mean visibility delay of 16 days from reference lab authorisation date to result uploading (75% compliance with the recommended 14-day target). The new reporting system reduced mean DST visibility delays from culture positivity by 23 days (86 days vs. 63 days). However, delays still posed adverse clinical risks in 38% of cases, including delayed regimen refinement, potential inappropriate treatment selection, and transcription errors.
Conclusion:
Significant delays in availability of TB DST results to clinicians and patients post-authorisation persist, presenting ongoing risks to patient care. Consideration should be given to electronic reporting of reference laboratory results directly to electronic patient records, or interim electronic sharing (email of individual or weekly batch) of authorised results to TB teams once available, to align with national TB strategy.
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Board No: 47 #2024226
"Tuberculosis at the Mater Hospital: 14 Months of Cases"
Principal Presenter: Brigid Keremer
Keywords: Tuberculosis, Mater, CasesTrack: General Infectious Diseases
Background
The demographics, clinical presentations and service utilisation of patients with tuberculosis (TB) disease varies by location. Understanding such characteristic is essential to optimise outcomes for individuals with TB, in keeping with Ireland’s TB elimination goals 2024-2030. We sought to describe the population of TB patients being treated in the Mater Misericordiae University Hospital (MMUH).
Methods
We undertook a retrospective review of electronic records of all patients with TB disease who were managed in MMUH from September 1st 2023 until October 31st 2024. We performed descriptive statistics on demographics, comorbidities, and clinical characteristics including outcomes.
Results
Of 37 patients treated for TB in 14 months (2.6/m), 27 (73%) were male and the median age was 35 (range 15-86). Only 7 patients (18.9%) were born in Ireland, 13 (35.1%) had no fixed abode, and 8 (21.6%) were seeking asylum. Six patients were people living with HIV (16.2%), and a HIV test was not checked in 3 (8.1%). Other comorbidities included chronic kidney disease (1), HbA1c of ≥48 mmol/mol (2, 5.4%), and low vitamin D (<50 nmol/L) (6, 16.2%). 27 of the 35 patients (77.1%) with available data were culture positive. 2 patients were GeneXpert positive but culture negative.
27 patients (73.0%) had pulmonary involvement, of whom 11 (40.7%) had cavitary disease. For those with cavitary disease, only 3 (27.3%) had sputum culture sent at 2 months of treatment. Only 9 patients (24%) had no extrapulmonary disease and 6 patients (16.2%) had ≥3 sites of disease. Of those with available culture results, 20 (74.1%) were pansensitive and 6 (22.2%) had monoresistance. Two patients had multidrug resistance (MDR), but only one was classified as MDR TB. Thirty patients accrued 651 inpatient bed days (mean 21.7 days, SD 17.34). Inclusion health was consulted in 8 patients (21.6%) and social work in 23 (62.2%). Respiratory were consulted in 15 (40.5%) cases and 4 patients (10.8%) had 26 outpatient visits to the Respiratory clinic (mean 6.5 visits per patient). 30 patients (81.1%) had 216 outpatient appointments with Infectious Diseases (mean 7.2 per patient), and 24 received TB medicines from the ID pharmacy. Only 10 patients (27.3%) had directly observed therapy and one patient died prior to treatment completion.
Conclusions
Most TB disease cases in MMUH are managed by the ID service. Providing adequate care for patients with TB is complex and required the input from multiple disciplines.
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Board No: 48 #2024124
"Evaluating the Management of Active Tuberculosis at a Tertiary Hospital: Insights from the 2024 Audit"
Principal Presenter: Sophie Jones
Keywords: Audit, Mycobacterium, TuberculosisTrack: General Infectious Diseases
Background: Data from the Health Protection Surveillance Centre (HPSC) shows that in 2023 Ireland recorded 224 cases of tuberculosis (TB), with an incidence rate of 4.4 per 100,000 population. This remains significantly above the World Health Organization (WHO)’s End TB target, which aims for an 80% reduction in TB cases between 2015 and 2030. A 2023 audit of our hospital’s outpatient TB service highlighted the need for enhanced reporting and collaboration with agencies such as the HPSC, to improve data collection and work towards the WHO's End TB goals.
Aim: To assess the management of active TB infections at our tertiary site and evaluate changes in service provision since last audited in 2023.
Methods: Patients diagnosed with active Mycobacterium tuberculosis (MTB) infection who attended the infectious diseases outpatient service from December 31, 2023, to December 31, 2024, were included. Patients with latent TB or non-tuberculosis mycobacterium infections were excluded. A retrospective review of patient records was conducted to assess key performance indicators (KPIs), including incidence of HIV testing and TB treatment completion.
Results: A total of 30 patients with active MTB infection were reviewed in 2024, with ages ranging from 21 to 77 years (mean age 41.8 years). 17 patients were male, and HIV testing was documented in 96.7% of all cases. Sites of MTB infection included: extra-pulmonary in 15 patients, pulmonary in 10 patients, and both in 5 patients. Of the 30 patients, 11 completed TB treatment in 2024. As of December 31, 2024, 18 patients remained on treatment, with completion expected within 12 months as planned.
Conclusion: Following the 2023 audit, we are committed to regular reporting to meet national standards and complete the audit cycle. Our 2024 audit showed an increase in MTB cases (from 18 in 2023), reflecting the national trend reported by the HPSC in 2023. The Health Service Executive (HSE)’s Striving to End Tuberculosis: A Strategy for Ireland 2024-2030 outlines a plan to reduce TB incidence in line with the WHO’s goals. Continued auditing will improve service delivery, enhance patient outcomes, and support the HSE’s goal of a collaborative approach to TB in Ireland. -
Board No: 49 #2024157
"Rising Numbers of Paediatric Tuberculosis Cases in Ireland- A Review of Practice in Children's Health Ireland 2019 - 2024"
Principal Presenter: Sanaa Mustafa
Track: General Infectious Diseases
Background
Mycobacterium tuberculosis is the causative pathogen of Tuberculosis (TB) which is the single biggest infectious killer globally in the last decade. The incidence in the Republic of Ireland has been steadily declining up to 2021. Activity since then was noted to be increased within the paediatric infectious disease (PID) department at Children's Health Ireland (CHI), which serves a population of over five million. The Irish public health system records only those cases of TB disease. The PID department undertook this audit to look at the burden of this disease over the last few years, review those cases of TB disease and TB infection, the path to diagnosis and the management of these patients. The aim of this audit was to review those cases referred for investigation and management of TB since 2019.
Methods
Cases were identified through the laboratory system as having had an Interferon Gamma Release Assay (IGRA) sent from PID during the time period January 2019 - September 2024. Case details were reviewed through their correspondence from PID to other healthcare providers, stored electronically.
Results
196 Children were investigated for TB. 91 (46%) were referred due to TB contact with 10 (9%) subsequently diagnosed with TB Disease (TBD) and 25(28%) with TB infection (TBI). 97(49%) were referred due to symptoms with 20 (21%) TBD and two with TBI diagnosis. Eight children were referred with a known diagnosis of TB, one with ongoing TBD on treatment, six with TBI. There was a marked increase in TBD diagnosis in 2024; 17 children with TBD as opposed to one child with TBD in 2019.
The Median age of the 30 children diagnosed with TBD was 6 years with 16 females. 63% had pulmonary disease, four asymptomatic with abnormal radiology. Five children had TB meningitis, one potts disease, one tibial osteomyelitis, one pericarditis, one paraspinal abscess, one miliary TB and one cervical adenitis. All Children survived.
Conclusion
Our Audit reflected an increased TB activity in children in the last two years in Ireland. Contact tracing referrals have increased to 34 in 2024 from a low of two in 2020. This may reflect a change in public health practice, an increased disease prevalence or both.
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Board No: 50 #2024140
"How Medical Providers and Students Perceive Tropical Medicine in Relation to their Careers and Studies: A Cross-Sectional Study"
Principal Presenter: Tara Morrissey
Track: Other
Background
In recent decades, tropical diseases have been seen to spread beyond the tropical belt, due to increased travel, climate change, urbanisation and deforestation. This spread has been followed by an increase in emerging diseases globally. This study aims to investigate how students and medical providers view tropical medicine as a specialty and thoughts on the teaching of the discipline in Ireland.
Method
An online questionnaire investigating medical practitioners’ and medical students’ perception of tropical medicine and how relevant they deem the topic to be in relation to their careers, future careers and studies was sent out to medical students in University College Cork, interns and senior house officers (SHOs), registrars and consultants of any specialty in Cork University Hospital between September and December in 2024. The results were analysed using descriptive statistics and Kruskal-Wallis testing.
Results
Of the 151 participants, 50.99% agreed and 9.27% strongly agreed that Tropical Medicine has relevance in Ireland. 61.6% expressed intent to work abroad. Tropical Medicine was seen as more relevant to working outside of Ireland than in Ireland (CI 95%, p-value 0.009). 42.38% disagreed and 22.52% strongly disagreed that they had an interest in Tropical Medicine as a specialty. Emerging Diseases was the area with most interest (29.8% very interested and 42.38% interested), differing to the overall interest in Tropical Medicine as a specialty (CI 95%, p-value <0.001). Antimicrobial stewardship was the area of least interest with 13.25% very interested and 25.82% interested. 50.33% disagreed and 13.91% strongly disagreed that their Tropical Medicine teaching is adequate. Adequacy of public health knowledge was not seen to relate to adequacy of knowledge on Tropical Medicine overall (CI 95%, p-value 0.246), while areas such as adequacy of knowledge on disaster medicine was found to have a relationship (CI 95%, p-value <0.001).
Conclusion
Tropical medicine is deemed to be relevant in Ireland but more relevant outside of Ireland. Interest expressed in certain aspects of tropical medicine do not relate to interest in tropical medicine as a specialty. Inadequate knowledge on topics relating to tropical medicine was expressed across most topics surveyed.
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Board No: 51 #2024156
"Prevalence of Malaria presenting to TUH and quality of care received: A Retrospective Study"
Principal Presenter: Eleanor Power
Keywords: Malaria, Immigration, ManagementTrack: General Infectious Diseases
Prevalence of Malaria presenting to TUH and quality of care received: A Retrospective Study
Authors : Eleanor Power1 , Roisin Carr1, Nalisu Mazubane2, Leah Colclough3, Heather Baker4, Ronan Desmond4, Sarmad Waqas1,5, Ashwin DelmonteSen2.
Departments of 1 . Clinical Medicine 2. Infectious diseases and 3 Pharmacy 4. Haematology Tallaght University Hospital 5. Clinical Medicine; School of Medicine; Trinity College Dublin, Dublin, Ireland.
Background
Malaria remains a significant global health concern. In Ireland, most cases occur in African immigrants, particularly from Nigeria and are linked to travel from West Africa, peaking in summer months due to visits to friends and relatives (VFR). (1)Tallaght University Hospital (TUH) serves an ethnically diverse population, with a higher percentage of Black residents than the national average.( 2) As immigration increases, we aimed to assess the prevalence of malaria at TUH. By evaluating adherence to treatment guidelines from local TUH guidelines (3) and the London Hospital for Tropical Diseases( HTD)(4), we aimed to access quality of care received.
Methods
The TUH haematology lab provided data on malaria-positive blood films from 2014 to 2024. Additionally, we used TUH HIPE data to identify patient cases. After excluding cases without positive films or patient records, the final dataset included 80 patients. Malaria severity was classified using TUH and LTD parameters: parasitaemia >2%, <2% with schizonts, or <2% with complications detailed as per TUH adult medicines guide. We reviewed medical records to assess whether patients were treated appropriately, documented complications, and checked for follow-up full blood counts (FBCs) post-IV artesunate therapy. Travel history, travel seasonality, and ethnicity were also analysed.
Results
Among 80 cases, 81% were Plasmodium falciparum, 10 were P. ovale, and 5 were P. vivax. Cases peaked in 2017 (18 cases). 24 cases were classified as severe, yet only 16 received appropriate treatment per TUH and LTD guidelines. Six cases received IV artesunate despite not meeting severe criteria. Post-artesunate FBCS were documented in six patients. Oral therapy alone was given in 44 cases , of which duration of treatment was noted in only 19. Complications arose in 6.6% of cases, jaundice being the most common. Most cases were linked to travel to Nigeria, with summer being the peak season and VFR the most commonly documented reason. Ethnicity was recorded in 33 cases.
Conclusions
Malaria at TUH is strongly linked to travel and immigration. Improvements are needed in clinical management, including better classification of severe cases, ensuring appropriate treatment, and enhancing documentation on treatment duration, follow-up FBCs, travel history, and ethnicity to support epidemiological analysis.
References
1 :Health Protection Surveillance Centre: Vector Borne diseases in Ireland 2022
2: CSO census 2022
3: TUH guidelines on management of malaria
4: The Hospital for tropical diseases , Malaria diagnosis and treatment guideline
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Board No: 52 #2024137
"A review of Imported Fever presentations across two Irish tertiary academic teaching hospitals"
Principal Presenter: Caoimhe Patchett
Keywords: Imported Fever, Travel Related Infection, Imported Fever pathwayTrack: General Infectious Diseases
Background:
Imported fevers are a broad and complex set of presentations to the emergency department without standardised management approaches. Malaria accounts for 22% of all imported fever presentations with viral aetiologies accounting for 45% of presentations. The aim of this audit across two hospital sites was to review clinical data recorded with the aim of establishing a standardised clinical pathway for systematic identification of imported fevers that can be implemented nationally.
Methods:
A retrospective audit was conducted of patients across two time periods in large tertiary hospitals with ID services. In one hospital site, imported fever presentations were identified using HIPE coding and cross referenced to malaria tests sent across a five-year period. In the second site, they were identified through malaria tests sent over one year. Clinical and laboratory data were collected from patient notes and electronic health care records. Data was analysed using STATA statistical software and descriptive statistics were used to present clinical parameters.
Results:
A total of 73 cases were identified across two hospital sites (26 in one site and 47 in second site) with a documented travel history. Viral haemorrhagic fever assessment occurred in 5(7%) of cases. This was indicated in 22(30%) cases. The most common reason for travel was visiting friends and relatives in 32% (n=26) of cases. Frequent travel locations were Nigeria (n=23, 32%), Malawi (n=4,5%), Uganda (n=4,5%) and Ghana (n=4,5%). Malaria prophylaxis was taken in11% (n=8) of cases with 5 cases undocumented. Travel vaccination status was recorded in 12(16%) of cases. The most common diagnosis was malaria in 27(37%) of cases. This was followed by 4(5%) invasive bacterial infections, 2(3%) dengue fever, and 2(3%) rickettsioses. An aetiology was not identified in 24(33%) presentations. 66(90%) patients were admitted to hospital. 32(44%) patients received antimicrobials. Additional serology was sent for 34(47%) patients.
Conclusion:
People visiting friends and relatives is the most common cohort presenting with imported fever. Malaria was the most common diagnosis, and rates of prophylaxis were low. In terms of clinical assessment, consideration of VHF was poor as was vaccination history. One third of patients did not receive a diagnosis, whilst testing and treatment practices were haphazard.
This study highlights the need for a standardised approach to the assessment and management of imported infections in Irish hospitals. The use of a standardised clinical assessment proforma and syndromic panels warrant further assessment for their impact on patient care as well as emerging pathogen surveillance.
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Board No: 53 #2024147
"A Tale of Two Threats: A Scoping Review of Mycobacterium Tuberculosis and Methicillin-Resistant Staphylococcus Aureus (MRSA) Coexistence in Human Infections in Sub-Saharan Africa."
