2026 Meeting - Abstracts IDSI

#2026333

"RSV vaccination produces T-cell responses in CAR-T recipients in the absence of humoral immunogenicity"

Principal Presenter: Ellen Walsh

Track: Virology

Background: Individuals receiving chimeric antigen receptor (CAR) T-cell therapy are at increased risk of severe respiratory viral infections, yet data on vaccine immunogenicity in this population remain limited. There is no data to date on immunogenicity of respiratory syncytial virus (RSV) vaccination in this population. We evaluated immune responses to RSV vaccination in CAR T-cell recipients compared with healthy controls.

Methods: n=14 adult CAR T-cell recipients treated at a national referral centre were included. All participants received a single dose of RSVPreF3 OA vaccine in September 2025. An age-matched healthy control cohort was recruited and vaccinated simultaneously (n=18). Blood was drawn at baseline and at a median of 1 month following vaccination. Humoral responses were assessed through RSV pre-fusion (PreF) binding antibody titres and neutralisation assays. Cellular responses were evaluated by interferon-gamma release assay following antigen stimulation.

Results: CAR T-cell recipients demonstrated variable baseline PreF antibody titres. Following vaccination, a significantly higher proportion of control subjects achieved a ≥4-fold rise in PreF titres compared to CAR-T recipients (94.4% vs 14.3%, Fisher’s exact test, p < 0.0001). Neutralising antibody activity correlated well with binding antibody titres, indicating functional relevance of the humoral response. IFN-γ and IL-2 production in response to RSV was significantly increased (p≤0.001, p≤0.001) following vaccination in CAR T-cell recipients, consistent with activation of antigen-specific T-cell responses. A consistent and significant cellular response was also seen in healthy controls. Responses in the CAR T-cell cohort were more heterogeneous than in healthy controls.

Conclusion: CAR T-cell recipients show cellular immune responses to RSV vaccination in the absence of meaningful humoral responses. Further research is needed to assess if T-cell immunogenicity in this cohort provides a clinical protective benefit. Correlation between binding and neutralising antibodies supports the use of binding assays as a surrogate marker of functional immunity in this setting.

ORAL PRESENTATION

#2026331

"Mapping Socioeconomic Determinants of AMR: A Five-Year Cohort Study in a Tertiary Irish Hospital"

Principal Presenter: Paul Reidy

Track: Epidemiology & Population Health

Background
Socioeconomic factors influence infectious disease risk, but their relationship with antimicrobial resistance (AMR) remains poorly defined. Understanding how deprivation and socioeconomic position shape AMR carriage is essential for targeted stewardship and public health action. This study assessed socioeconomic patterns associated with major resistance phenotypes in a large Irish hospital cohort.

Methods
We analysed 4,907 unique patients with AMR alerts from September 2018 to October 2023 and compared them with a denominator cohort of 66,327 hospital patients from the same time period. Residential addresses were geocoded and matched to Irish census Small Areas, enabling linkage to Pobal HP Index measures and associated socioeconomic indicators. Socioeconomic status (SES) was captured using deprivation scores, social class rank, unemployment level, household overcrowding rate, and medical card status. Statistical analyses conducted in R included Welch’s t-test, Wilcoxon rank-sum, ANOVA and Kruskal–Wallis tests, with pairwise Tukey and Dunn post-hoc comparisons. Multivariable logistic regression modelled independent predictors of AMR, and stratified models characterised socioeconomic patterns across CPE, ESBL, MRSA and VRE.

Results
On average AMR patients lived in significantly more disadvantaged areas than non-AMR patients (t = −5.24, p < 0.001). Medical card holders had markedly higher odds of AMR (OR 2.19, p < 0.001), and increasing age was associated with higher AMR risk (p < 0.001). SES varied significantly across resistance phenotypes (ANOVA p < 0.001). ESBL infections were consistently associated with higher SES, with significantly higher HP Index scores compared with both CPE (p = 0.007) and VRE (p < 0.001). VRE cases were concentrated in the most disadvantaged groups. MRSA showed strong associations with deprivation markers, including medical card status and household overcrowding (both p < 0.001). Multivariable models confirmed that higher social class was protective against AMR, while overcrowding showed mixed effects depending on phenotype. Stratified analyses demonstrated phenotype-specific socioeconomic signatures: higher SES increased ESBL risk, overcrowding increased MRSA risk, and deprivation increased VRE risk.

Conclusions
Socioeconomic disadvantage is strongly associated with AMR carriage; however, the direction and magnitude vary substantially by resistance phenotype. These findings highlight the importance of integrating socioeconomic context into AMR surveillance and targeted stewardship interventions.

ORAL PRESENTATION

#2026330

"Pilot Assessment of Antimicrobial Resistance Gene Detection in Hospital & Urban Wastewater using Molecular Methods"

Principal Presenter: Paul Reidy

Track: Epidemiology & Population Health

Background:
Antimicrobial resistance (AMR) is a critical public health issue. Antimicrobial consumption in healthcare is a significant driver and may affect the ecology of AMR. While monitoring antibiotic prescribing is routine practice, there are no established methods for directly assessing the impact of clinical prescribing on environmental AMR levels. This pilot study explores whether molecular quantification of antimicrobial resistance genes (ARGs) in wastewater could serve as a feasible indicator of these impacts of antimicrobial usage patterns, ultimately aiming to provide a potential tool for evaluating antimicrobial stewardship measures.

Methods:
Wastewater samples were collected from two distinct locations: a tertiary academic referral hospital (high antibiotic exposure) and an urban university site (low antibiotic exposure). Samples were collected from two sites at each location, over two days, with multiple biological replicates. ARG presence and abundance were quantified using Resistomap SmartChip quantitative PCR (qPCR), targeting 72 common ARGs. Relative abundance of each ARG was calculated using the 2⁻ΔCt method, normalising gene abundances to the 16S rRNA gene. Statistical analyses included Wilcoxon rank-sum tests with Benjamini–Hochberg corrections for gene-level comparisons and principal component analysis (PCA) for multivariate data exploration.