Principal Presenter: Deborah Ndukwu
Track: General Infectious Diseases
Background
The coexistence of Mycobacterium tuberculosis (MTB) and Methicillin-Resistant Staphylococcus aureus (MRSA) in human infections represents a significant yet understudied threat to global public health. This is of particular significance in Sub-Saharan Africa (SSA), where high burdens of TB, HIV/AIDS, and antimicrobial resistance (AMR) converge. Despite the growing recognition of MTB-MRSA co-infections, there is a limited synthesis of evidence on their epidemiology, clinical impact, and management in these high-risk areas. This scoping review aims to address this gap by exploring the prevalence, risk factors, and outcomes of MTB-MRSA co-infections in SSA.Methods
A comprehensive scoping review was conducted. We searched PubMed, Web of Science, and Scopus, until 31 December 2024. We included observational and experimental studies, case reports, as well as Studies involving humans with confirmed or suspected coinfection of Mycobacterium tuberculosis (TB) and Methicillin-Resistant Staphylococcus aureus (MRSA). Studies were screened for eligibility, and data were extracted on epidemiology, risk factors, clinical outcomes, and management strategies. The findings were summarised using descriptive statistics and thematic analysis as specified in the protocol.Results
The review included 170 studies, confirming that MTB-MRSA co-infections are not well reported in SSA, particularly as this region is home to a high rate of immunocompromised individuals such as those with HIV/AIDS or chronic lung disease. Significant risk factors for MTB-MRSA co-infection were reported as: overcrowded living circumstances, poor access to healthcare, and high rates of antibiotic usage. This led to severe clinical manifestations evidenced by greater fatality rates than single-pathogen infections. Also recorded were changes associated with early diagnosis such as limited access to microbiological tests. Management attempts were also restricted by drug resistance, lack of resources, and poor infection prevention and control (IPC) practices.Conclusion
This review sheds light on the growing burden of MTB-MRSA co-infections in SSA. It helps us know how urgent the region needs targeted interventions for these co-infections. Given this, improved diagnostic capabilities, antimicrobial stewardship programs, and context-specific treatment guidelines are pivotal to addressing this dual threat. Future research should focus on understanding the mechanisms of coexistence and developing integrated approaches to curb the impact of these co-infections in resource-limited settings such as in Sub-Saharan Africa. -
Board No: 54 #2024179
"Sustainable preparedness of the National High Level Isolation Unit (NHLIU) through implementation of a Quality Dashboard"
Principal Presenter: Siti Mardhiah Muhamad Fauzi
Keywords: implementation science, preparedness, high consequence infectious diseasesTrack: Other
Background
The NHLIU forms a central component of a national multi-disciplinary approach to High Consequence Infectious Disease (HCID) management. It is governed by international standards, and ensuring that these standards are met is critical to safe functioning of the unit. This project aims to develop and implement a quality dashboard which aims to allow (i) summarising of Key Performance Indicators (KPIs) (ii) rapid alerting of critical deficiencies (iii) ease of reporting to internal and external collaborators.
Method
Consolidated Framework of Implementation Research(CFIR) and Quality Implementation Framework(QIF) were used as frameworks for this implementation project. Three main processes were identified: development of an implementation team, engaging with relevant stakeholders, and development of the Quality Dashboard(QD). Guidelines from European Centre for Disease Prevention and Control, European Network of Infectious Diseases, John Hopkin’s and current NHLIU’s readiness checklist provided KPI standards.
Results
An implementation team was established with the NHLIU’s clinical lead, fellow, project manager and Clinical Nurse Managers, with support from Information Management Systems. A thematic analysis of international guidelines, alongside an assessment of NHLIU’s organisational and governance structure identified four common themes – staff wellbeing, unit maintenance, operational management and clinical care.
A scoping interview with relevant stakeholders was completed to carry out a needs, capacity, and fitness assessment. A secondary outcome within this was to gauge stakeholders’ buy-in, and to identify potential facilitators and barriers.
All stakeholders engaged positively and agreed that the QD would fit their current workflow processes. Factors that would increase QD’s implementation were identified: importance of simulation exercises, engagement of leaders and frontline workers, technological support and training sessions upon implementation. Potential barriers included risk escalation requiring cross-directorate working, organisational approach and avoiding redundancy with internal workflow.
These findings were incorporated into the pilot QD. There are 84 KPIs, of which 16 are critical to be maintained ready. The KPIs are owned by relevant stakeholders and are categorised into the four domains identified during thematic analysis, providing oversight and support to stakeholders.
Conclusion
The QD has had positive stakeholders’ engagement and allows visualisation of KPIs according to stakeholder themes. Implementation of the QD will contribute to sustainable preparedness of NHLIU against emerging health threats. It will be embedded within the quality governance structure of the broader hospital group but allow national multi-disciplinary visibility of this important component of Ireland’s Health Protection Strategy.
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Board No: 55 #2024197
"Mpox Marks The Spot: Uncovering Latent Safety Threats in Emergency Preparedness Through In-Situ Simulation"
Principal Presenter: Andrew Ngaditono
Track: General Infectious Diseases
Background:
The recent first imported case of clade I Mpox in a Dublin hospital underscores the need for high-consequence infectious disease (HCID) preparedness across all Irish hospitals. Although rare, HCIDs require robust appropriately adapted local protocols. In-situ simulation (ISS) is a cost-effective approach to evaluating these protocols, identifying latent safety threats, and optimising emergency department (ED) response within existing infrastructure. We present findings from a multidisciplinary ISS on Mpox management in the ED of a Model 3 Dublin hospital, led by teams from Emergency Medicine (EM), Infectious Diseases, Microbiology, and Infection Prevention & Control (IPC).Methods:
A one-hour ISS was conducted in the ED to assess workflows, communication, and infection control measures in the management of a suspected Mpox case, from triage identification to sample collection in the isolation room. An EM intern portrayed the patient, while an EM registrar and two EM nurses participated in the simulation. None had received prior HCID-specific training. Laminated local Mpox guidelines—including risk assessment, PPE donning/doffing, and sample collection/packaging—were readily available. GlitterBug® fluorescent lotion was discreetly applied to the intern’s upper body, with ultraviolet light subsequently used to identify IPC breaches. The multidisciplinary team observed the simulation, followed by a debriefing session.Results:
ISS identified four categories of latent safety threats: work environment and physical space, processes and protocols, teamwork and communication, and training and competency. IPC vulnerabilities were evident in triage, where ultraviolet light revealed contamination of multi-use equipment (blood pressure cuff, oxygen saturation probe), and surfaces (department doors) concerning for potential fomite spread. This revealed gaps in triage preparedness and local cleaning protocols. Although no clinician contamination was identified post-doffing, participants reported difficulties following PPE donning/doffing and sample collection protocols, indicating a need for improved hands-on training, formalised buddy system for real-time coaching, and improved guideline format. Additionally, miscommunication occurred due to lack of shared mental models among participants and the absence of intercom speakers between the isolation room, anteroom, and corridor, hindering coordination.Conclusion:
ISS effectively identified latent safety threats in HCID management, revealing critical gaps in IPC, protocol adherence, training, and communication. Potential mitigation strategies include developing a triage room action card for patient placement and cleaning, refining protocols, incorporating hands-on PPE and sample collection training with peer coaching, and enhancing communication infrastructure. These targeted interventions can strengthen ED response to HCIDs and improve overall patient and staff safety.
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Board No: 56 #2024178
"Strengthening National Preparedness for High Consequence Infectious Disease (HCID) through Development of a Multi-disciplinary National High Level Isolation Unit - Intensive Care Unit Working Group (NHLIU-ICU WG)"
Principal Presenter: Emma McGorman
Track: General Infectious Diseases
Background:
The National Isolation Unit at the Mater Misericordiae University Hospital (MMUH) is Ireland's designated treatment facility for suspected or confirmed High-Consequence-Infectious-Disease (HCIDs). Following a 2019 review of the existing National Isolation Unit infrastructure, the recommendation was to build a new National High Level Isolation Uni, now currently nearing completion. It is located on the ground floor of the recently complete Rock Wing building. The facility has the capacity to treat two critically unwell patients within one footprint. In preparation for the new facility a NHLIU-ICU working group was established with the aim of developing the ICU model of care for a patient with an Airborne or Contact HCID.
Methods:
A dedicated NHLIU-ICU WG was established by the Staff Development Facilitator and Clinical lead. This was a subgroup of the NHLIU Clinical Operations and People Project (COPP), which forms the governance structure for the NHLIU in development of the MMUH.
This NHLIU-ICU WG membership included physician and nursing representation from ICU, NHLIU and Infection Prevention and Control (IPC). A terms of reference was established, with meeting frequency set at fortnightly initially and a quorum of 6 people. A list of objectives was set out with the aim of developing the Critical Care model of care, facilitating the education and training of critical care staff and ensuring cross directorate interoperability during activation periods.
Results:
The NHLIU ICU WG met on 4 occasions, first meeting on October 29th 2024. Meeting frequency was subsequently reduced pending NHLIU construction completion. A Gantt chart was developed outlining the key tasks and timelines including service design/operation, workforce planning, HCID networking/collaboration, education and training, quality and research.
All NHLIU-ICU WG outcomes, including the Gantt chart were reported to the NHLIU COPP. An education and collaboration meeting was arranged between the NHLIU-ICU WG and ICU experts from the U.S. National Emerging Special Pathogens Training and Education Centre (NETEC). An Airborne HCID ICU protocol was developed to improve immediate preparedness in view of a recent admission of an Mpox Clade 1a to MMUH.
Conclusion:
Experience from prior outbreaks such as Ebola Virus Disease 2014-2015, demonstrates that early access to appropriate critical care support markedly improves survival. That said, the management of the critically unwell HCID patient is complex due to the stringent IPC measures required and staff training considerations. The NHLIU-ICU WG has been established to ensure critical care support can be safely provided in Ireland to adult patients with a HCID who clinically deteriorates.
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Board No: 57 #2024192
"An Audit of PCR Testing for the Diagnosis of Invasive Bacterial Infection in Children"
Principal Presenter: Sofia Griggs
Track: General Infectious Diseases
Introduction
Polymerase chain reaction (PCR) testing is an important adjunctive tool for the diagnosis of invasive bacterial infection (IBI), but can result in false-positive test results. In particular, “low level detection” of some pathogens on blood PCR often represents upper airway carriage, rather than IBI. In recent years, we have noticed an increase in blood PCR tests for IBI being ordered in CHI, despite the decrease in IBI incidence resulting from successful childhood immunisation campaigns. We therefore aimed to audit blood PCR testing for IBI across CHI to explore potential trends in ordering and to ensure they are in line with national guidelines.
The Irish Meningitis and Sepsis Reference Laboratory (IMSRL), based at CHI Temple Street, provides a PCR based diagnostic service for key bacterial pathogens causing sepsis and/or meningitis, including N. meningitides (meningococcus, Nmen), S. pneumoniae (pneumococcus, Spn), H. influenzae (Hinf), and S. agalactiae (Group B Streptococcus, GBS).
Methods
We carried out a cross-site retrospective audit of laboratory results and medical records on a representative sample of children attending CHI who had blood sent to IMSRL for PCR in 2023. All patients with a positive detection on blood PCR were included, along with a representative sample (15%) of patients with negative blood PCR results from each CHI inpatient site. PCR samples sent post-mortem were excluded. The audit was reviewed and approved by the CHI Clinical Audit Programme (Audit Ref No. CA24-08-07).
Results
There were 682 blood samples sent across CHI in 2023, of which 28 (4.1%) were positive for a bacterial pathogen. Of the 28 positive results, however, 10 (36%) were low level detections (mostly Hinf). Notably, none of the patients with low level detection results had a discharge diagnosis of IBI, and none had a positive blood culture. There was large variation between the three CHI sites in the number of blood PCR requests sent. A summary of results by CHI site was as follows:
· CHI Temple Street: 10/185 (5.4%) positive (5 Hinf, 4 Spn, 1 GBS). Three low level detection (2 Hinf, 1 Spn)
· CHI Crumlin: 17/317 (5.4%) positive (14 Hinf, 2 Nmen, 1 GBS). Ten low level detection (7 Hinf, 1 Spn, 1 Nmen, 1 mixed (multiple targets))
· CHI Tallaght: 1/179 (0.6%) positive (Hinf)
Among the patients with negative PCR results 48% had documentation at least once that they were awaiting a PCR result, potentially indicating a delay in discharge.
Conclusions
There was a low yield of positive PCR results from blood, and at least a third of these likely represented false positive results. False positive results may lead to unnecessary additional investigation and therapies. False positive results, and awaiting results of PCR testing in the setting of a low pre-test probability of IBI, may lead to delays in hospital discharge. PCR testing for bacterial pathogens should only be carried out where clinical and laboratory findings indicate a reasonably high pre-test probability of IBI.
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Board No: 58 #2024118
"AN AUDIT OF THE CLINICAL SERVICES PROVIDED TO CONGENITAL CYTOMEGALOVIRUS INFANTS IN IRELAND"
Principal Presenter: Aliya Hamid
Track: General Infectious Diseases
Background
Congenital cytomegalovirus (cCMV) is the most common in-utero infection in the developed world and the most common non-genetic cause of sensorineural hearing loss (SNHL) in children.1,2 Evidence suggests that 6 months valganciclovir therapy may prevent progression of hearing loss in affected infants, however routine monitoring for side effects is necessary.3
Method
A retrospective audit of infants attending the Irish national Paediatric Infectious Diseases service for cCMV treatment (January 2021–April 2024) was done. Outcomes collected were treatment indication, treatment commencement age, and toxicity monitoring. Practice was benchmarked against ESPID consensus guidelines (2015/2024).
Results
17 infants were identified to have completed 6 months’ treatment and were included in this audit. The mean age at treatment commencement was 27.7 days (Range: 3–70 days) with 11/17 (64.7%) of babies starting within the first 30 days of life. The remaining 1/3rd had commencement after 30 days. The commonest indication was an abnormal MRI scan (11/17, 64.7%) and 9/17(52.9%) infants had SNHL.Blood monitoring was in line with guidance (i.e. weekly tests for first month, then monthly afterwards2) in 8/17 infants (47% of infants getting ≥9 blood checks during the 6-months course).
Treatment modification occurred in 3/17 (17.7%) infants due to neutropenia (<0.5x109/L). Of these, one had a dose reduction and two had temporary cessation. Baseline characteristics did not vary between infants with or without toxicity.
Conclusions/Learning Points
Delayed detection of cCMV infection contributed to initiation of treatment at>30 days of life in 1/3rd patients. Overall, the treatment was well tolerated with only 3 cases of temporary treatment modification. In this small audit, toxicity predictors could not be identified. Toxicity monitoring frequency could be reduced but larger studies are required to confirm the safety of this. -
Board No: 59 #2024216
"Bedside Diagnosis of Neonatal Sepsis by Detection of Serum Amyloid A."
Principal Presenter: Julia Nowak
Keywords: Neonatal Sepsis, Biomarkers, Rapid diagnosticsTrack: General Infectious Diseases
Sepsis is a serious medical condition and a global health concern. Specifically, neonatal sepsis results in 225,000 neonatal deaths globally per annum and newborns in low- and middle-income countries (LMICs) are particularly vulnerable. Uganda has one of the highest rates of neonatal sepsis deaths in the world at 17 neonatal deaths per day. Such high mortality rates are largely due to the absence of suitable biomarkers and diagnostic systems to enable early diagnosis. However, Serum Amyloid A (SAA) is emerging as a potential standalone biomarker for the diagnosis of neonatal sepsis. SAA can be detected by laboratory-based tests, but these are often unavailable in LMICs.
The objective of this study was to evaluate the diagnosis of sepsis in neonates through detecting SAA, a recognised infection/inflammation biomarker, using a rapid and point-of-care lateral flow test. Early diagnosis can facilitate treatment and decision-making which will improve neonatal sepsis outcomes and improve neonatal mortality, a key objective of WHO SDG 3.2. Facilitating a LMIC-compatible rapid diagnostic test provides critical assistance in neonatal sepsis diagnosis, particularly in environments where the lack of resources hinders neonatal care.
To address these issues, in an ethically-approved study we deployed a competitive, lateral flow test (NeoSep-SAA; Accuplex Diagnostics Limited, Ireland) to semi-quantitatively detect SAA in whole blood at patient-side in a LMIC. Our study assessed the performance of NeoSep-SAA for neonatal sepsis detection in a highly powered study of 714 neonatal samples. C-Reactive Protein, a widely recognised sepsis-related test was run alongside as a comparator. Over 100,000 items of clinical data were collected and analysed.
We demonstrate NeoSep-SAA performance and suitability in a LMIC for detection of neonatal sepsis with high sensitivity and specificity, 92% and 73%, respectively, comprising a large neonatal cohort (n = 714). NeoSep-SAA significantly out-performed the gold-standard biomarker, C-Reactive Protein, (sensitivity: 37 %) for neonatal sepsis detection (P < 0.0001, 95% CI). Results are available within 5 minutes and test format is compatible with small blood volumes available from neonates (5 µl).
This study demonstrates NeoSep-SAA can successfully detect sepsis and potentially enable a rapid decision to initiate antibiotic therapy to improve neonatal mortality incidence. Given both the unsuitability of current sampling systems and absence of current testing for neonatal sepsis in LMICs, we propose that NeoSep-SAA is ideal for the detection of neonatal sepsis in resource-limited environments.
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Board No: 60 #2024227
"Breaking Boundaries: Reimagining the definition of Lemierre syndrome in an Irish context"
Principal Presenter: Kaitlyn O'Brien
Keywords: lemierre syndrome, OPAT, Irish case reportTrack: General Infectious Diseases
Presentation: 21 year old male presented with a 10 day history of fevers, unilateral pleuritic chest
pain and odynophagia having already received oral antibiotics in the community with no
improvement.
Diagnosis and treatment: Radiological imaging undertaken to exclude pulmonary embolism showed
cavitating lesions in thorax concerning for tuberculosis. With the sub-acute presentation and no
history of TB exposure, a CT neck was performed which showed a right sided peritonsillar abscess
without internal jugular vein (IJV) thrombosis. Fluid drained grew Streptococcus mitis and Rothia
mucilaginosa. Patient successfully completed a 6 week course of intravenous antibiotics.
Discussion:
This case highlights the need for clinicians to consider a broader differential for cavitating lung
lesions such as Lemierre syndrome (LS) in a young patient. The absence of IJV involvement on
imaging should not exclude LS and given the rise in antimicrobial resistance worldwide this once rare
disease may become more prevalent in the general population. -
Board No: 61 #2024195
"Rhizopus azygosporus in a High-risk AML Case"
Principal Presenter: Teresa Ana Botin Lopez
Keywords: Mucormycosis, Immunocompromise, Acute Myeloid LeukemiaTrack: General Infectious Diseases
Mucormycosis is a rare but life-threatening fungal infection with high mortality, particularly in immunocompromised patients. Diabetes mellitus (DM), hematologic malignancies, transplantation, and prolonged neutropenia are major risk factors for its development. We present a challenging case of a diabetic patient with high-risk acute myeloid leukemia (AML) who developed Rhizopus azygosporus mucormycosis.
A 58-year-old male with type 1 DM was diagnosed with acute myeloid leukemia (AML) after presenting with severe anemia and neutropenia. Bone marrow evaluation confirmed 70% blasts, cytogenetic studies revealed an ETV6 translocation and BCOR mutation, categorizing him as high-risk. He received induction chemotherapy with cytarabine and idarubicin, along with posaconazole prophylaxis.
During aplasia, he developed fever and respiratory symptoms (cough and dyspnea), initially managed with broad-spectrum antibiotics. A CT scan revealed an anterior mediastinal mass and a left pleural effusion. Despite drainage his symptoms persisted, and bronchoscopy deemed non-diagnostic. Given the suspicion of invasive fungal infection, he was empirically started on amphotericin B.
A bone marrow biopsy showed persistance of the disease so FLAG-IDA salvage chemotherapy was administered. His condition worsened with persistent fever, weight loss, worsening cough, and hemoptysis. A biopsy of the progressing mediastinal mass showed fungal elements initially suggestive of Aspergillus but fungal PCR & molecular testing confirmed diagnosis of Rhizopus azygosporus.
Given the poor prognosis of AML complicated by mucormycosis, we decided to withhold further AML treatment to avoid exacerbating Rhizopus proliferation. Oral Isavuconazole was prescribed to facilitate hospital discharge and outpatient palliation.
Mucormycosis is a rare but aggressive angio-invasive fungal infection caused by fungi from the order Mucorales, including Rhizopus, Mucor, and Lichtheimia species. It predominantly affects immunocompromised individuals and the prognosis remains poor with mortality rates ranging from 45% to 90%.
Clinical presentations can be pulmonary, rhinocerebral, cutaneous or even disseminated. Diagnosis requires imaging techniques such as CT/MRI, histopathologic examination showing broad, ribbon-like hyphae with right-angle branching and molecular testing with PCR and sequencing for species identification.
A multidisciplinary approach and a prompt diagnosis are essential for optimal management, control of predisposing factors such as DM/immunosupression, surgical debridement whenever possible and antifungal therapy - first line liposomal amphotericin B and isavuconazole as salvage therapy -.
This case is to illustrate an uncommon yet severe presentation of mucormycosis with a fungal mediastinal mass and underscores the diagnostic challenges in differentiating Rhizopus from Aspergillus, highlighting the importance of molecular diagnostic techniques for accurate identification.
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Board No: 62 #2024171
"Aortic root abscess four years post-Bentall’s procedure - A Case Report"
Principal Presenter: Ruairi Corcoran
Keywords: Prostheses, MSSA, AortaTrack: General Infectious Diseases
The Bentall procedure is a cardiac surgery to replace the aortic root, ascending aorta and aortic valve with a composite graft. Periprosthetic aortic root abscesses are a potentially life threatening complication of Bentall procedures, occurring in 1-2% of cases, often requiring high risk repeat procedures to remove infected material. Periprosthetic aortic root abscesses caused by Staphylococcus aureus carry a high mortality rate, with recent literature quoting figures of between 26 and 46%.
This is the case of a 51 year old gentleman who presented to the Emergency Department with a vague one day history of productive cough, chest pain radiating to his shoulders, and fevers. This was on a background history of Bentall’s procedure and insertion of a tissue aortic valve replacement in the context of severe aortic regurgitation in 2020.
Laboratory tests revealed raised inflammatory markers. The patient was initially managed as a respiratory sepsis on IV Ceftriaxone and azithromycin, which was changed to IV flucloxacillin on day 2 following blood cultures returning as positive for methicillin sensitive Staphylococcus aureus. On day 3 of admission, CT Aortography was performed due to slow clinical progression and persistence of the patient’s chest pain. This revealed a large periprosthetic aortic root abscess.
The patient was managed medically on IV flucloxacillin for a further 14 days, prior to transfer to a nearby facility for replacement of aortic root and valve. His initial postoperative course was complicated by atrial fibrillation. He did well clinically and biochemically postoperatively and was discharged 10 days following his procedure. He was continued on IV flucloxacillin as well as oral Rifampicin for 6 weeks postoperatively to complete an 8 week total course of therapy. The patient has since been reviewed in outpatient clinics, and has remained well with complete functional recovery.
This case serves to highlight the importance of having a low threshold for cross sectional Computed Tomography (CT) imaging in patients with Staphylococcus aureus bacteraemia, particularly in those with backgrounds of vascular prosthesis or cardiac valve replacements. Imaging of the graft was not performed until day 3 of this patient's admission, as a respiratory tract infection was thought to account for his symptoms and biochemical picture. This may have posed a potentially life-threatening treatment delay. The case also highlights the necessity of surgical source control in the successful management periprosthetic Aortic root abscesses.
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Board No: 63 #2024127
"A Rare Widespread Vesicobullous Eruption Likely Precipitated by Mycoplasma pneumoniae Infection"
Principal Presenter: Stephen Connolly
Track: General Infectious Diseases
Mycoplasma pneumoniae infections are known to be associated with a variety of dermatological manifestations ranging from simple exanthems and urticarias to life threatening Stevens-Johnson syndrome and toxic epidermal necrolysis. We detail the case of a 30-year-old female from Somalia who presented to our hospital with a widespread bullous rash in the setting of demonstrated acute Mycoplasma pneumoniaeinfection.
The patient presented to the emergency department with a 3-week history of dry cough, sore throat and a progressive bullous rash spreading from the volar aspect of the patient’s wrist bilaterally to cover the limbs and trunk. Examination revealed extensive, tense vesicles and bullae, up to 3.5cm in diameter, with erosions in the gingiva and buccal mucosa. There was no ocular involvement, and the axillae and head were spared. Peripheral eosinophil count was within normal limits, as was a 4th-generation HIV antigen/antibody test. Chest radiography revealed consolidation in the lateral basal segment of the right lower lobe. Initial differential diagnosis included infection vs immunobullous including linear IgA disease, bullous lupus and epidermolysis bullosa aquisita. HSV and VZV swabs were negative, as were screening for SLE, connective tissue disease and bullous pemphigoid antibodies. Histopathology results from a skin biopsy revealed a split at the lamina lucida level of the dermal epidermal junction with marked eosinophilic and lymphohistiocytic infiltrates. Direct immunofluorescence showed strong linear IgG and C3 at the dermal epidermal junction, in-keeping with an immunobullous aetiology. Given the constellation of respiratory findings and likely immune-mediated skin findings, testing for Mycoplasma pneumoniae IgM and IgG was pursued, with IgM testing strongly positive.
The patient was discharged on oral doxycycline and topical corticosteroids with close outpatient follow up. On follow up review, the patient had not tolerated oral doxycycline and her skin lesions were non-resolving. She was commenced on prednisolone with clarithromycin having declined re-admission. The patient at this point was sadly lost to follow up, having relocated suddenly to Sweden, where she continued her care.
Mycoplasma pneumoniae skin manifestations are more common in paediatric patients, and include erythema multiforme, Stevens-Johnson syndrome and the recently described Mycoplasma-induced rash and mucositis (MIRM) which affects patients with a mean age of 11 years in the initial systematic review that described the phenomenon. This report describes a rare vesicobullous manifestation of Mycoplasma pneumoniaeinfection in an adult, and highlights the need to consider this pathogen in similar presentations. -
Board No: 64 #2024176
"An Uncommon Cause of Cervical Lymphadenitis in a Paediatric Patient: A Case of Glandular Tularemia"
Principal Presenter: Roisin Coyne
Keywords: Cervical Lymphadenitis, Paediatric, TularemiaTrack: General Infectious Diseases
Background
Tularemia, a zoonotic disease caused by Francisella tularensis, a highly virulent gram-negative species of bacteria. Transmission occurs by bites from ticks, mosquitoes, and flies, though inhalation of contaminated aerosols or ingestion of infected food/water. Tularemia is a notifiable disease in Ireland, with no domestically reported cases since its inclusion in 2012 and one internationally acquired case reported in 2023.
Clinical course
Herein, we report the case of a 7-year-old female who presented with anterior and posterior cervical confluent abscesses. Failing medical treatment and following assessment for TB, she underwent incision and drainage by the ENT team and following a course of IV Ceftriaxone was discharged on oral Penicillin with scheduled follow-up. Shortly after discharge, she re-presented with new-onset supraclavicular abscess, which necessitated aspiration.
Given the atypical progression, an extensive workup was undertaken. Initial blood cultures and serology were negative, and histopathological analysis suggested a ruptured sebaceous gland. Following consultation, further investigations returned negative for Tuberculosis, Brucella, Bartonella, HIV, Leishmaniasis, Syphilis and other granulomatous infectious diseases. Pus was sent for 16S and 18S PCR that returned as not detected. Due to diagnostic uncertainty and new dermatological manifestation of bullous lesions further testing for tularaemia was requested. This confirmed the diagnosis of Tularemia serologically. The patient was treated with a two-week course of Ciprofloxacin.
Discussion
Tularaemia, although rare, can be considered as a differential diagnosis in cases where standard diagnostic pathways fail to yield a definitive result. Additionally, the successful diagnosis and management of this case was facilitated by a multidisciplinary approach, emphasising the necessity of collaboration among teams when dealing with complex or refractory cases.
Conclusion
This case report serves to raise awareness of tularaemia as a differential diagnosis for paediatric cervical abscesses in Ireland, particularly in cases with an unclear aetiology. It also represents the diagnosis of a rare, notifiable disease, necessitating public health investigation.
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Board No: 66 #2024160
"An unusual case of Tubo ovarian abscess caused by Gemella asaccharolytica and Chalmydia Co-Infection"
Principal Presenter: Areej Elzubair
Track: General Infectious Diseases
Background
Pelvic inflammatory disease may be complicated by a Tubo ovarian abscess, and can have long term implications for patient’s health and fertility.
Gemella was first described as Neisseria haemolysans in 1938. It is is a genus of gram positive bacteria ,catalase negative .
Methods: We present a case of 23 years old lady from Malawi admitted to Tallaght University hospital , with 9 months history of abdominal pain ,associated with heavy irregular periods. No fever or diarrhoea. She was diagnosed with tuboovarian abscess diagnosed on CT abdomen and pelvis which showed bilateral rim enhancing multiloculated adnexal collection /cysts up to 9.4 cm on the right, and 6.7 cm on the left in keeping with bilateral tubo-ovarian abscess and pelvic inflammatory disease with Small volume ascites .Right kidney demonstrated moderate hydronephrosis and there was also report of small bowel thickening suggestive of enteritis .Right external iliac vein was compressed by ovarian lesions .Retroperitoneal adenopathy was also reported.
Patient underwent IR guided right nephrostomy insertion and ultrasound aspiration from pelvis.
Results:
The endocervical swab detected chlamydia. She had pus sample sent which yielded Gemella asaccharolytica detected on 16s pcr.
Patient was initially treated with ceftriaxone, doxycycline ,metronidazole and stat of gentamicin . She deteriorated clinically and required laparotomy with right salpingoophorectomy and partial drainage of collections .She required ICU admission postoperatively.
Currently she is treated with OPAT(Outpatient parenteral antimicrobial therapy),iv ceftriaxone, po doxycycline and po metronidazole and making good clinical progress.
Conclusion: Newer molecular diagnostic methods allowed identification of pathogens for this patient and she is making recovery via OPAT antimicrobials after undergoing surgical intervention.