Results:
Clear differentiation between hospital and urban wastewater resistomes was observed. Principal component analysis indicated that the primary variance (44.4%) distinctly separated hospital-derived from urban-derived ARG profiles. Gene-level comparisons revealed significant differences (adjusted p < 0.0001) across all ARGs tested, with substantial hospital enrichment noted in clinically relevant resistance classes, including aminoglycoside, β-lactam, and macrolide antibiotics.

Conclusions:
This pilot study suggests the feasibility of using molecular ARG quantification in wastewater to distinguish antibiotic-exposed (hospital) from less-exposed (community) populations. Given these clear distinctions, future work will evaluate correlations between wastewater ARG abundances and local antimicrobial prescribing patterns. If confirmed, ARG monitoring could become a valuable tool in assessing and guiding clinical antimicrobial stewardship interventions.

ORAL PRESENTATION

#2026329

"“Establishing a Dedicated Multidisciplinary Team for Complex Bone and Joint Infections"

Principal Presenter: Laura Howard

Track: General Infectious Diseases

Introduction:
Bone and joint infections (BJIs) include periprosthetic joint infections (PJIs), fracture-related infections (FRIs), septic arthritis, and osteomyelitis (Armbruster et al., 2025). PJIs represent complex complications associated with significant morbidity and healthcare burden, requiring multidisciplinary input beyond a single clinician (Broom et al., 2023). This study outlines the implementation and early experience of a dedicated multidisciplinary team (MDT) for BJIs at a tertiary centre.
Methods:
A BJI MDT was established in June 2025, comprising a lead orthopaedic surgeon, infectious diseases consultants, microbiology consultants, a physician associate, an advanced practice nurse, clinical nurse specialists and specialist trainee doctors. Meetings were held fortnightly to review new referrals and ongoing management. A prospective database was developed to capture patient demographics, infection characteristics, surgical interventions, microbiology, and antimicrobial therapy. This evolved into a live MDT platform generating formalised reports integrated into electronic records.
Results:
Over eight months, 49 cases were reviewed (65% male, 35% female), with ages ranging from 25 to 91 years (mean 63 years). Case complexity varied, with 29% requiring discussion over three MDT meetings and 21% reviewed in a single session.
Lower-limb involvement predominated, with 37% of cases affecting the knee and 35% affecting the hip. PJIs accounted for most cases (61%), followed by FRIs (25%) and septic arthritis (14%). Most PJI presentations were late (>30 days from index surgery), at 90%, with only 10% early. Common comorbidities included diabetes, rheumatoid arthritis, osteoarthritis, hypertension, and hyperlipidaemia.
Among PJI cases, 53% underwent two-stage revision, 17% underwent debridement, antibiotics, and implant retention (DAIR), 13% underwent a single washout, and 10% underwent single-stage revision. The remaining 7% had completed the first stage and were awaiting the second stage, with an average interval of 10 weeks between stages.
Microbiological analysis showed Gram-positive organisms in 53% of cases, with coagulase-negative staphylococci accounting for 28%. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified in 15% of PJI cases, while 19% demonstrated no growth.
The majority of PJI cases (94%) received outpatient parenteral antimicrobial therapy (OPAT) or intravenous therapy followed by oral step-down, with 6% managed on oral therapy alone. Additionally, 40% required prolonged treatment (3–6 months) and/or long-term suppressive therapy.
These findings highlight the heterogeneity and complexity of cases managed within the MDT, reinforcing the need for coordinated multidisciplinary evaluation.
The database will support longitudinal outcome assessment. The primary outcome at 24 months will be clinical cure, defined as patient survival, absence of infection, and no ongoing antimicrobial therapy. Treatment success will be defined as clinical cure with retention of the index prosthesis (Davis et al., 2022).
Conclusion:
A dedicated BJI MDT enables structured multidisciplinary decision-making and comprehensive data capture. Early experience demonstrates consistent case review across a complex patient cohort and has supported quality improvement initiatives, including implementation of new theatre sampling kit, sample processing and implementing decolonisation protocols prior to surgery. Ongoing follow-up will determine the impact of MDT input on clinical outcomes, including cure and treatment success at 24 months.

ORAL PRESENTATION

#2026321

"Urinary Tract Infections and Diagnostic Stewardship – A multi-centre trainee led “Skip the Dip” Audit"

Principal Presenter: Bearach Reynolds

Track: General Infectious Diseases

Background

Diagnostic stewardship involves the appropriate use of diagnostic tests to improve the diagnosis and treatment of infections. Urine dipsticks are one such test. A HSE Antimicrobial Resistance Programme position paper on urine dipsticks advises against their use in patients >65 years, catheterised patients, and male patients under 65; particularly in the absence of signs and symptoms of urinary tract infection (UTI). This audit assesses the appropriateness of urine dipstick use against HSE standards. A secondary aim was to assess the feasibility of establishing a Diagnostic Stewardship Trainee Network, a group of Infectious Diseases Trainees, passionate about diagnostic stewardship.

Methods

This audit was conducted across two Irish hospitals, capturing three 24-hour General Internal Medicine (GIM) call periods per site. All GIM admissions were included. Data were recorded using an audit tool derived from the HSE position paper, with anonymised results pooled across both sites.

Results

166 admissions were captured; 41% female, median age 72 years.

UTI was the working diagnosis for N=20 (12%) of all admissions.

Urine dipstick was performed in N=50 (30.1%) of all patients.

Among N=50 who had a urine dipstick performed, 40% were female with a median age 73.5 years. 17/50 had a working diagnosis of UTI.

22% of urine dipsticks in this group were deemed clinically appropriate by the reviewing clinician based on the HSE standards.

In N=20 patients with working diagnoses of UTI, 50% were female with a median age of 78.5. Urine dipstick was performed in 17/20. Notably, only 2/17 of dipsticks in the UTI group were compliant with guidelines.