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Board No: 67 #2024172
"Infant Botulism caused by Clostridium botulinum Neurotoxin Type B"
Principal Presenter: Tiarnán Fallon Verbruggen
Keywords: Infant Botulism, Neurotoxin, Baby-BIGTrack: General Infectious Diseases
Introduction:
Infant botulism (IB) is an intestinal toxaemia caused by the ingestion of spores from Clostridium botulinum, or a related bacterium, leading to an acute flaccid paralysis.[1] Here we present a new patient, with characteristic nerve conduction studies and laboratory-confirmed botulinum neurotoxin type B (BoNT/B), who successfully responded to a combination of botulinum antitoxin (BAT) and human botulinum immunoglobulin treatment (Baby-BIG).
Case Presentation:
A previously healthy 9-week-old infant presented to a regional hospital with difficulties breastfeeding and constipation. Overnight they developed progressive oro-pharyngeal and facial weakness with loss of her suck and gag reflexes and sluggish pupillary light reflexes. A descending flaccid paralysis evolved and the patient was transported to the paediatric intensive care unit for ventilation support.
This infant was predominantly breastfed with some exposure to store-bought anti-colic drops and glycerine. The family lived on a farm and a family member worked as a carpenter on local construction sites. No signs of infection or inflammation were detected on serology, cerebrospinal fluid or extended viral panels. No abnormalities were detected on MRI Brain and Spine. Stool samples had been sent for botulism culture but remained pending. Bedside nerve conduction studies showed low amplitude compound muscle action potentials (CMAPs) with an incremental increase when repetitive high frequency stimulation at 50Hz was applied. These findings combined with the clinical features strongly supported a diagnosis of infant botulism.[1]
Our patient was treated initially with Equine Heptavalent Botulinum Antitoxin (BAT). It is the only antidote readily available in Ireland and early treatment is shown to be most effective, however, it has a relatively short duration of action (5-7 days).[2] Clostridium botulinum neurotoxin type B (BoNT/B) was subsequently detected on the stool samples. Human Botulism Immune Globulin (‘Baby-BIG’) was sourced via public health authorities in California. Baby-BIG is manufactured specifically for infant botulism. It is more effective against BoNT types A and B, has a longer duration of action (up to 6 months) and protects against relapse of symptoms while the infant’s gastrointestinal tract remains colonised.[2]
Our patient was discharged home after 2 weeks in hospital, has had close follow-up with their local paediatric services and has made a full recovery.
Conclusion:
Infant Botulism is a rare but reversible cause of flaccid paralysis that requires prompt recognition but can be aided by nerve conduction studies.[1] BoNT types A and B are most common and early treatment with Baby-BIG remains the gold standard.[2] Where possible, Baby-BIG should be given to prevent late symptoms or relapse, even if BAT has already been administered.[2, 3]
References:
[1] Roscow LK, Strober JB. Infant Botulism: Review and Clinical Update. Paediatr Neurol. 2015; 52: 487-492.
[2] Arnon SS et al. Human Botulism Immune Globulin for the Treatment of Infant Botulism. N Engl J Med. 2006; 354: 462-71.
[3] Shelly E et al. Infant Botulism due to C. butyricum type E toxin: a novel enivormental association with pet terrapins. Epidemiol. Infect. 2015; 143: 461–469.
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Board No: 68 #2024210
"A case of Ventriculitis following infection with Neisseria meningitidis Serogroup B."
Principal Presenter: Emily Farnan
Keywords: Ventriculitis, Neisseria meningitidisTrack: General Infectious Diseases
A previously-well fully vaccinated 15-year old boy presented to his local hospital with a 1-day history of myalgia, pyrexia, photophobia and worsening headache. On arrival, he had a diffuse non-blanching maculopapular rash, severe headache, GCS 14, and unequal pupils. He was treated with cefotaxime and dexamethasone. CT Brain demonstrated hydrocephalus. His pupils equalised after receiving 3ml/kg 3% NaCl and he was transferred to a tertiary paediatric intensive care unit self-ventilating on a propofol infusion. Initial CRP and white cells were elevated (CRP 284mg/L, WCC 23x109/L, Neutrophils 20.9 x109/L). He was coagulopathic (PT 23.1) with a high Lactate (5.4). The remainder of his bloods were grossly normal. Meningococcal B DNA was detected on In Genius PCR screen at presentation, and 3 days later. No CSF was obtained due to the concerns regarding hydrocephalus. Clinically he improved, his headache resolved, and he had no neurologic deficit. His antibiotics were switched to Ceftriaxone. He became febrile day 6 of a planned 7 days of treatment and thus antibiotics were continued past seven days while a cause for fever was investigated.
An MRI Brain with contrast day 6 of antibiotics demonstrated improvement of the degree of dilatation of lateral ventricles; however, showed fluid levels within the occipital horns of the lateral ventricles bilaterally that was mildly T2 hypointense compared to CSF that demonstrated diffusion restriction (Figure 1). There was associated thin FLAIR hyperintensity in the ependymal lining without any abnormal enhancement of the ventricular walls (Figure 2). There was no focal parenchymal abnormality or intracranial collection.
Figure 1: Ax DWI MUSE Figure 2: Ax T2 FLAIR
Discussion
In Europe, Neisseria meningitidis has been shown to cause approximately 30% of paediatric meningitis cases. Ventriculitis is a known complication of central nervous system infections; however, ventriculitis following invasive meningococcal disease is rare (0.6%). Our case highlights ventriculitis as a possible complication of N meningitidis serogroup B infection.
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Board No: 69 #2024224
"Complexities in the Diagnosis and Management of Prosthetic Valve Q Fever Endocarditis"
Principal Presenter: Cian Lenihan
Keywords: Endocarditis, Prosthetic Valve, Chronic InfectionTrack: General Infectious Diseases
Background: Q fever endocarditis is an uncommon yet severe manifestation of chronic Coxiella burnetii infection, predominantly affecting prosthetic valves. Its presentation is often subtle, culture-negative, and lacks typical echocardiographic findings, resulting in diagnostic delays. Diagnosis often hinges on specific serology and PCR testing. Management is complex, especially in high-risk surgical candidates, and typically requires prolonged antibiotic therapy in combination with close multidisciplinary oversight.
Case Description: A 69-year-old male with a history of autoimmune hepatitis, prosthetic aortic valve replacement (AVR) with ascending aortic graft in 2014 and pulmonary sarcoidosis with interstitial lung disease, presented with progressive weight loss, persistent fever, and pancytopenia. Following an ambulatory bronchoscopy with biopsy confirming non-caseating granulomas consistent with sarcoidosis, he became febrile and confused with subsequent neuroimaging revealing a subdural hematoma requiring surgical evacuation. He was successfully discharged home, before re-presenting several days later with further confusion, fevers and gait disturbance. An MRI revealed stability of his known subdural haematoma, but a new occipital infarct. Concurrent abdominal imaging demonstrated splenomegaly and splenic infarction complicated by abscess formation. Transthoracic echocardiography identified aortic prosthetic valve vegetations, probable perforation of the anterior mitral leaflet, and findings consistent with an aortic root abscess.
Multiple blood cultures throughout admission were negative. Extensive investigations confirmed chronic Q fever endocarditis. Most recent serology showed a markedly high phase-2 (acute) IgG titre of 1:40960 with PCR now negative. The patient had no obvious exposure history, living rurally but denying farm-animal contact. Given his high surgical risk profile, a multidisciplinary team (MDT) opted initially for conservative medical management with prolonged antibiotic therapy (doxycycline and hydroxychloroquine), monitoring closely with serial echocardiography. His admission was further complicated by a pulmonary embolism, necessitating cautious anticoagulation following further MDT discussion. Over six weeks, his clinical status improved significantly with resolution of fever and gradual resolution of echocardiographic abnormalities, avoiding surgical intervention.
Consideration was made about the longstanding diagnoses of AIH and sarcoidosis. A prior liver biopsy (previously taken for presumed AIH) was reviewed. However, PCR testing of both liver and lung biopsy, retrospectively performed for Q fever, was negative. He was discharged home with continued antibiotic therapy and planned for short-interval follow up and outpatient PET-CT scan.
Discussion: This case underscores the diagnostic and therapeutic complexity of Q fever endocarditis, particularly in patients with prosthetic valves and elevated surgical risk. Effective multidisciplinary collaboration enabled careful evaluation and individualised decision-making, leading to substantial clinical improvement with medical therapy.
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Board No: 70 #2024111
"Steven-Johnson Syndrome Secondary to Mycoplasma pneumoniae Infection"
Principal Presenter: Nicola McNally
Keywords: Steven-Johnson Syndrome, Mycoplasma pneumoniae, SJSTrack: General Infectious Diseases
Background: Stevens-Johnson Syndrome (SJS) is a rare but severe mucocutaneous disorder, often triggered by infections or medications. Mycoplasma pneumoniae is a known infectious cause of SJS, particularly in pediatric and adolescent populations. We present a case of a 17-year-old female who developed SJS secondary to Mycoplasma pneumoniae infection.
Methods: A 17-year-old female presented to the emergency department with a one-week history of flu-like symptoms, including fever, dry cough, sore throat, nausea, and fatigue. She had been treated with antibiotics by her general practitioner but showed no improvement. On the day of admission, she developed blistering of the lips and oral exudates on the roof of the mouth and palate. A chest X-ray revealed right-sided pneumonia. Extensive polymerase chain reaction (PCR) testing confirmed Mycoplasma pneumoniae infection.
Results: The patient was evaluated by multiple specialties. Dermatology diagnosed her condition as SJS secondary to Mycoplasma pneumoniae. She subsequently developed vaginal ulceration, which was assessed by gynecology. Ophthalmology identified bilateral conjunctival injection and episcleritis but noted no further complications. A multidisciplinary approach was employed to manage her symptoms and prevent progression.
Conclusion: This case highlights the importance of recognizing Mycoplasma pneumoniae as a potential trigger for SJS. Early identification and multidisciplinary management are crucial to preventing severe complications. Clinicians should maintain a high index of suspicion for SJS in patients presenting with mucocutaneous symptoms and pneumonia, particularly in young individuals with Mycoplasma pneumoniae infection.
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Board No: 71 #2024164
"Aseptic Meningitis Secondary to NSAID Use in a 73-Year-Old Female."
Principal Presenter: Tanveer Hamid
Keywords: #AsepticMeningitis, Meningitis, EncephalitisTrack: General Infectious Diseases
A 73-year-old female with Ménière’s disease developed aseptic meningitis, likely from NSAID use. She presented with severe headache, vomiting, and transient visual hallucinations. Initial workup suggested encephalitis or meningitis, but cerebrospinal fluid (CSF) analysis and imaging ruled out infection. Symptoms resolved after stopping NSAIDs, confirming NSAID-induced aseptic meningitis.
Background:The patient, on hormone replacement therapy, had Ménière’s disease, no drug allergies, and no smoking history.
Case Presentation:On Day 1, she reported a severe headache (10/10), vomiting, and fluid intolerance after taking ibuprofen. She was alert (GCS 15/15), with elevated inflammatory markers but negative COVID-19/influenza swabs. Suspecting meningitis or encephalitis, she received antibiotics (Cefuroxime, Vancomycin) and antivirals (Acyclovir 10mg/kg TDS). CT brain was normal; lumbar puncture (LP) showed WCC 65/mm³, glucose 2.3 mmol/L, protein 1094 mg/L, with negative viral PCR, Gram stain, and culture.
On Day 2, headache improved, but hallucinations emerged. On Day 3, the infectious diseases team reviewed the case. The presentation, including a history of cold sores 3–4 weeks prior, raised suspicion for Herpes simplex virus (HSV) encephalitis despite the negative HSV PCR, as early infection may yield false negatives. NSAID-induced aseptic meningitis was also considered. Acyclovir increased to 15 mg/kg TDS, doxycycline added, and MRI was normal.
On Day 4, repeat LP remained negative for infection (including HSV, Mycoplasma, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae); antibiotics stopped, hallucinations resolved. Antivirals continued pending further LP. On Day 7, a third LP showed improvement (glucose 3.3 mmol/L, protein 475 mg/L, WCC 30/mm³), with negative tests. Antivirals ceased, symptoms resolved with paracetamol, and she felt “almost normal.” Diagnosed with NSAID-induced aseptic meningitis, she was discharged, advised to avoid NSAIDs, with follow-up in 3 weeks.
Discussion:NSAID-induced aseptic meningitis may involve hypersensitivity or meningeal irritation. Ibuprofen use, negative infectious workup, and symptom resolution post-discontinuation supported this diagnosis. Hallucinations suggested encephalitis, but normal MRI and improving CSF aligned with NSAID cases. Clinicians should suspect this post-NSAID use when infections are excluded.
Conclusion:This case highlights NSAID-induced aseptic meningitis as a diagnosis of exclusion in an elderly female with severe headache and vomiting. Prompt recognition and cessation of the offending agent led to full recovery. Patients with similar presentations warrant careful drug history review and avoidance of NSAIDs in confirmed cases.
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Board No: 72 #2024175
"Leuconostoc Lactis - an opportunistic Bacteremia"
Principal Presenter: Kate O'Shea
Keywords: Bacteremia, leuconostoc lactis, immunosuppressionTrack: General Infectious Diseases
Leuconostoc lactis is a catalase-negative Gram-positive coccus (GPC) that is often found in foods, particularly in fermented dairy products. In the past, L. lactis was not thought to be pathogenic to humans, but occasional cases of infections caused by this organ-ism such as ventriculitis, osteomyelitis, and bloodstream infection have been reported in recent years. There have been three cases of Blood stream infection caused by L. lactis Reported in the literature. These cases have been associated with immunocompromised patients, broad spectrum antibiotic use and biliary disease.
This is a case of L. lactis bacteremia in a 60 year old man from Australia in the context of a polymicrobial bacteraemia, advanced pancreatic cancer and a complicated biliary stent. The patient presented to the Emergency department with sepsis and isolation of Escherichia coli, Extended-Spectrum Beta-Lactamase-producing Klebsiella pneumoniae and Enterococcus faecium. This sepsis was attributable to cholangitis with imaging supportive of blocked biliary stents. The patient was initially managed on IV vancomycin and meropenem. A drain was inserted through percutaneous transhepatic cholangiography on day 3 of his admission, and significant improvement in his clinical status and inflammatory markers followed.
The patient improved clinically and biochemically until day 14 of his admission at which point repeat cultures were taken following a temperature spike. Two separate sets of blood Cultures demonstrated growth of Leuconostoc lactis. IV Amoxicillin was started due to the organism’s intrinsic resistance to Vancomycin, and raised MIC to meropenem. Following commencement of amoxicillin, repeat clearance cultures were negative on 3 consecutive days and the patient had no further clinical signs of infection.
This case serves to highlight the risk of opportunistic bacteremias in immunocompromised patients, treated with broad spectrum antibiotics. The extended use of vancomycin and meropenem in this case provided a selection pressure permitting the emergence of this organism, which is intrinsically resistant to vancomycin and had a raised MIC to meropenem. This case also underscores Leuconostoc lactis as a rare causative pathogen of bacteremia in immunocompromised patients with biliary disease.