Conclusion

Based on HSE guidelines, almost 80% of urine dipsticks were considered clinically inappropriate.

This project may act as a pilot for future diagnostic stewardship audits through this network.

ORAL PRESENTATION

#2026313

"Improving Intravenous Access Success Through Simulation-Based and Ultrasound-Guided Training: A Combined Audit and Quality Improvement Initiative"

Principal Presenter: Patrick Carey

Track: General Infectious Diseases

Background
Difficult intravenous access (DIVA) is a common clinical challenge associated with repeated cannulation attempts, patient discomfort, delays in treatment, and escalation to central venous access. Bedside ultrasound-guided peripheral intravenous cannulation improves success rates, yet uptake outside specialist teams remains limited. We aimed to evaluate baseline cannulation practices and to implement a targeted training intervention to improve outcomes.

Methods
A prospective audit was conducted over ten working days across two Infectious diseases wards. All patients requiring intravenous cannulation were included. Data collected included number of attempts, number of operators involved, and escalation to central venous access (central venous catheters [CVCs] or peripherally inserted central catheters [PICCs]). Proportion of patients meeting criteria for DIVA was assessed using A-DIVA predictive score.

A subsequent quality improvement intervention was implemented, consisting of simulation-based ultrasound training delivered by Emergency Department clinicians, followed by supervised bedside practice with the aim of achieving independent competency.

Results
Forty patients required cannulation during the audit period. A total of 47 cannulas were successfully placed following 100 attempts. Cannulations were performed by nurses (n=30), doctors (n=5), and the intravenous cannulation team (n=6). Escalation included two CVC insertions (anaesthetics) and one PICC line (interventional radiology). Three patients had unsuccessful attempts with no intravenous access established.

Ten patients met criteria for DIVA. Within this group, patients required an average of 2.2 cannulas each within 10 day period, with a mean of 3.7 attempts per successful cannula and involvement of an average of two operators per cannulation episode. There were 11 referrals to the intravenous cannulation team for these patients.

Clinical impact included eight missed antibiotic doses and a cumulative delay of 78 hours in antibiotic administration due to lack of intravenous access. Additionally, there were two CVC insertions and four PICC line requests attributable to difficult access.

Following implementation of structured simulation based training to ward staff for bedside ultrasound-guided cannulation, provisional data demonstrates use of ultrasound device on 10 occasions to establish intravenous access, achieving successful cannulation in 8 cases (80% success rate), with an average of 1.8 attempts per successful cannulation. The pilot project is ongoing with final data expected later this year.

Conclusion
Baseline data demonstrate a significant burden associated with DIVA on Infectious diseases inpatient wards, including procedural inefficiency, treatment delays, and escalation to central access. A structured training programme incorporating simulation and supervised ultrasound-guided practice represents a feasible strategy to improve cannulation success.

ORAL PRESENTATION

#2026307

"Respiratory Syncytial Virus (RSV) Immunisation Policies in Neighbouring Regions: Effectiveness of Maternal Vaccination versus Infant Monoclonal Antibody against hospitalisation for RSV-associated Respiratory Tract Infection (RTI) on the Island of Ireland"

Principal Presenter: Bryony Treston

Track: Epidemiology & Population Health

Background: Respiratory Syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) in infants. From 1 September 2024, the Republic of Ireland (ROI) introduced the long-acting RSV monoclonal antibody nirsevimab for infants. Simultaneously, Northern Ireland (NI) introduced maternal RSVpreF vaccination for pregnant women from 28 weeks’ gestation. This created a unique opportunity to compare effectiveness of differing immunisation strategies in similar populations where policy-driven allocation, rather than patient or provider choice minimised selection bias.

Aim: The primary objective was to estimate real-world effectiveness of strategies against hospitalisation for RSV-associated-RTI in infants <6 months across the island of Ireland. A secondary objective was to compare their impact on bronchiolitis-related emergency department (ED) attendances.
 
Methods: We conducted a multicentre, test-negative, case-control study to analyse effectiveness of nirsevimab and maternal RSVpreF against hospitalisation for RSV-associated-RTI in infants. Included infants were aged <6 months, with bronchiolitis, wheeze or LRTI, admitted to one of five sites, encompassing all tertiary paediatric intensive care across the Island (Children’s Health Ireland hospitals, Dublin and Royal Belfast Hospital for Sick Children, Belfast). Data were collected on admissions in ROI from 1 October 2024 to 1 February 2025, and in NI from 1 September 2024 to 30 April 2025. Product effectiveness against primary outcome was estimated by comparing odds of nirsevimab or maternal RSVPreF vaccination receipt among RSV cases versus controls using multiple logistic regression. Time series modelling was used to compare ED attendances for bronchiolitis during the 2024/25 season to preceding seasons (2017/18 to 2023/24, excluding COVID-19 pandemic seasons).

Results: Primary analysis included 254 infants; 165 in ROI (85 RSV-positive cases, 80 RSV-negative controls) and 89 in NI (49 RSV-positive cases, 40 RSV-negative controls). In ROI, 34% of cases and 83% of controls had received nirsevimab. In NI, 6% of cases and 30% of controls had received maternal RSVpreF vaccination. Unadjusted effectiveness against RSV-associated hospitalisation in infants under six months was estimated at 89% (95% CI 77–95%) for nirsevimab and 85% (95% CI 47–97%) for RSVpreF. A significant reduction in actual versus predicted bronchiolitis-related ED attendances was observed across both regions, with a greater decrease in ROI than in NI (52% and 37% respectively).
 
Conclusions: This is the first all-Ireland comparison of two distinct RSV immunisation strategies implemented in comparable populations and healthcare systems following the first season of implementation. Both interventions showed high effectiveness in preventing RSV-associated hospitalisation. Differences in product uptake may have shaped population-level impact, with greater reductions in ED attendances observed in ROI, where coverage was higher.