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Board No: 73 #2024116
"First case of endemic Ehrlichia canis infection in a dog from Ireland: One Health Perspectives"
Principal Presenter: Julia McCarthy
Keywords: E.canis, Zoonosis, One HealthTrack: Other
Background
Ehrlichia canis is an intracellular bacterium that colonises macrophages and monocytes in the host. Clinical manifestation in dos have been described with fever, polyarthropathies, thrombocytopenia or anemia. Chronic ehrlichiosis is also associated with pancytopenia in dogs (Canis familiaris). This pathogen has been reported in the United States of America (southern states), South America, Asia, Africa, Australia and Southern Europe (Mediterrranean countries). Primarily a canine disease. E. canis has been reported in cats (Felis catus) and humans (Homo sapiens) with clinically affected individual in all species. Previously never reported in Ireland, this is the first confirmed endemic case of E. canis in the island of Ireland and raises concerns for the apparition of new endemic pathogens as well as potential One Health concerns.Case Description
A 6.5 year old, female spayed dog from Wicklow was referred to the UCD Veterinary Hospital for a chronic thrombocytopenia, fever and lameness. This clinical signs were waxing and waning for 6 months with no proper response to steroids. Upon investigations, the dog was hyperglobulinaemic, anaemic, thrombocytopenic and had bilateral retinochoroiditis. Rapid screening testing for tick borne diseases (4Dx Plus, Idexx) was positive for E. canis and the infection was confirmed upon quantitative serlogy and PCR on blood.Results
Investigations confirmed the E. canis infection in this dog and ruled out multiple myeloma or any other potential disease susceptible to lead to a similar clinical presentation or biochemical changes. The dog was treated with 28 days of doxycycline and steroids and the clinical signs resolved including the occular changes. A PCR at the end of the antimicrobial therapy was negative.Conclusion
This is the first endemic case documented in the island of Ireland of E. canis in a dog. This dog had never left Ireland and is mostly walked off leash in the Wicklow mountain. Previous work in parasitology and companion animal had identified ticks capable of transmitting E. canis in various area of Ireland but no previous dog tested positive. This case report is relevant as it illustrate the emergence of new endemic pathogens with zoonotic potential in Ireland. This illustrate the global changes One Health encompasses with emergence of new pathogens due to animal travel and climatic changes and thus emergence of potential new zoonosis in previously indemn areas. -
Board No: 74 #2024167
"Cryptococcus neoformans Causing Localized Osteomyelitis of the Ribcage"
Principal Presenter: Robert Shannon
Track: General Infectious Diseases
Cryptococcus neoformans is fungal pathogen that typically causes disease of the lungs and central nervous system, and rarely in hosts without major immunocompromise from transplant or HIV [1]. We detail the case of a 53-year-old patient from South Africa with a background of chronic kidney disease stage IV, type 1 diabetes mellitus and sarcoidosis and who developed a localised infection of his right 6th rib with fluconazole-resistant Cryptococcus neoformans as the proven aetiological agent. The patient presented with a one-month history of painful soft tissue swelling on his anterior chest wall, denying systemic symptoms. He had recently relocated from South Africa to Cork, and was taking a tapering course of prednisolone for his sarcoidosis, most recently being on a maintenance dose of 5mg daily.
CT imaging revealed an expansile right anterior rib lesion extending into the subcutaneous tissue anterior to the serratus anterior muscle, measuring 5.6 x 3.26 x 6.0 cm. Initial suspicion was for that of an aggressive malignancy.
Biopsy of the lesion revealed granulomatous inflammation however subsequently cultured Cryptococcus neoformans. CT scanning revealed no other sites of infection. A 4th generation HIV test was negative, as was CSF cryptococcal antigen. The patient was initiated on voriconazole monotherapy with therapeutic drug monitoring for a planned 12 month course. By the seventh months of the patient’s therapy, his chest wall lesion had fully resolved clinically and serum cryptococcal antigen titre had fallen to from 1:800 to 1:64.
Cryptococcus neoformans causing localised soft tissue and bone disease is exceedingly rare, with approximately only 100 cases described in the literature to date [2]. Fluconazole resistance is uncommon, with a prevalence of 12.1% (95% CI 6.7-17.6%) in one large systematic review [3]. This case illustrates the utility in considering cryptococcal infections in HIV-negative patients who nonetheless have additive immunosuppression from a constellation of risk factors for infection, and details successful use of voriconazole in uncommon scenario of fluconazole-resistant strains.
References:
1.Maziarz EK, Perfect JR. Cryptococcosis. Infectious Disease Clinics. 2016;30:179–206.
2. Papadakis. Cryptococcus neoformans Osteomyelitis of the Tibia: a Case Report and Review of the Literature.
3. Bongomin F, Oladele RO, Gago S, Moore CB, Richardson MB. A Systematic Review of Fluconazole Resistance in Clinical Isolates of Cryptococcus species. Mycoses. 2018;61:290–7.
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Board No: 75 #2024188
"Clinical Outcomes of a Nurse-Led Injectable Antiretroviral Therapy Clinic in the Mater Misericordiae University Hospital"
Principal Presenter: Amy Walsh
Keywords: HIV, Nurse-Led, Injectable Antiretroviral TherapyTrack: General Infectious Diseases
Background
Nurse-led long-acting injectable (LAI) antiretroviral therapy (ART) clinics have emerged as an innovative approach to improve accessibility and adherence for people living with HIV (PWH). The effectiveness of nurse-led clinics is a subject of growing interest, as they may alleviate pressure on physicians and increase service user engagement in treatment (Pu et. al, 2024). In March 2024 we established a nurse led LAI clinic in the Mater Misericordiae University Hospital (MMUH). Here we describe the establishment of the clinic and experience to date.
Methods
PWH attending MMUH Infectious Diseases (ID) clinics interested in LAI use were evaluated at monthly multidisciplinary meetings (MDT) for LAI eligibility. Eligibility criteria for LAI included; undetectable HIV RNA for >6 months, Body mass index (BMI) <30kg/m2, no known HIV drug resistance to cabotegravir (CAB) or rilpivirine (RPV), no history of INSTI monotherapy, and had a negative hepatitis B surface antigen. PWH unable to commit to 2-monthly attendance for LAI and women of childbearing age not willing to be on contraception were excluded.
Eligible PWH were given an oral lead-in for 28 days to assess tolerability to CAB & RPV. PWH attended their initiation visit and 6 monthly follow-up within physician-led HIV clinics, for clinical nurse specialist (CNS) review. The remaining LAI visits were exclusively nurse-led. PWH availing of LAI were provided with a phone number and email contact to facilitate communication and co-ordination of appointments. We present descriptive analyses of PWH on LAI and the nurse-led pathway.
Results
Of 22 PWH assessed for LAI eligibility, 18 (75%) were deemed suitable. Those ineligible had a history of INSTI monotherapy (1), irregular clinic attendance (2), and detectable viraemia (1). Five patients deemed suitable were planned to commence LAI early 2025 to coincide with their routine HIV follow up. Of the 13 (72%) who began LAI in 2024, 38% were male, the median age was 35 (IQR 44) and the median duration of diagnosed HIV was 11 (IQR 23) years. A further 2 (18%) PWH discontinued LAI after 6 months for personal preference reasons.
Those switching to LAI cited concerns around unintentional disclosure, difficulties with daily oral adherence, and psychological stress related to HIV management as reasons for switching. Acceptability among PWH on LAI, as measured by clinic attendance within the flexing dosing window of target treatment dates was 100%. Viral suppression was maintained for all PWH on LAI to date.
Conclusion
In the MMUH, nurse-led LAI clinics demonstrated promise in maintaining patient engagement. This model of care provides an alternative to physician-led care for PWH. Further work is needed to refine such model.
References
Pu, X., Malik, G., & Murray, C. (2024). Nurses' experiences and perceptions of running nurse‐led clinics: A scoping review. International Journal of Nursing Practice, 30(6), e13285.
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Board No: 76 #2024185
"Potential Cost Savings from “Opt Out” Routine CD4 T Lymphocyte Measurement in Cork University Hospital"
Principal Presenter: Stephen Connolly
Track: Virology
Background:
CD4 T lymphocyte depletion was Identified early in the HIV pandemic as an inverse correlate of susceptibility to infection, and a surrogate marker of cell-mediated immunity. CD4 measurement has been relatively widely available since the 1980s as part of routine HIV care. CD4 levels have been used to indicate immunocompetency and guide use of antimicrobial prophylaxis, and in the pre-START era to guide initiation of antiretroviral therapy (ART).
Routine CD4 measurement in people living with HIV (PLWH) who maintain viral suppression with ART is no longer supported by international guidelines. For PLWH who are established on ART with stable CD4 cell counts of greater than 350 cells/mm3 on two occasions over a year apart, measurement guidelines differ as follows; the European AIDS Clinical Society suggests yearly frequency, and the British HIV Association suggests stopping measurement completely, in the absence of clinical concerns.
Anecdotal experience shows PLWH attending clinics undergo CD4 measurement at each visit due to an “opt out” feature of the HIV clinic computer order set for blood testing.
Methodology:
An audit was performed on 49 patients attending the Cork University Hospital HIV clinic, with all those attending on two randomly-chosen clinics included who are receiving ART > 3 months. The number of “excessive” CD4 count measurements was calculated for each patient over a two year period and the day of the clinics, from the perspective of the EACS and BHIVA guidelines. Potential costs saved through judicious use of CD4 testing were calculated using unit pricing obtained from the immunology laboratory.
Results:
On the day of the clinics selected, 47/49 clinic attendees (96%) had a CD4 measurement. 24.5% would have been indicated by EACS guidelines, and with 16.3% with BHIVA guidelines. In 38 patients attending for 2 years or more, 417 CD4 counts were ordered; 198 (47.5%) would have been indicated by EACS guidelines, and 52 (12.5%) by BHIVA guidelines. We used a unit price of €16.48 per test which would offer the following yearly savings; €42,963 as per EACS guidelines, and €71,475 as per BHIVA guidelines.
Conclusion:
Through simple measures such as adaptations of order sets and discussion sessions, large potential cost savings are demonstrated to be achievable. More work on patient acceptability surveys and re-audit of interventions are indicated. -
Board No: 77 #2024145
"Machine Learning Enhances Inflammatory Phenotypes Linking Gut Microbiota to Cardiovascular Risk in HIV and Non-HIV Populations"
Principal Presenter: Rachel Mac Cann
Track: General Infectious Diseases
Background
Chronic inflammation in people with HIV is linked to long-term co-morbidities, including cardiovascular disease (CVD). We previously described distinct inflammatory profiles from 24 biomarkers, linked to gut and T-cell inflammation, that were associated with CVD. We aimed to validate these results and assess if additional biomarkers or gut microbiome signatures could potentially enhance CVD prediction in PWH.
Methods
People with and without HIV from three international cohort studies were included. 55 biomarkers were measured using quantitative immunoassays. Principal component analysis (PCA) and hierarchical clustering (HC) was performed on the original 24 biomarkers. A recursive feature addition (RFA) model was used to assess the stepwise addition of 31 additional biomarkers, selecting those that enhanced the model for repeat PCA and HC. Multinomial logistic regression explored associations between clusters and CVD outcomes. Microbiota composition was analysed by 16S rRNA amplicon sequencing of stool samples, with differentially abundant species identified by Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC) and correlated to biomarkers using Spearman correlation.
Results
408 participants (median age 50 [IQR] 43–58) years; 83% male; 68% White; 78% with HIV) were included. PCA of the baseline 24 biomarkers revealed 3 clusters with equal distribution of PWH. Cluster 3 (n= 41) showed higher inflammation markers (IL1-β, IL-6, TNF-α), immune regulation (TSLP, MIP1-α), and T-cell differentiation (IL2, IL12, IFN-γ). This cluster included older participants (median 51 years [ 47-55]), with a higher BMI (median 27.5 (IQR: 24.4–29.2), higher triglyceride levels (median 1.98: IQR 1.23- 2.62), and a higher prevalence of CVD (n= 16, 39%). After RFA, 13 of the 31 additional biomarkers were added to the PCA, and cluster 3 now included GM-CSF, IFN-α2a, TGF-α, and Thrombopoietin, with a stronger CVD association (OR: 2.13, 95% CI: 1.03- 4.4, p= 0.04).
ANCOM-BC revealed enrichment of 5 and depletion of 7 gut microbial species in cluster 3. Correlation analysis found several biomarkers identified in cluster 3 (IFN-l2, MIP-1 α, MCP-1, CD40-ligand, TGF-α) associated with a depletion of short-chain fatty acid- producing species (Bacteroides coprocola, Bacteroides massiliensis, Fusobacterium mortiferum and Dialister invisus) that are linked to inflammation regulation and CVD outcomes.
Conclusions
This study confirmed that distinct inflammatory clusters are associated with CVD parameters. We enhanced cluster accuracy, identifying biomarkers and gut microbial signatures that potentially enhance CVD prediction.
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Board No: 78 #2024183
"The implementation of a statin prescribing protocol for people living with HIV (PWH) in the Mater Misericordiae University Hospital’s Infectious Diseases clinic"
Principal Presenter: Aoife Heeney
Track: Virology
Background
People living with HIV (PWH) have an increased risk of atherosclerotic cardiovascular disease (ASCVD) and guidelines recommend annual risk assessment. HMG-Co A reductase inhibitors (statins) decrease the incidence of major adverse cardiovascular events in PWH and international guidelines are now recommending statin initiation in all PWH >40 years with estimated 10 year ASCVD risk of >5%, and in those with ASCVD risk <5% if other risk factors present. We aimed to assess the adherence of the Mater Hospital with the US guidelines published by the American College of Cardiology, American Heart Association & HIV Medicine Association.
Methods
A retrospective review of PWH attending clinic over a 1-week period was carried out. All PWH were included unless engaged with care <1 year. Clinical and laboratory data were collected and guideline adherence reviewed. A statin prescribing protocol was developed and implemented in clinic with clinician educational sessions provided. 7 months after the protocol implementation we carried out another review of all PWH attending clinic over a 1-week period to assess the impact of our interventions.
Results
Of 81 PWH reviewed pre-intervention the median(IQR) age was 45(37-52) years, 42(52%) were male, and 79(98%) had an undetectable HIV viral load. 3(4%) had a current diagnosis of ASCVD with 25(31%) having hypertension, 34(42%) dyslipidaemia, and 20(25%) active smokers. With regards to guideline adherence, 72(89%) had lipids checked over the previous year, however only 10(12%) had a risk score documented. 17(21%) were deemed moderate to high risk on subsequent ASCVD score calculation with only 9(53%) of these receiving statin therapy.
Following intervention 80 PWH were assessed; median(IQR) age was 44(35-51) years and 54(68%) were male. 64(80%) had lipids checked in the preceding year and 13(16%) had a risk score calculated. 16(20%) were deemed moderate to high risk on subsequent ASCVD score calculation with only 9(56%) of these receiving statin therapy.
Conclusion
Adherence to Statin prescribing guidelines was suboptimal in our clinic both pre- and post-intervention. Reasons for this may include time limitations in clinic, lack of guideline familiarity amongst rotating staff, competing priorities in clinic and patient refusal. There is an ongoing need for further interventions including more regular educational sessions, and the consideration of a clinic proforma which may act as a prompt to clinicians.
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Board No: 79 #2024196
"Barriers to Long-Acting Injectables for HIV Patients with Documented Oral Treatment Failures in the West of Ireland"
Principal Presenter: Dorarca Lynch
Keywords: HIV, Long-Acting InjectablesTrack: Virology
Background
Long-acting injectable antiretroviral therapies (LAI-ARVs) offer a novel and effective option for managing HIV, particularly for those with adherence challenges (1). This audit evaluated the feasibility of and barriers to LAI-ARVs at Galway University Hospital (GUH) as part of a newly established clinical pathway for patients with documented oral treatment failures. GUH HIV clinic is a regional clinic serving approximately 700 patients, with over 50% traveling more than 90 minutes to access care.