ORAL PRESENTATION

#2026305

""Drip, Drip, Hooray! A Deep Dive into Outpatient Parenteral Antimicrobial Therapy Awareness at an Irish University Hospital""

Principal Presenter: Mubashir Habib

Track: Other

Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) enables safe administration of intravenous antimicrobials in the community, reducing hospital stay and improving antimicrobial stewardship. However, awareness and implementation can be variable across different institutions.

Methodology: A cross-sectional, anonymized study was conducted in September 2025 among staff at an Irish university teaching hospital following approval from the Quality Improvement department (ID: 5479). Data was collected using a structured questionnaire administered online. Participants included doctors of all grades and nursing Staff. The questionnaire assessed OPAT awareness, perceived benefits and contraindications, knowledge of governance, confidence in OPAT assessment, and participant’s perceived need for further training.

Results: A questionnaire was sent to 800 healthcare professionals, of whom 136 opened the link and 89 responded.

Overall, 63% (n=55) had previously used OPAT, while 33% (n=29) were aware of OPAT but had never used it, and 3% (n=3) were not aware of OPAT. The infectious diseases team was correctly identified as the OPAT service’s clinical governernance speciality by 79% (n=68) of respondents.

The most frequently perceived benefits of OPAT were reduced hospital stay (98%, n=87), improved patient comfort (87%, n=77), reduced healthcare-associated infection risk (92%, n=81), cost savings (88%, n=77), and improved treatment compliance (81%, n=72). Confidence in identifying OPAT-appropriate patients was variable: 20% (n=17) reported being very confident, 60% (n=52) somewhat confident, and 21% (n=18) not confident.

Among non-users or those only aware of OPAT (n=46), barriers included unclear referral pathways (30%, n=14), previous bad experiences (7%, n=3), and availability of alternative outpatient antibiotic pathways (11%, n=5), while 50% (n=23) reported other or no barriers.

A large majority (87%, n=77) felt that additional formal OPAT training would be beneficial. Participants were provided with correct answers at the end of the questionnaire, so the survey also functioned as both an assessment of awareness as well as an educational tool.

Conclusion: Awareness of OPAT was high among healthcare professionals in our institution, with strong recognition of its clinical and economic benefits. However, confidence in patient selection and uncertainty regarding referral pathways were identified as barriers to wider adoption. Many respondents felt that more formal OPAT training is needed. These findings will inform future OPAT program expansion and education strategies.

ORAL PRESENTATION

#2026303

"Treatment goals: LDL-c Levels in People Living with HIV – an Audit against the European AIDS Clinical Society 2025 Updated Guidelines"

Principal Presenter: Fiorina Rigonat

Track: Virology

Background

Cardiovascular disease (CVD) remains a leading cause of mortality among people with HIV (PWH), emphasising the importance of optimal management of dyslipidaemia. Statin therapy is shown to reduce cardiovascular events, and the European AIDS Clinical Society (EACS) guidelines version 13.0 from October 2025, recommend specific LDL-c targets based on individual cardiovascular risk stratification. This audit aims to evaluate adherence to these guideline-recommended LDL-c targets in PWH with cardiovascular risk factors.

Methods

The audit population comprised a randomly selected subset of PWH attending the SVUH Infectious Diseases Department who were prescribed statin therapy. Data were collected retrospectively from electronic health records, pharmacy records, and medical correspondence and evaluated against EACS guidelines on cardiovascular disease prevention, specifically dyslipidaemia management. Cardiovascular risk was assessed using the SCORE2 tool in accordance with guideline recommendations. Patients classified as high risk were expected to achieve an LDL-C target of <1.8 mmol/L (70 mg/dL) and a >50% reduction from baseline, while those at very high risk were expected to achieve an LDL-C target of <1.4 mmol/L (55 mg/dL) and a >50% reduction from baseline.

Results

A total of 67 PWH on statin therapy were included in this audit. The median (IQR) age was 56.0 (51.0-63.0) years, and 47 (70%) were male. All patients were receiving antiretroviral therapy. Atorvastatin was prescribed in 51 (76%), and rosuvastatin in 16 (24%) of cases. Based on cardiovascular risk, 19 (28%) patients were classified as low-moderate risk and had a median (IQR) LDL-c of 2.3 [1.5-2.8] mmol/L, 34 (51%) were classified as high risk and had a median (IQR) LDL-c of 2.0 [1.8-2.5] mmol/L, and 14 (21%) were classified as very high risk and had a median (IQR) LDL-c of 2.0 [1.6-3.0] mmol/L. 9/34 (26%) in the high-risk group met the target of <1.8 mmol/L, and 3/14 (21%) in the very high-risk group met the target of <1.4 mmol/L. Among those not meeting targets, clinical action was documented in 9/25 (36%) high-risk patients and 4/11 (36%) very high-risk patients.

Conclusion

This audit indicates that achievement of LDL-c targets was suboptimal to the new guidelines and highlights the importance of early auditing when new guidelines become available so as to increase awareness and ensure adherence

To address this, we propose a number of interventions including dissemination of audit results to relevant clinical and pharmacy team, teaching sessions for clinical staff, and implementing a pharmacy-led initiative to optimise statin prescribing in this patient group.

ORAL PRESENTATION

#2026302

"Ten-Year Review of Hepatitis B Virus Infection Care and Impact of Updated Management Guidelines on Patients at a Tertiary Infectious Diseases Centre"

Principal Presenter: Helina Alemayehu

Track: Virology

Background

The management of Hepatitis B Virus (HBV) infection is nuanced. Treatment decisions combine patient and viral parameters. The European Association for the Study of Liver disease (EASL) released new guidelines for the management of HBV infection in 2025. These lowered the treatment threshold. We audited our HBV care over ten years in line with the previous guidelines across five domains: initial assessment, surveillance, treatment initiation, and treatment safety. We assessed the impact of the updated 2025 guidelines on treatment eligibility.

Methods

Electronic patient records of new HBV infection referrals to the Infectious Diseases Department at St James’s Hospital from 2015 – 2025 were reviewed. Demographic data and disease-specific outcomes as per guidelines were recorded. Wilcoxon rank sum and Pearson’s Chi-square test assessed adherence with guidelines, with subsequent multivariable logistic regression models used to further characterise factors influencing guideline non-adherence.

Results

There were n=367 new HBV infection referrals from 2015 – 2025. The majority were male (270/367, 73%) and median age was 42 (IQR 36 – 51). 35% were from Sub-Saharan Africa, with 29% from Eastern Europe. 81/367 (30%) required a translator. All patients had HIV and HCV serology checked, while 92% had HDV status assessed (n=17 HDV IgG positive). N=320 (87%) had a Fibroscan™ and n=286 (78%) had an ultrasound in the first 12 months. Male sex (OR 0.47, 95% CI 0.27 – 0.82, p=0.008) and HIV co-infection (OR 0.34, 95% CI 0.17 – 0.65, p=0.001) were associated with reduced likelihood to attend for ultrasound. All patients had ALT and AST assessed every six months. N=110 (30%) had an ALT above the upper limit of normal. Surface antigen was checked in n=239 (65%) annually. N=254 (69%) had an ultrasound in the preceding twelve months. 26% (n=86) were on treatment, with 71/86 having an undetectable viral load, and six clearing HBV surface antigen. Of those receiving tenofovir DF, 91% had their renal function checked in the preceding year, while 67% had urinary protein/creatinine assessed.

Of the patients not receiving HBV therapy, n=25 have a Fibroscan™ >7kPa, with n=8 of these having a viral load >2,000 IU/ml and a further n=3 having ALT >ULN. These would meet 2025 guidelines for treatment consideration.

Conclusion

Overall adherence to EASL guidelines for HBV monitoring is high. There may be scope to reduce the frequency of surveillance ultrasounds being requested in specific patient groups. The updated EASL guidelines have increased the number of patients eligible for treatment consideration.

ORAL PRESENTATION

#2026299

"Assessment of Partner Notification Strategy to Improve Management of Syphilis Among Pregnant Women in Blantyre, Malawi"

Principal Presenter: Deirdre Foley

Track: Epidemiology & Population Health

Background: Congenital syphilis (CS) remains a major global health challenge, with rising incidence driven in part by maternal reinfection during pregnancy. Partner notification (PN) is a key strategy to prevent reinfection and reduce mother-to-child transmission, yet data on its effectiveness in low-resource settings are limited. This study aimed to assess PN coverage, partner management outcomes, and barriers to effective PN among pregnant women with syphilis in Blantyre, Malawi.

Methods:A mixed-methods study was conducted across four primary health centres. Quantitative data were collected through a cross-sectional survey of women diagnosed with syphilis during pregnancy or at time of delivery. PN was defined as informing partners of exposure, and completed partner management when their partner was tested and received care appropriate to their test result. Associations between demographic factors and partner treatment were assessed. Qualitative data were obtained through semi-structured interviews with a subset of women and healthcare workers, and analysed using reflexive thematic analysis.

Results: Among 131 women with syphilis, n=117 (89.3%) reported being advised to notify their partners. However, only 76 (58.0%) partners received treatment, and 40 (30.5%) met criteria for completed partner management. Partner treatment was significantly associated with being married or cohabiting (p=0.0005), but not with age, HIV status, or education. No significant association was observed between partner treatment and adverse birth outcomes. Qualitative findings highlighted multiple PN approaches, with patient-led notification predominating. Key barriers included fear of partner reaction, poor communication, stigma, misinformation, and partner reluctance to access care, while facilitators included community sensitisation and healthcare worker involvement in complex cases.

Conclusions: Partner notification was widely implemented but substantial attrition occurred between notification and partner treatment, highlighting critical gaps in the PN cascade. These findings underscore the need for standardised definitions and outcome measures for PN, alongside context-specific, multi-component interventions that address structural, interpersonal, and health system barriers.

ORAL PRESENTATION

#2026298

"Rabies Post-Exposure Prophylaxis: A National Multicentre Audit"

Principal Presenter: Ahmed Al Badi

Track: Epidemiology & Population Health

Background

Rabies is a fatal zoonotic infection once clinical symptoms develop. However, it is entirely preventable with post-exposure prophylaxis (PEP). While Ireland is rabies free, the risk of exposure persists due to international travel and exposure to endemic countries.

Methods

We evaluated patients referred to emergency departments or infectious diseases departments for post-exposure prophylaxis against rabies across four tertiary hospitals in 2025.

The centres included were Mater Misericordiae University Hospital, St James’s Hospital, St Vincent’s University Hospital, and Galway University Hospital.

Vaccination and electronic medical records were reviewed. The use of PEP, with either human rabies immunoglobulin (HRIG), vaccination, or both was compared with the HPSC interim guidance issued in October 2025. Data was analysed using Microsoft Excel.

Results

A total of 50 patients were included in this audit. Exposures occurred across 22 countries, most commonly Thailand, Morocco, Vietnam, and Ireland. Notably, all potential rabies exposures in Ireland were related to bats.

The most common animal exposures were to dogs (19), followed by cats (12) and bats (11). Other animals included monkeys, squirrels, pigs, and horses.

Only 6 patients had documented prior rabies immunisation, the remainder were either non-immune or had unknown immunisation status. The combined rabies risk included patients with red (23) and amber (27) exposure.

In 32 patients PEP being HRIG, vaccination or both were started abroad, while 18 patients travelled back to receive their PEP.

HRIG was administered in 13 patients, of whom 9 (69.2%) received it appropriately and 4 (30.8%) inappropriately. All inappropriate HRIG administration occurred abroad.