Methods
The audit included HIV patients with documented treatment failure in the past year who were assessed by a multidisciplinary team. Eligibility criteria included resistance profiles, hepatitis serologies, and clinical suitability for LAI-ARVs. Data was collected on barriers encountered during selection and initiation.
Results
Of the 20 patients evaluated, eight (40%) were excluded due to documented antiretroviral resistance (8-NNRTI, 1-INSTI), one (5%) was ineligible due to suspected A1/A6 clade. One lacked resistance testing and had documented breakthrough on NNRTI or INSTI treatment. One patient declined participation, and one had no subtype available with concerns regarding A1/A6 clade infection. In total, 8/20 (40%) were deemed suitable for LAI.
Three of the eight suitable patients (15%) could not be contacted. Among the remaining five (25% of the cohort), one attended an initial visit but disengaged, becoming unreachable before initiating therapy. Another patient, eager to begin, missed two appointments: one due to an unplanned hospital admission and another because of transport difficulties. Three patients (15%) who were undergoing workup have now commenced LAI-ARVs and are not detectable.
Major barriers included resistance due to longstanding adherence challenges, geographical isolation requiring significant travel, and communication breakdowns leading to disengagement. Delays accessing resistance testing results further impeded timely initiation.
Conclusions
This audit highlights significant barriers to the successful implementation of LAI-ARVs for HIV patients with oral treatment failures. These include high rates of treatment resistance in patients with a longstanding history of treatment failure and difficulty engaging patients in attending clinic at regular intervals, possibly compounded by geographical distances. These factors need to be considered as newer treatment options become available.
Despite these challenges, successfully initiating three patients on LAI-ARVs demonstrates feasibility when logistical barriers are addressed. Their engagement highlights the potential of long-acting injectables to improve adherence and reduce clinic visits. Expanding access, optimising selection, and enhancing support structures remain key to maximising success.
1. Gandhi et al
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Board No: 80 #2024122
"Switching to B/F/TAF in a real-world cohort of older people with HIV and a high burden of non-AIDS-related comorbidities"
Principal Presenter: Sam McConkey
Keywords: HIV, co-morbidities, BiktarvyTrack: Virology
Background: Older people with HIV (PWH) have an increased prevalence of age-associated comorbidities. We assessed the effect of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in PWH aged ≥50 years with a high burden of comorbidities and comedications.
Results: 401 PWH aged ≥50 years who switched to B/F/TAF were included; median age 56 years; 86% male, 81% White; 18% aged ≥65 years. Overall, 65%/21%/14% switched from INSTI-/NNRTI-/boosted PI-based regimens, respectively. Baseline comorbidities included cardiovascular (48%), neuropsychiatric (34%) and musculoskeletal (28%); 22% reported taking ≥5 comedications. At 24M, 96% (315/328) had viral load <50 c/mL; viral suppression rates were similar by age, sex, race and those with ≥2 comorbidities/≥5 comedications at switch, with no treatment emergent resistance to B/F/TAF. Drug-related adverse events (DRAEs) occurred in 13% (54/401) and serious DRAEs in 0.2% (1/401). DRAEs leading to discontinuation occurred in 7% (27/401). Laboratory findings remained stable with no worsening in lipid, renal or liver parameters. Median (Q1, Q3) weight change was +1.0 kg (-1.3, 3.2) at 24M. No clinically significant DDIs were expected between B/F/TAF and comedications commonly prescribed in this cohort. At 24M, B/F/TAF treatment persistence was 90% (359/401). Treatment satisfaction was high at baseline and increased through 12M (median [Q1, Q3] HIVTSQc: +24.5 [13.0, 29.0]; n=290).
Conclusion: In this cohort of PWH aged ≥50 years with a high prevalence of comorbidities, switching to B/F/TAF was highly effective and generally well tolerated. Cardiometabolic and renal parameters remained stable and high rates of persistence were maintained though 24M. These data support the safety of switching to B/F/TAF in older PWH.
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Board No: 81 #2024132
"Once-Weekly Islatravir Plus Lenacapavir in Virologically Suppressed PWH: Week 48 Safety, Efficacy, and Metabolic Changes"
Principal Presenter: Conor Moran
Keywords: Lenacapavir, HIV, GileadTrack: Virology
Background: Islatravir (ISL), a nucleoside reverse transcriptase translocation inhibitor, and lenacapavir (LEN), a capsid inhibitor, have potent anti-HIV-1 activity with pharmacokinetic profiles supporting once-weekly oral dosing. In the current trial (NCT05052996), weekly oral ISL+LEN maintained a high rate of virologic suppression at Week (W) 24. Here, we report W48 results.
Materials and Methods: In this Phase 2, randomised, open-label, active-controlled study, virologically suppressed adults on bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) were randomised 1:1 to receive weekly oral ISL 2 mg + LEN 300 mg or to continue daily B/F/TAF. Virologic outcomes, safety, lymphocyte counts, weight, body mass index (BMI), and adherence (by pill count) were assessed.
Results: Overall, 104 participants (52/group) were randomised and dosed. Median age was 40 years (range 26–76) and 19 (18.3%) were assigned female at birth. At W48, 49 (94.2%) participants assigned to ISL+LEN and 48 (92.3%) assigned to B/F/TAF had HIV-1 RNA <50 copies/mL; no participants had HIV-1 RNA ≥50 copies/mL; 3 (5.8%) and 4 (7.7%) participants, respectively, had no available data AEs occurring in ≥10% of the ISL+LEN group were upper respiratory tract infection (13.5%), COVID-19 (11.5%), and diarrhoea (11.5%). No Grade ≥3 AEs related to ISL+LEN were reported. Two participants (3.8%) discontinued ISL+LEN due to unrelated AEs. There were no significant differences between ISL+LEN and B/F/TAF groups in mean change from baseline in CD4+ T-cells (–12 vs –29/µL; P=0.88) or lymphocytes (–0.07 vs –0.03x109/L; P=0.23). Median (IQR) weight and BMI changes from baseline were –0.2 kg (–2.7 to 3.0) and –0.05 kg/m² (–0.95 to 0.91) for ISL+LEN, and 0.1 kg (–1.9 to 2.7) and 0.03 kg/m² (–0.64 to 0.84) for B/F/TAF. Mean adherence through W48 was 99.2% for ISL+LEN and 98.1% for B/F/TAF.
Conclusions: Weekly oral ISL+LEN maintained a high rate of virologic suppression at W48. Through Week 48, ISL+LEN was well tolerated without significant changes in CD4+ T cell count, lymphocyte count, or weight. Adherence to this weekly oral dosing regimen was high. ISL+LEN has the potential to become the first weekly oral complete regimen for the treatment of HIV-1 infection.
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Board No: 82 #2024123
"Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in treatment-naïve people with both HIV-1 and hepatitis B: 3-year outcomes from ALLIANCE"
Principal Presenter: Conor Moran
Keywords: Hepatitis B, HIV, GileadTrack: Virology
Introduction: The ALLIANCE study showed that bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) was non-inferior to dolutegravir + emtricitabine/tenofovir disoproxil fumarate at achieving HIV-1 RNA suppression, and superior at achieving HBV DNA suppression at Week 48 in treatment-naïve adults with both HIV-1 and hepatitis B virus (HBV), with high rates of HIV-1 and HBV suppression observed at Week 96 [1]. Here, we report longer-term efficacy and safety of B/F/TAF in adults with HIV-1 and HBV through 3 years of treatment.
Methods: ALLIANCE (NCT03547908) was a randomised, double-blind, active-controlled Phase 3 clinical study. This analysis reports data from participants who had received B/F/TAF in the 96-week randomisation phase, plus 48 weeks of open-label extension (participating countries only). Baseline demographics and clinical characteristics, HIV-1 suppression (HIV-1 RNA <50 copies/mL), HBV suppression (HBV DNA <29 IU/mL), alanine aminotransferase (ALT) normalisation (2018 American Association for the Study of Liver Diseases criteria), hepatitis B e-antigen (HBeAg) and surface antigen (HBsAg) loss/seroconversion at Week 144, and treatment-emergent adverse events (TEAEs) through to end of study (EOS) are reported.
Results: At baseline, most participants receiving B/F/TAF (N=121) were male at birth (92.6%) and Asian (89.3%), with a median (range) age of 31 (19–65) years; 49.6% had ALT levels above the upper limit of normal and 76.0% were HBeAg positive. In total, 106 participants received B/F/TAF through Week 144. High levels of HIV-1 RNA (99.0%) and HBV DNA (80.2%) suppression were maintained after 144 weeks of treatment. ALT normalisation was maintained and HBeAg and HBsAg loss/seroconversion continued through Week 144, indicating sustained anti-HBV activity. By EOS, 8.3% of participants had discontinued treatment prematurely.
Conclusions: At Year 3, B/F/TAF maintained high rates of HIV-1 and HBV virologic suppression, with favourable HBV treatment outcomes and HBsAg and HBeAg loss/seroconversion persisting into Year 3. Safety findings through 3 years were consistent with the established profile of B/F/TAF; most TEAEs were mild to moderate and rates of study drug discontinuation were low. These results further support the longer-term use of B/F/TAF in people with both HIV-1 and HBV.
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Board No: 83 #2024206
"12-month Outcomes of Cabotegravir plus Rilpivirine Long-acting Every 2 Months in a Real-world Setting: Effectiveness, Adherence to Injections, and Patient-Reported Outcomes from People with HIV-1 in the German CARLOS Cohort"
Principal Presenter: Leigh Lehane
Track: General Infectious Diseases
HIV
Background: Injectable long-acting (LA) cabotegravir (CAB) plus rilpivirine (RPV) offers an alternative mode of drug administration with less frequent dosing than daily oral antiretroviral therapy (ART). CARLOS is a non-interventional, 3-year, multicenter cohort study including people living with HIV-1 (PWH) on suppressive daily oral ART who switched to CAB+RPV LA dosed every 2 months in routine clinical care in Germany. To describe outcomes at Month (M) 12.
Methods: M12 effectiveness outcomes include virologic suppression (HIV-1 RNA <50 copies/mL), virologic non-response (HIV-1 RNA ≥50 copies/mL), and virologic failure (two consecutive HIV-1 RNA ≥200 copies/mL, or a single HIV-1 RNA ≥200 copies/mL followed by treatment discontinuation). Additional outcomes include adherence to the injection window and change in HIV Treatment Satisfaction Questionnaire status version (HIVTSQs) score.
Results: In total, 351 PWH were included in the analysis at M12. Overall, 95.1% (n=1847/1943) of CAB+RPV LA injections were administered before or within the ±7-day injection window, and 4.9% (n=96/1943) occurred late. At M12, 85.8% (n=301/351) of participants maintained virologic suppression, and 9.7% (n=34/351) discontinued due to tolerability (n=13/351 [3.7%]; n=10 due to injection-related reasons) or non-virologic reasons (n=21/351 [6.0%]). There were five participants with virologic failure (n=5/351 [1.4%]). For participants (n=251/351) completing the HIVTSQs at both baseline (mean score, 54.6/66) and M12 (mean score, 61.0/66), a statistically significant and clinically meaningful improvement in treatment satisfaction was observed (mean change, +6.4; p<0.001).
Conclusion: In this real-world cohort, CAB+RPV LA maintained high rates of virologic suppression, with few treatment failures, in the first 12 months following switch. There was a low rate of discontinuation due to injection site reactions, and the majority of injections were administered within the ±7-day injection window or earlier. Despite high baseline scores on oral ART, a statistically significant and clinically meaningful improvement in treatment satisfaction was observed for participants remaining on CAB+RPV LA at M12.
Prior presentation: Data included in this abstract have previously been presented in full at the 25th International AIDS Conference; July 22-26, 2024; Munich, Germany; Poster TUPEB095.
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Board No: 84 #2024204
"Similar Virologic Outcomes and Frequency of Isolated Viraemic Events (Blips, LLV and Suspected VF) between Oral and Long-acting Antiretroviral Therapy: A Pooled Analysis of Phase 3/3b Cabotegravir + Rilpivirine Long-acting Studies"
Principal Presenter: Leigh Lehane
Keywords: HIV, LONG-ACTING INJECTABLES, CABOTEGRAVIRTrack: General Infectious Diseases
HIV
Background: The definition and management of viral blips varies across clinical guidelines. Long-acting (LA) antiretroviral therapy (ART) may present different management considerations for healthcare providers. In Phase 3/3b studies, viral blips (single viral load [VL] between 50–<200 c/mL with adjacent values <50 c/mL) with cabotegravir plus rilpivirine LA (CAB+RPV LA) were not associated with confirmed virologic failure (CVF; two consecutive VLs ≥200 c/mL) through up to 152 weeks of follow-up. We present a pooled post hoc analysis assessing virologic outcomes following viral blips, low-level viraemia (LLV; ≥2 consecutive VLs between 50–<200 c/mL), and isolated suspected virologic failure (SVF; single plasma VL ≥200 c/mL with the subsequent value <200 c/mL), through 1 year in CAB+RPV LA Phase 3/3b studies.
Methods: Viral blips, LLV and VLs meeting isolated SVF criterion were analysed across the Phase 3/3b FLAIR, ATLAS, ATLAS-2M (through Week 48) and SOLAR (through Month 12) studies. Isolated SVF was divided into a: (1) single VL ≥200–<500 c/mL; (2) single VL ≥500–<1000 c/mL; (3) single VL ≥1000 c/mL, all with the subsequent adjacent VL <200 c/mL. SVFs that became CVF at next VL testing were excluded. Plasma samples were analysed for HIV-1 RNA VL using the Abbott RealTime HIV-1 assay.
Results: Overall, 2506 participants were included (CAB+RPV LA, n=1692; comparator oral ART, n=814). The proportion of participants experiencing viral blips was 6% (n=97/1692) and 7% (n=61/814) with LA and oral ART, respectively; <2% had LLV or isolated SVF in both arms. CVF occurred in <1% of participants (LA arm, n=16/1692; oral, n=7/814). In the LA arm, 25% (n=3/12) of participants with isolated SVF had subsequent CVF vs. 23% (n=3/13) in the oral ART arm.
Conclusion: In this pooled analysis through 1 year, CVF rates were low and similar between oral and LA. Viral blips and LLV were similarly infrequent with LA and oral ART and were not associated with CVF. Isolated SVF events were rare, with similar rates of subsequent CVF with LA and comparator oral ART. These data suggest similar outcomes after isolated viraemic events with both LA and oral ART.
Prior presentation: Data included in this abstract have previously been presented in full at HIV Drug Therapy Glasgow; November 10-13, 2024; Glasgow, Scotland; Poster P040.
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Board No: 86 #2024194
"Treatment-Emergent Integrase Strand Transfer Inhibitor (INSTI) Resistance-Associated Mutations among People with HIV-1 Treated with Dolutegravir (DTG) + Lamivudine (3TC) with Pre-existing M184V/I from Real-world and Interventional Studies"
Principal Presenter: Leigh Lehane
Keywords: HIV, Dolutegravir, ResistanceTrack: General Infectious Diseases
HIV
Background: The 2-drug regimen DTG + 3TC has a high barrier to resistance and is recommended as first-line and maintenance therapy for people with HIV-1. Previous meta-analysis estimates of virologic failure were low among people using DTG + 3TC in real-world and interventional settings regardless of baseline M184V/I presence. We report INSTI mutation incidence in populations using DTG + 3TC, including those with pre-existing M184V/I, from real-world evidence (RWE) and interventional studies.