Among the 35 patients who did not receive HRIG, this was appropriate in 27 (77.1%) cases and inappropriate in 8 (22.9%) patients. Unfortunately, in cases where HRIG was not received inappropriately, patients presented to local hospitals >7 days after commencing vaccination, precluding HRIG administration.

Vaccination was confirmed to be appropriate in 50 (100%) of patients. 44 patients required 2-4 doses of the vaccine. While 3 patients required >4 doses of the vaccine due to receiving non-WHO approved vaccines. 3 patients were missing data fields on the number of vaccinations.

Conclusion

Overall, national HRIG administration is at 100% adherence to guidelines. Vaccination adherence was at least 100%, with missing data fields for 3 patients. There needs to be a standardised database collection tool combined with a referral form that assists in further maintaining appropriate standard of practice. There may be difficulties encountered with patients receiving non-WHO-approved vaccines requiring repeat vaccination.

ORAL PRESENTATION

#2026292

"Chronic respiratory disease and outcomes in adults hospitalised with RSV"

Principal Presenter: Fiona Murphy

Track: Epidemiology & Population Health

Background:
Respiratory syncytial virus (RSV) is a recognised cause of morbidity in adults, particularly among those with chronic respiratory disease. However, the extent to which underlying respiratory comorbidity predicts clinical outcomes in hospitalised patients remains unclear. We aimed to evaluate the prevalence and clinical impact of pre-existing respiratory disease in adults hospitalised with RSV.

Methods:
We conducted a retrospective cohort study of adults admitted with PCR-confirmed RSV across two tertiary centres (n=124; GUH 2024/2025; SJH 2025/2026). Data collected included demographics, comorbidities, radiographic findings, in-hospital complications, and clinical outcomes, including length of stay (LOS), requirement for respiratory support, ICU admission, and in-hospital mortality. Patients were stratified according to the presence of underlying respiratory disease and by severe disease, defined as a composite of ICU admission, non-invasive ventilation (NIV) or high-flow oxygen, or death.

Results:
The median age was 75 years (IQR 63–82), and 52% were female. Pre-existing respiratory disease was present in 52 patients (42%), representing the most common comorbidity.

Overall morbidity was substantial: median LOS was 7 days (IQR 4–12), 44% had abnormal chest radiography, 15% required NIV or high-flow oxygen, 6% were admitted to ICU, and in-hospital mortality was 4%. In-hospital complications occurred in 52% of patients, most commonly secondary respiratory pathology, including bacterial pneumonia and exacerbations of chronic obstructive pulmonary disease or asthma.

Patients with underlying respiratory disease experienced a high burden of respiratory complications. However, respiratory comorbidity was not associated with severe outcomes (36% vs 43%, p=0.56), nor with ICU admission, requirement for respiratory support, or mortality. Similarly, no individual comorbidity was predictive of disease severity.

Severe outcomes occurred in 18% of patients overall and were strongly associated with the development of in-hospital complications (91% vs 43%, p<0.001), rather than baseline patient characteristics or comorbidity burden.

Conclusions:
Chronic respiratory disease is highly prevalent among adults hospitalised with RSV and contributes to significant respiratory morbidity, particularly through secondary complications. However, it does not predict severe clinical outcomes. These findings suggest that baseline respiratory comorbidity alone is insufficient for risk stratification and highlight the importance of in-hospital clinical trajectory in determining outcomes. Future risk models should incorporate dynamic clinical factors rather than relying solely on pre-existing disease.

ORAL PRESENTATION

#2026269

"The changing epidemiology of Pneumocystis jirovecii pneumonia (PJP) in Ireland between 2018-2023, with a focus on non-HIV cohort: A national retrospective population-based study and single-centre review."

Principal Presenter: Josephine Hebert

Track: Epidemiology & Population Health

Background

The epidemiology of Pneumocystis jirovecii pneumonia (PJP) has evolved significantly over the last 50 years, and is increasingly seen in immunocompromised patients who are Human Immunodeficiency Virus (HIV) negative. (1) The data on the epidemiology of PJP in Europe is scarce and we aim to study this on a national level.

Methods

We carried out a retrospective analysis of all episodes of care in Irish hospitals from 01/01/2018-31/12/2023 using the Irish National Quality Assurance and Improvement System (NQAIS). Patients >16 years with a diagnosis of PJP during their admission were included. We simultaneously performed an audit of PJP cases in a single Irish centre. Patients with a positive Pneumocystis jirovecii polymerase chain reaction (PCR) were included and their records were reviewed. Statistical analysis was carried out using Microsoft Excel and Jamovi version 2.7.12.

Results

548 inpatients were diagnosed with PJP in Ireland between 2018-2023, 433 (79%) of whom were HIV-negative. The incidence of PJP in Ireland has increased from 1.45 per 100,000 population in 2018 to 2.02 per 100,000 in 2023, driven by a rise in the incidence of PJP in the non-HIV cohort.

With regards to underlying causes for PJP, Human Immunodeficiency Virus (HIV) accounted for only 21% of cases. 24% of patients had a solid malignancy, while 15% of patients had a haematological malignancy, and the rates of these were overall steady between 2018-2023. The rates of pulmonary diseases as an underlying cause increased from 7% in 2018 to 16% in 2023. The inpatient mortality rate was 34% amongst HIV-negative patients. Non-HIV patients with PJP were more likely to be older and frailer and had significantly higher mortality rate than patients with HIV (p<0.001).

Discussion

This incidence of PJP in Ireland has risen between 2018-2023, driven by a rise in the incidence of PJP amongst HIV-negative patients. Considering the high mortality rate in this cohort, further guidelines are needed on chemoprophylaxis in high-risk groups, including patients with solid and haematological malignancies.

References

1. Rhoads S, Maloney J, Mantha A, Van Hook R, Henao-Martínez AF. Pneumocystis jirovecii Pneumonia in HIV-Negative, Non-transplant Patients: Epidemiology, Clinical Manifestations, Diagnosis, Treatment, and Prevention. Curr Fungal Infect Rep. 2024;18(2):125-35.