Methods: A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching Ovid MEDLINE®, Embase®, PubMed, Cochrane library databases, and relevant congresses for RWE and interventional studies reporting DTG + 3TC use in people with HIV-1 published between January 2013 and March 2024. All publications with ≥10 people using DTG + 3TC (all studies) and all publications with ≥10 people using DTG + 3TC that evaluated baseline M184V/I, even if 0 people with baseline M184V/I were reported (studies evaluating M184V/I at baseline), were included. To avoid double-counting people from studies with multiple publications or overlap with another study population, unique populations were collectively represented by a “lead” publication with most recent study data and/or highest N.
Results: Overall, 300 publications (n=249 RWE, n=51 interventional) reporting DTG + 3TC use were identified, representing 108 discrete cohorts and trials and 47,350 unique people with HIV-1 after accounting for population overlap. Of those, 30 lead studies (N=10,383) reported ≥10 people and evaluated M184V/I at baseline. Overall prevalence of baseline M184V/I was 5% (512/10,383) among studies evaluating M184V/I at baseline and 0.9% (406/47,350) among all studies. Prevalence of M184V/I in interventional studies was 20% (219/1096) and 8% (221/2914) among studies evaluating M184V/I at baseline and among all studies, respectively (several interventional studies focused on M184V/I, overestimating prevalence). Treatment-emergent INSTI resistance was reported in 6/47,350 (0.01%) people across all studies and in 2/10,383 (0.02%) among studies evaluating M184V/I at baseline. None of the treatment-emergent INSTI resistance cases had known M184V/I at baseline.
Conclusion: No cases of treatment-emergent INSTI resistance development were identified among people with HIV-1 who had M184V/I before DTG + 3TC therapy (0/512). Results indicate that using DTG + 3TC when M184V/I is present may not increase the risk of INSTI mutation development.
Prior presentation: Data included in this abstract have previously been presented in full at HIV Drug Therapy Glasgow; November 10-13, 2024; Glasgow, Scotland; Poster P330.
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Board No: 87 #2024193
"Evaluation of Weight Gain on Incident Hypertension among People with HIV-1 Receiving Dolutegravir (DTG)-Based Regimens or Comparator Antiretroviral Therapy (cART) in Randomized Clinical Trials through 96 Weeks."
Principal Presenter: Leigh Lehane
Keywords: Dolutegravir, Weight, HIVTrack: General Infectious Diseases
HIV
Background: Weight gain has been observed with integrase strand transfer inhibitor (INSTI)-based treatment with an association between INSTI use and hypertension (HTN) in some studies. We observed no difference in odds of incident HTN and minimal weight increase in participants receiving dolutegravir (DTG)-based or comparator antiretroviral therapy (cART) through Week 96. Here, we evaluated the relationship between ART use, weight gain, and HTN risk among participants without baseline HTN receiving DTG or cART in pooled phase 2/3 studies.
Methods: Data from participants naive to ART randomized to either DTG-based ART (+ ABC/3TC or TDF/FTC), or cART (EFV/TDF/FTC, RAL + 2 NRTIs, or DRV/r + 2 NRTIs), were pooled from the SPRING-1 and -2, SINGLE, and FLAMINGO trials. HTN at baseline, Week 24, Week 48, and Week 96 was defined as a single systolic blood pressure (SBP) ≥140 and/or diastolic blood pressure (DBP) ≥90 mm Hg, HTN history or HTN adverse event, and/or antihypertensive use. Mixed-models repeated-measures (MMRM) evaluated adjusted change from baseline in weight. Bayesian joint models (JM) evaluated the associations between treatment, weight change, and treatment and weight change interaction with HTN risk. Models were adjusted for key baseline variables and pooled treatment.
Results: Among 2345 participants, 23% (n=530) were excluded for baseline HTN; of the remaining, 927 received DTG-based ART and 888 received cART. At Week 96, adjusted mean (SE) change in weight was 1.98 (0.242) kg for DTG-based vs 1.59 (0.212) kg for cART (treatment difference, 0.39 kg; 95% CI, −0.25, 1.04; P=0.230). From JM, treatment (DTG-based vs cART) was not independently associated with HTN risk through Week 96 (mean, M [hazard ratio, HR], 1.099; 95% credible interval [CrI], 0.876, 1.370). On average, a 1-kg increase in weight was estimated to increase HTN risk (HR) by 1.012 (CrI, 1.004, 1.020). No evidence of treatment separation was observed through the treatment-weight interaction (DTG-based HR, 1.013 [1.003, 1.022]; cART HR, 1.009 [0.998, 1.020]).
Conclusion: Weight gain was moderately associated with HTN risk through Week 96. ART was not an independent risk factor for HTN. Weight gain attributed to treatment effect impacted HTN risk similarly.
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Board No: 88 #2024191
"Switching to DTG+3TC vs 3-Drug Regimens in Routine Clinical Care: Long-term Swedish Data"
Principal Presenter: Leigh Lehane
Keywords: HIV, Dolutegravir, StigmaTrack: General Infectious Diseases
HIV
Background: Swedish HIV treatment guidelines recommend that switching to the 2-drug regimen dolutegravir (DTG) + lamivudine (3TC) for maintaining virologic suppression should be considered in people with HIV in routine clinical care. We assessed long-term outcomes of switching to DTG+3TC (vs 3-drug regimens; 3DRs) in virologically suppressed individuals in Sweden.
Methods: Retrospective data for all ART-experienced people with HIV with HIV RNA <50 copies/mL and switching to either DTG+3TC or any 3DR were obtained from the Swedish National Quality Registry for HIV (InfCareHIV). Within-group precision rates for virological failure (VF; having 2 consecutive HIV RNA levels ≥200 copies/mL prior to/by assessment time point) were determined for the DTG+3TC and 3DR groups at months M6, M12, M24, M36, and M42 post-switch. A logistic generalized estimating equations (GEE) model was used to find associations between patient demographics and clinical predictors of VF.
Results: Between July 2019 and May 2023, 2461 people with HIV switched regimens, 1125 (46%) to DTG+3TC and 1336 (54%) to 3DR. The mean estimated time of extended exposure was 17.4 and 23.7 months for the DTG+3TC and 3DR groups, respectively. At M6, 1778 people had data, M12 (n=1418), M24 (n=985), M36 (n=444), and M42 (n=174). Thirty-seven on 3DR met VF versus 7 on DTG+3TC. VF rates for the DTG+3TC group were 0.0013 (95% CI, 0.0002-0.009) at M6, and 0.0036 (0.0009-0.014) at M12, 0.003 (0.0005-0.02) at M24, 0.018 (0.005-0.07) at M36, and 0.029 (0.004-0.2) at M42. VF rates for the 3DR group were 0.003 (0.001-0.009) at M6, 0.014 (0.008-0.024) at M12, 0.018 (0.01-0.031) at M24, 0.021 (0.01-0.044) at M36, and 0.023 (0.009-0.061) at M42. In a GEE model (adjusting for treatment, ART adherence, time, sex, age, baseline CD4+ cell count, HIV subtype, baseline drug resistance mutations, HBV and HCV serostatus, and viral blips before baseline and during the study), male sex and CD4+ cell count ≥500 at baseline were significantly associated with decreased risk of VF (adjusted odds ratio, 0.41 [0.19-0.86], p=0.019, and 0.28 [0.14-0.59], p=0.001, respectively). Viral blips post-switch and suboptimal adherence were significantly associated with increased risk of VF (4.84 [2.45-9.589], p<0.001, and 3.72 [1.12-12.34], p=0.032, respectively).
Conclusion: In this long-term real-world retrospective study, no significant difference in the risk of VF between DTG+3TC and 3DR were found. These findings strengthen switching to DTG+3TC as an effective strategy for maintaining virologic suppression in clinical practice.
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Board No: 89 #2024202
"A Clinical Audit of FibroScan Utilisation in Hepatitis B Patients: Trends, Management, and Outcomes"
Principal Presenter: En Qing Lim
Keywords: Chronic Hepatitis B, FibroScan, Liver Fibrosis StagingTrack: General Infectious Diseases
Background:
Chronic hepatitis B (CHB) infection carries a risk of liver fibrosis, cirrhosis and hepatocellular carcinoma. FibroScan is a non-invasive means to assess fibrosis progression and provide prognostic information in those with CHB infection. The European Association for the Study of the Liver guidelines recommend non-invasive fibrosis assessment using FibroScan in combination with serum biomarkers for staging liver disease and guiding treatment decisions. This audit aims to evaluate the incidence of FibroScan utilisation and consequential impact on management decisions in Cork University Hospital (CUH) CHB cohort.Methods:
Patients with CHB who received FibroScan between January 2022 to January 2023 were included in the study. Data was extracted from medical records and analysed using descriptive statistics via SPSS software.
Results:
A total of 117 patients with CHB received FibroScan in CUH during the study period. Of these, 62% were male, with a mean age of 43 years (range 20 to 71). The majority were from South East Asia (n= 24, 20.5%) and Sub-Saharan Africa (n=30, 25.6%). The most common indication for FibroScan was routine assessment for liver fibrosis (59.8%, n=70). Other indications included staging with elevated ALT (7.6%, n=9), and ultrasound findings suggesting fibrosis 3.4% (n=4). Mean fibrosis scores were 5.83kPa (range 2-17.5kPa), with 17 patients (14.5%) having a score >7kPa, indicating moderate fibrosis. Mean CAP score was 228 and 37.6% (n=44) had a CAP score suggestive of hepatic steatosis. Management changes were observed in 8 patients (6.8%) following FibroScan; four commenced antiviral treatment, one was referred for cirrhosis management, three were referred for liver biopsy. Of these patients referred for liver biopsy, two had a normal FibroScan (3.32kPa/235CAP 4.5kpa/CAP 125), the third had a fibroscan suggestive of cirrhosis (17.5kPa/CAP 218). Of those who initiated antiviral treatment, fibrosis scores ranged from 4.9- 10.5kPa.Conclusion:
Fibroscan was effectively utilised as a non-invasive alternative to liver biopsy for staging CHB and guiding treatment decisions, particularly regarding antiviral therapy, surveillance, and lifestyle interventions. While a significant portion of patients showed abnormal FibroScan results indicating potential fibrosis or cirrhosis, only a small proportion had management changes post-FibroScan, indicating that other factors (biochemical markers, viral load, clinical considerations) influenced treatment decisions. Combining FibroScan with biochemical tests remains a valuable tool in guiding surveillance and antiviral treatment for CHB.
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Board No: 91 #2024200
"A Single Centre Audit of Chronic Hepatitis B Management"
Principal Presenter: Grace Kenny
Track: Virology
Background
Chronic hepatitis B is a common presentation in infectious diseases outpatient settings. This audit aimed to evaluate compliance with international guidelines in a single centre.
Methods
We included individuals with either a positive surface antigen or detectable hepatitis B viral load (VL) sent from infectious diseases clinics in the Mater Hospital between July and October 2024. We audited treatment and monitoring standards against the European Association for the Study of the Liver (EASL) 2017 hepatitis B management guidelines.
Results
A total of 94 individuals were included in this audit. Median (IQR) age was 39 (34-45) years and 62 (66%) were male. 20 (21%) of visits were first appointments and 74 (79%) were return appointments. 5 (5%) individuals had HIV coinfection, 5 (5%) had previous hepatitis C coinfection and 3 (3%) had hepatitis D coinfection. 66 (70%) were hepatitis A (HAV) IgG positive, 12 (13%) were IgG negative and 16 (17%) had not had HAV immune status checked. 28 (30%) were on treatment for chronic hepatitis B. The most common indication for treatment was the presence of a viral load >2000 IU/ml, an ALT above the upper limit of normal (ULN) and presence of fibrosis (6 (21%) of those on treatment), followed by e-antigen positivity with age >30 years or presence of HIV coinfection (both 5 (18%) of those on treatment). Regarding treatment endpoints, 8 (28%) of those on treatment had a detectable viral load. Of these 3 were on treatment <3 months while the remainder had a viral load of <300. 6 (21%) of those on treatment had an ALT >ULN, 3 of whom were recently started on treatment. Regarding hepatocellular carcinoma (HCC) screening, using the PAGE B score, 21 (75%) of those on treatment had an intermediate or high risk of HCC. 19 (90%) had an alpha fetoprotein in the prior 6 months, but 10 (48%) of these had not had an ultrasound within the last 6 months. In terms of monitoring of patients not on treatment, 62 (94%) had follow up planned within the recommended time frame.
Conclusion
Hepatitis B management was broadly in line with EASL guidelines, with the majority of those established on treatment achieving suppression of VL and normalisation of ALT . However this audit demonstrated gaps in elements of our hepatitis B service including in assessment of hepatitis A immunity and HCC screening.
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Board No: 91 #2024181
"Hyperventilation Syndrome in Long COVID: A Cross-Sectional Analysis of End-Tidal Capnography, Heart Rate and Symptoms in Individuals with Long COVID"
Principal Presenter: Tara Ramsbottom
Track: Virology
Background:
Long COVID is a multisystem disorder often characterised by persistent, unexplained symptoms including exertional breathlessness and palpitations. Whether hyperventilation syndrome contributes to this presentation remains unclear.
Objectives:
We aimed to assess differences in ventilatory patterns, heart rate and symptoms among individuals with long COVID attending our clinic.
Methods:
In a cross-sectional analysis conducted within the All Ireland Infectious Diseases (AIID) Cohort, people with long COVID (LC group) attending the long COVID service were compared to a control group consisting of people attending services who had recovered from COVID-19 without developing long COVID. Participants underwent nasal capnography and pulse oximetry measurements from which end-tidal carbon dioxide (ETCO2), heart rate and symptoms were recorded at baseline, during reading, during hyperventilation and during recovery for periods of 3 minutes. Dysfunctional breathing was assessed using the Nijmegen questionnaire. Data was analysed using Mann-Whitney-U test for continuous variables and Chi-Square test for categorical variables. Data are median (IQR) unless otherwise specified.
Results:
Of 57 participants (45 in the LC group and 12 controls), the LC group were older (42 [33.5-49] years versus 30.5 [27-40.5] years, P=0.01), but with similar time since initial infection (LC 48 [39-74] weeks versus controls 39.5 [7-57] weeks, P=0.15). 34 participants in the LC group were female (76%) compared to 6 in the control group (50%). Baseline ETCO2 was not different between groups, neither was proportional change in ETCO2 during recovery. However, there was a statistically greater reduction in ETCO2 during reading in the LC group (-20 [-34.6 to -2.9]mmHg versus controls 0 [-6.6 to -2.9]mmHg, P=0.045), combined with higher heart rate (LC group 90 [74 to 92]bpm versus controls 77 [64 to 81]bpm, P=0.067). Although there was no significant difference in rate of acute and chronic hyperventilation patterns, the LC group had higher Nijmegen scores than the control group (28 [17.5 – 32.5] versus 1.5 [0 – 8.3], P<0.001) and more frequently reported symptoms during the protocol.
Conclusion:
Participants with long COVID had significant reduction in ETCO2 during reading, increased rates of symptoms and higher Nijmegen scores. This suggests a specific dysregulated hypocapnoea in those with long COVID that may aid diagnosis and help target therapy. -
Board No: 92 #2024229
"Audit of St Vincent's University Hospital, PrEP waiting list."
Principal Presenter: Patrick Carey
Track: General Infectious Diseases
Background
Pre-exposure prophylaxis (PrEP) has become a key component in the prevention of HIV transmission. Local STI prevalence is 25-30% at each PrEP outpatient appointment. Capacity for additional patients is limited nationally. This audit aimed to examine the characteristics and health status of PrEP patients on the SVUH waiting list; providing insight into their demographics, sexual health, and vaccination status.Method
A total of 285 patients from the PrEP waiting list were reviewed in 2024. Data on demographics, sexual health, vaccination status, and PrEP usage were collected from patient records. The cohort was assessed for STI diagnoses and vaccination history.Results
The average age of the patients was 33 years, with a median age of 31 years (interquartile range: 27–37). 53% (151) of the 286 participants were Irish, with people from Brazil making up the majority of the remaining patients (19%). The vast majority (91%) identified as men who have sex with men.54% were new PrEP users. Of the remainder 64 (51%) patients took it daily, 49 (39%) used event-based dosing and 8 (6.4%) alternated between the two regimens.
23 (8%) attendees to our PrEP clinic were diagnosed with an STI at their first visit. Similarly there were high rates of non immunity to vaccine preventable illnesses; 77 (27%) for Hepatitis A, 72 (52%) for Hepatitis B, 127 (45%) for MPOX and 61 (21%) for HPV.
2 attendees engaged in commercial sex work, 5 volunteered injecting drugs with 14 disclosing previous chemsex.
Conclusion
This audit highlights the demographic and clinical characteristics of patients on the PrEP waiting list in SVUH. STI prevalence was lower than standard PrEP clinics, although still demonstrates risk for HIV infection. A limitation is that this reflects STI prevalence at a single point in time. In the context of the global MPOX epidemiology there is a need for targeted vaccination in those who are unable to access PrEP clinics. The findings support enhanced PrEP capacity nationally. -
Board No: 93 #2024119
"HIV pre-exposure prophylaxis alters innate immunity to infection"
Principal Presenter: Liam Townsend
Keywords: PrEP, Immunology, CytokinesTrack: Other
Background
Certain sexual practices, such as condomless anal sex, remain a significant risk for HIV infection amongst gay, bisexual and other men who have sex with men (gbMSM). HIV pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) significantly reduces the risk of HIV infection. In some gbMSM it is likely that ongoing intermittent HIV exposure leads to an immune response dictated by the innate immune system, partly aborted by PrEP, preventing a mature adaptive response. Innate immune responses to HIV and other stimuli are under-studied in PrEP users. Prior cytokine work in monocytes from PrEP users demonstrated increased IL-17 and TNFα production, suggesting innate immune differences. TDF has demonstrated effects on the host immune response, with reduced LPS-mediated IL-10 production, enhanced type III interferon levels and ISG expression. This suggests that PrEP may have immunomodulatory effects, independent of HIV exposure.
Methods
Low-risk gbMSM, as defined by ≤5 condomless sex partners in the preceding six months, were recruited. This included current PrEP users and those who were due to commence PrEP. Social, demographic, and sexual health factors were recorded. Peripheral blood mononuclear cells were isolated from whole blood, with subsequent monocyte isolation. Monocyte phenotypes were analysed via flow cytometry, and monocyte cytokine production was assessed by Luminex Multiplex ELISA under unstimulated conditions as well as after stimulation with R848 (TLR7/TLR8 agonist) and Mycobacterial tuberculosis (pan-activation receptor agonist). Cytokines measured included MIP1α, MIP1β, TNFα, IL-10, IL-1α, IL-1β, IFNγ, IFNα, GCSF and GMCSF.
Results
N=17 gbMSM were recruited (n=10 not on PrEP, n=7 PrEP users). They were matched for age, ethnicity, number of sexual partners, substance misuse, and prior sexual transmitted infecton (STI) history. The median time on TDF/FTC in PrEP users was 463 days (IQR 441 – 1416). Taking PrEP was associated with increased CD14 expression on monocytes. Under unstimulated conditions, PrEP was associated with reduced monocyte GMCSF production. Following stimulation with R848, PrEP use was associated with reduced production of MIP1α, MIP1β, IL-10, IL-1α, GCSF and GMCSF. Following stimulation with Mtb, PrEP was associated with increased GMCSF, IL-1β and TNFα production.
Conclusions
PrEP modulates monocyte phenotype and function resulting in decreased cytokine production in response to R848 and increased cytokine production in response to Mtb. These functional effects may impact innate immunity to infection in people taking PrEP, independent of lifestyle factors.
ORAL PRESENTATIONPDF (1.25 MB) -
Board No: 94 #2024138
"Satisfaction Survey for HIV Pre-Exposure-Prophylaxis users at The Mater University Hospital Sexual Health Service"
Principal Presenter: Coleen Finlay
Keywords: PrEP, Survey, Service ImprovementTrack: General Infectious Diseases
Background:
The National Standards for the delivery and management of HIV Pre-Exposure Prophylaxis (PrEP) recommend that services providing PrEP undertake service user satisfaction surveys. The Mater Misericordiae University Hospital (MMUH) performed a PrEP service user satisfaction survey to identify areas of improvement.
Methods:
We designed an online satisfaction survey in SurveyMonkey to evaluate key aspects of the journey through the service: linkage to care, attendance experience, areas of improvement, and overall satisfaction. The survey included 36 questions, 32 of them formatted as multiple-choice. MMUH PrEP users were informed in advance about the survey, which was distributed through the service email in February 2025. All data collected was deidentified and compliant with General Data Protection Regulations. The results are presented using descriptive analyses.
Results:
Of 846 users, 245 (29%) participated in the survey with a completion rate over 90%. The majority of respondents were under the age of 44 (80%), had a bachelor’s or higher degree level of education (80%), and had been attending the MMUH PrEP service for over 18 months (71%). Most respondents (80%) were on the service waiting list (WL) before accessing PrEP, with 67% of them being on the WL for >6 months. Half of the users who were on the WL tried accessing other PrEP services but only a few managed to avail of PrEP privately (17%) or through another public service (9%).
The communication with the service was rated as very good/excellent by 80% of respondents, and >85% feel the service is welcoming and that the time spent in clinic was adequate. Most respondents (95%) find their clinician friendly and approachable, have confidence in their provider (97%), and feel the service treats them with dignity and respect (98%). In open-ended question, 70% of respondents highlighted the staff as the best aspect of the service.
Over half the respondents would prefer to receive PrEP care using telemedicine and the majority (85.5%) would like to have direct access to the test results performed in clinic. Importantly, nearly all respondents (97%) think the Health Service Executive should provide more funding towards access to PrEP.
Conclusion:
Overall MMUH PrEP users are very satisfied with the service and highlighted the staff as the best aspect of the service. However, there are important areas for improvement around decreasing waiting times for new appointments and direct access to test results.
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Board No: 95 #2024223
"An audit evaluating the clinical demands of the HIV Pre-Exposure Prophylaxis in the Mater Hospital to optimise use of resources"
Principal Presenter: Maria McWalter
Track: General Infectious Diseases
Background:
HIV Pre-Exposure Prophylaxis (PrEP) is an effective way of preventing HIV transmission for those at risk. Historically, PrEP users attend services every 3 months for HIV/STI screening, sexual health counselling, and review the need for ongoing PrEP. However, increasing numbers of people seeking PrEP and limited funding are putting pressure on PrEP services and led to the need for waiting list to access the service. We aimed to evaluate current practices in the Infectious Diseases PrEP service in MMUH to identify low-risk groups eligible for 6-monthly follow-up visits and the potential impact of its implementation to reduce the PrEP waiting list.
Methods:
We conducted a single-centre retrospective audit on the MMUH PrEP service from July 2024 until October 2024. Data on demographic and clinical information was extracted from the local electronic patient record. PrEP users were classified as low risk (i.e. eligible for 6-monthly visits with interim HIV & STI self-testing) if the met they were aged 25-50 years, had been on PrEP >12 months, had a stable eGFR >60ml/min, lacked a history of syphilis and substance misuse, were able to self-test, and had no communication barriers to engage with the sexual health service if issues arise. All data collected were de-identified and compliant with General Data Protection Regulations. We performed descriptive analyses.
Results:
Of 500 PrEP users included in the analysis inclusion, 68% (343/500) were deemed eligible for 6-monthly clinic visits. These included patients aged 25 -50 with normal renal function who had been established on PrEP for more than 12 months, with no recent STI or prior syphilis infection. Amongst those eligible, 76.3% (262/343) had always been reviewed in person every three months. Based on average visit scheduling times and service data for 2024, each PrEP user had on average 3.4 attendances per annum with 15 minutes allocated to each visit. A 6-monthly visit model applied on the eligible population, could potentially save 209 minutes per week of clinic time, which could permit for up to seven new visits slots (30 minutes each) per week.
Conclusion:
Two thirds of PrEP users in MMUH were found to be low risk. To meet the demand of new service users and to expand availability, identifying suitable low-risk candidates for 6 monthly PrEP clinic visits could facilitate new patient visits over the current model of care of every three months.
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Board No: 96 #2024215
"Neurological symptoms, high cerebrospinal fluid protein and HIV: A case series"
Principal Presenter: Tara McEnteggart
Keywords: HIV, neurological symptoms, CSFTrack: General Infectious Diseases
Neurological presentations in patients living with HIV can be life-threatening. A wide variety of causes can be implicated and in many cases the origin is not identified. Using three cases of patients with neurological symptoms, a CSF lymphocytic pleocytosis with high protein and HIV, we consider the range of underlying causes.
Case 1:
37year old healthcare worker presented with fatigue, progressing to confusion and aggression indicating acute personality change. CSF showed a lymphocytic pleocytosis(29 WCC/cmm, 90%lymphocytes), raised protein(2280mg/l) and normal glucose. A viral encephalitis was suspected, however CSF viral panel(EMV, CMV, HSV1/2, VZV) was negative. An early HIV infection was diagnosed(HIVarchitect+, Vidas p24 ag+/ab-, Innolia+). The absence of an alternative infectious agent led to the consideration of encephalitis related to acute HIV infection. Antiretroviral therapy(ART) was initiated leading to rapid improvement and restoration of cognitive function.
Case 2:
68year old Ukrainian man presented with ascending paralysis, on a background of HIV, compliant on ART for 5months, and recent remission from diffuse large b-cell lymphoma(DLBCL). His CD4 count was 48(38.2%)cells/mm3 and his HIV viral load was not detected. CSF examination showed lymphocytic pleocytosis(810 WCC/mm3, 60% lymphocytes ), raised protein(7959mg/l), low glucose(<0.1mmol/l). A diagnosis of Burkitt’s Lymphoma was secured on CSF flow-cytometry with positive CD19/CD20 molecules and a high EBV viral load(24,760,676 copies/ml). The patient was palliated, as combined pathology rendered him unfit for intrathecal chemotherapy.
Case 3:
41year old Zimbabwean lady presented with severe headaches progressing to fluctuating GCS. CSF analysis showed a lymphocytic pleocytosis(355 WCC/cmm, 80% lymphocytes), raised protein(23,110mg/l) and normal glucose. MRI brain reported abnormal leptomeningeal enhancement throughout both hemispheres and cerebellar oedema. HIV infection was diagnosed(HIVarchitect+, Innolia+). Further extensive investigations on multiple CSF samples and serum were negative, including flow cytometry and TB GeneXpert. Dexamethasone was initiated due to suspected CNS lymphoma, alongside ART. Due to the unknown cause of this clinical and radiological picture TB treatment was commenced. Despite broad-spectrum treatment the patient continued to deteriorate and fatal hydrocephalus developed.
Discussion:
HIV should be considered in any patient presenting with new neurological symptoms.
This series of cases highlight a selection of the wide range of causes of acute neurological symptoms in HIV presenting with a comparable CSF analysis. -
Board No: 97 #2024166
"Respiratory Syncytial Virus in Sligo University Hospital"
Principal Presenter: Daniel FitzPatrick
Keywords: RSV, Vaccination, Antimicrobial StewardshipTrack: General Infectious Diseases
Background
Respiratory Syncytial Virus (RSV) primarily affects those at extremes of age. A vaccine is now available in Ireland and is part of the childhood vaccination schedule for those born between September 2024 and February 2025. There had been a decrease in paediatric admissions secondary to RSV. This vaccine is not available publically for adults, costing upwards of €200. A 2024 HIQA analysis determined potential cost of a national RSV vaccination scheme targeting those aged over 65 to be approximately €146 million, or €76 million for over 75s.
Methods
Retrospective chart review of patients admitted to Sligo University Hospital (SUH) between September 2023 and February 2024.
Patients were included through positive RSV swabs. Patients under 18 years of age were excluded from this analysis.
Information regarding admissions including age, length of stay (LOS), antibiotic use, respiratory support, ICU admission, readmissions and mortality was collected from discharge letters, ED Triage information, handover documents and PiMS. Patients without this information were excluded.
Results
243 patients were identified as having RSV during September 2023 and February 2024. 151 people were excluded due to age or insufficient data. 89 patients were included in this analysis. The age range was 19 to 100 years, median of 75. Range of LOS was 0 to 48 days, mean LOS of 8.4 days and median of 5 days. 2 patients required admission to ICU. 15 patients required oxygenation, with fewer requiring High flow oxygen (6 patients) or non-invasive ventilation (6 patients).
Antibiotics were given to 51 patients. Antibiotics used included amoxicillin/clavulanate (17 patients) and piperacillin/tazobactam (7 patients), with fewer patients receiving others. 70 patients were not readmitted, with 10 readmitted within 60 days, and 8 still inpatients at 30 days. 30-Day mortality was 2.2%, and 6.1% at 90 days following admission.
Conclusion
The adult burden of RSV in SUH disproportionally affects those over 70, with a mean age of 75. A median LOS of 5 days demonstrates a significant use of inpatient bed days due to RSV, totalling more than 700 bed-days. Furthermore, antibiotics were given to most patients, which could signify concurrent bacterial infections or inappropriate antibiotic use for treatment of a viral infection.
This cohort had low mortality but a significant inpatient burden related to RSV. Increased education regarding availability of the RSV vaccine may be beneficial, but individual cost may be a deterrent. Further analyses regarding RSV presentations to other facilities may aid justification for a larger adult RSV vaccination scheme. -
Board No: 98 #2024115
"Simultaneous atraumatic splenic rupture and extensive central venous thrombosis due to patients with EBV"
Principal Presenter: Nicola McNally
Keywords: EBV, Atraumatic splenic rupture, Central venous thrombosisTrack: General Infectious Diseases
Background:
Epstein-Barr virus (EBV) is a common viral infection, typically presenting as self-limiting infectious mononucleosis. Rare complications include atraumatic splenic rupture, occurring in less than 0.5% of cases, and venous thromboembolism (VTE), usually in immunocompromised patients. Concurrent occurrence of both complications in immunocompetent individuals is exceptionally rare.Methods:
We present a case of a 17-year-old immunocompetent female with atraumatic splenic rupture secondary to EBV. She underwent an emergency splenectomy and massive transfusion due to hemodynamic instability. Despite postoperative prophylactic anticoagulation, follow-up imaging revealed portal vein, right external iliac, and common iliac vein thrombosis.Results:
The patient was commenced on therapeutic anticoagulation for 12 weeks. Follow-up imaging at six weeks demonstrated complete resolution of the thrombosis. She recovered fully with no further complications and was discharged with a post-splenectomy vaccination schedule.Conclusion:
This case demonstrates the rare simultaneous occurrence of atraumatic splenic rupture and extensive VTE in an immunocompetent patient with EBV. It highlights the importance of early recognition and vigilance for both complications, even in young, otherwise healthy individuals.