ORAL PRESENTATION

#2026268

"Blood, Bowel and Heart: The Streptococcus Gallolyticus Triad"

Principal Presenter: Marcela Merc

Track: General Infectious Diseases

Abstract:

Background

Research associates Streptococcus gallolyticus bacteraemia with not only malignant, but premalignant colonic lesions, which can serve as a portal of entry for invasive infections like infective endocarditis. This study aims to assess clinician recognition of these associations at our hospital by evaluating treatment and referral pathways for S. gallolyticus bacteraemic patients as a quality assurance measure.

Methods

A retrospective review was performed for all inpatient presentations in 2014 to 2023 inclusive resulting in a positive blood culture for S. gallolyticus. Apart from demographic data, investigative information with a focus on echocardiography, radiography and endoscopy was noted.

Results

A total of 33 patients were identified, with an average age of 77.8 years and a male preponderance (n=22, 66.7%). All patients suffered significant co-morbidity. 28 patients (84.8%) underwent echocardiography, with evidence of infective endocarditis present in 2 cases. Contrast computed tomography was performed for 27 patients (81.2%), with findings suggestive of colorectal malignancy among 5. Overall, 14 (42.4%) patients underwent a colonoscopy. Non-dysplastic adenomas, low grade dysplastic adenomas and adenocarcinomas were identified among 1, 6 and 3 patients respectively. Only 1 patient with an identified adenocarcinoma proceeded to surgery, all other tumours were managed expectantly.

Conclusions

Cases were largely in line with recommendations appreciating the relationships with S. gallolyticus and infective endocarditis and colorectal cancer; as >80% of cases were non-invasively investigated. Marked deficits lie in endoscopic evaluation. Whether this was due to patient frailty, patient preference, physicians or endoscopist decision or clear radiographic imaging is unclear and further study remains warranted.

ORAL PRESENTATION

#2026253

"Antimicrobial consumption in severe acute respiratory infections during 2025/26 season"

Principal Presenter: Siti Mardhiah Muhamad Fauzi

Track: General Infectious Diseases

Background
Management of hospitalised patients with severe acute respiratory infections (SARI) secondary to vaccine-preventable respiratory viruses is controversial. American Thoracic Society guidelines provide a conditional recommendation for antimicrobials, whereas Infectious Disease Society of America recommends a more individualised approach.

We aim to assess the rate of confirmed viral infection in SARI and the rate of bacterial coinfection and antimicrobial prescription in this cohort.

Methods
Prospective data collection of patients admitted with SARI symptoms and positive nasopharyngeal swab (NPS) for influenza A/B, SARS-CoV-2 or respiratory syncytial virus (RSV) during winter season of 2025/2026 at St James’s Hospital were performed. Demographic data, medical history, antimicrobial usage during inpatient stay and severity of infection were recorded. Severe infection was a defined as requiring non-invasive ventilation, ICU admission, or death. Univariate analysis (Wilcoxon rank sum, Pearson’s chi-squared test) was used to assess differences between patients who received antimicrobials and those who did not. Factors associated with antimicrobial duration were assessed using Spearman’s rank correlation coefficient, with significant variables included in a multivariable linear regression model.

Results
There were n=1,257 SARI presentations from December 2025 – February 2026, with n=227 (18%) positive NPS; n=148 Influenza, n=67 RSV and n=11 SARS-Cov-2. Median age was 73, 53% female, and median comorbidity count 4. 205/227 (90%) had no vaccine status documented. 102 (46%) patients had an abnormal admission CXR, median admission CRP was 48mg/L, and 29 (13%) patients had severe disease.

Antimicrobials were prescribed in 196 (87%) patients, median total duration was 7 days (IQR 5-8); with median 4.5 days intravenous. 152 (67%) patients had at least one sample sent for sputum/blood culture or urinary antigen. 33/227 (15%) had a positive culture.

Antimicrobial therapy initiation was associated with higher admission C-reactive protein (OR 1.03, 95% CI 1.02 – 1.05, p<0.001). Antimicrobial duration was associated with age (β coefficient 0.04, 95% CI 0.01 – 0.06, p=0.008), male sex (β coefficient 0.95, 95% CI 0.04 – 1.86, p=0.04) and admission CRP (β coefficient 0.01, 95% CI 0.0004 – 0.02, p=0.04). It was not associated with culture results or disease severity.

Conclusion
Antimicrobial consumption in viral respiratory infections is high, and median duration exceeds current guidelines. This is despite low rates of confirmed bacterial co-infection. Antimicrobial usage is not influenced by microbiological data. This study highlights the need to empower individual physicians to reduce antibiotic use in hospitalised patients with SARI due to confirmed respiratory viral infection.

ORAL PRESENTATION

#2026248

"Utilisation of the Hospital for Tropical Diseases London parasitology service by Irish hospitals: a three-year quantitative review (2022–2025)"

Principal Presenter: Siobhán O'Regan

Track: Epidemiology & Population Health

Background
Ireland does not have a dedicated parasitology reference laboratory or clinical service. As a result, Irish healthcare providers access specialised parasitology diagnostics and clinical advice through the Hospital for Tropical Diseases (HTD) in London, UK, highlighting the importance of regional collaboration in complex infectious disease care. The extent and nature of this relationship have not previously been quantified. Understanding referral patterns is essential to guide strategic development of parasitology services and workforce planning in the Irish health service.

Methods

A retrospective review was conducted of referrals from Irish hospitals with Infectious Diseases services to the HTD Parasitology Service between 2022-2025. Data were collected from the HTD Clinical Parasitology referral email archive and laboratory information system. Interactions were characterised as test request, clinical consultation or multidisciplinary meeting(MDM). Variables included suspected condition, investigations requested and clinical outcomes.

Results
84 clinical referrals were received from 10 Irish hospitals between 2022-2025. Clinical consultation requests constituted 47.6%(n=40) with 22 referred for at least one MDM discussion.

Most frequently suspected infections from clinical referral were Echinococcosis, Neurocysticercosis and Trypanosomiasis(Figure 1).

There were 32(38%) MDM referrals overall including Neuroparasitology (n=13,40%), Echinococcosis(n=11,34%) and Histopathology MDMs(n=4, 12.5%) (Figure 2).

989 samples were received from Irish hospitals in the parasitology laboratory over 3 years. 876(89%) were serology tests and 113(11%) were molecular/microscopy tests. Echinococcus, toxocara, strongyloides, schistosoma and leishmania serology were most requested.

Laboratory referral volume has increased by >40% annually since 2022(Figure 3).

Review of clinical consultation and MDM outcomes shows that specialist Clinical Parasitology advice resulted in recommendations for further parasitological investigations in 49% of interactions(n=41) and a change to treatment in 30% of interactions, highlighting the clinical value of the service.

Conclusions
Sustained engagement with the UK HTD Parasitology Service highlights the continuing need for specialist parasitology expertise to support Irish hospitals, particularly in a time of increasing migration and global spread of parasitic infections. Quantifying utilisation of this service provides an evidence base to guide future planning for enhanced domestic specialist expertise and training in parasitology in Ireland.

ORAL PRESENTATION

#2026243

"Investigating Factors Associated with Achieving Sustained Virologic Response Following Intention To Treat Hepatitis C Virus Infection with Direct-Acting Antivirals"

Principal Presenter: Thomas Talbot

Track: Virology

Background
Hepatitis C virus (HCV) infection eradication is possible through direct-acting antiviral (DAA) therapy. However, retaining people with HCV infection in care to deliver treatment and confirm cure remains challenging. This is in part due to the characteristics of people still living with HCV infection, with lower socioeconomic status as well as people who inject drugs (PWIDs) being over-represented compared to the general population. We report on ten years of DAA therapy, identifying factors associated with failure to engage in care and failure to achieve sustained virologic response (SVR).

Methods
All DAA therapy courses prescribed by the Infectious Diseases Department at St James’s Hospital from 2014 – 2024 were reviewed. Engagement with care and SVR rates as per protocol (APP) were assessed, as well as SVR rates on an intention to treat (ITT) basis. APP was defined as attending for treatment week 4, end of treatment, and week 12 SVR visits, while ITT was defined as having DAAs prescribed. Univariate analysis and subsequent multivariable logistic regression models identified patient- and disease-related factors associated with achieving SVR on an ITT and APP basis, as well as factors associated with delayed SVR confirmation.

Results
There were n=881 DAA courses prescribed, with the most common regimens being sofosbuvir/ledipasvir (26%), sofosbuvir/velpatasvir (20%), and ombitasvir/paritaprevir/ritonavir/dasabuvir/ribavirin (15%). The ITT SVR was 86%. N=478 attended APP, with SVR of 96% in this cohort. Pre-existing fibrosis was associated with failure to achieve SVR APP (χ2=4.28, p=0.04). Using a multivariate logistic regression model, being housed (OR 1.62, 95% CI 1.04 – 2.51, p=0.03) and not having a primary care provider (OR 1.68, 95% CI 1.08 – 2.61, p=0.02) were associated with not achieving SVR based on ITT. Using a similar model, failure to attend appointments was associated with young age (OR 0.98, 95% CI 0.96 – 0.99, p=0.04), being housed (OR 0.52, 95% CI 0.34 – 0.79, p=0.002), having a history of intravenous drug use (OR 3.33, 95% CI 2.05 – 5.42, p<0.001), and being identified via opportunistic screening programmes (OR 1.59, 95% CI 1.07 – 2.36), p=0.02). Liver transient elastography significantly improved following treatment.

Conclusions
We demonstrate high SVR rates for HCV DAA therapy as per protocol. We identify several patient factors that influence engagement with care and should inform the design of agile treatment programmes to ensure HCV eradication.

ORAL PRESENTATION

#2024235

"A Survey of HIV Stigma in the Healthcare Setting: Irish Perspective and Results"

Principal Presenter: Siobhan Quirke

Track: Other

Introduction: HIV-related stigma contributes to delayed care, reduced engagement and suboptimal medication adherence. Identifying dimensions of stigma that persist and factors that perpetuate them, is critical to informing interventions to reduce discrimination towards people living with HIV (PLWH). We present findings from respondents in Ireland, drawn from a broader ECDC-led survey. (1)

Methods: European Centre for Disease Prevention and Control (ECDC) and European AIDS Clinical Society (EACS) conducted a survey to assess HIV-related stigma among healthcare workers across Europe and Central Asia. A questionnaire was administered online to clinical and non-clinical professionals. Participants were recruited voluntarily via social media, newsletters, and emails with additional outreach via training bodies, HR departments, professional societies. The non-probability sample limits generalizability, the findings offer valuable insights into HIV-related stigma.

Results: Among 154 respondents (mean age 41, SD = 11.9), 65% identified as female. Most were from Ireland (73%) (Western Europe/North America (12%), Eastern Europe (3%), Africa (5%), Asia (4%). The majority held clinical roles (95%), mainly in hospitals (n = 115), dental clinics (n = 10), or primary care (n = 9). Most had completed infection control training (89%), half received post-exposure prophylaxis (PEP) training (48.7%). Fewer reported education on inclusion (59%) or HIV-related stigma (34%). While 75% demonstrated accurate knowledge of transmission, 21% expressed concern about acquisition during wound care and 33% during phlebotomy; up to 10% used extra precautions such as double gloving (3%) or scheduling procedures last (6%). Nearly one in five observed unwillingness to treat PLWH) and 35% overheard discriminatory remarks in the past year. Overall, there were positive attitudes relating to the sexual and reproductive rights of PLWH. Most reported willingness to provide care to key populations; men who have sex with men (98%), transgender people (98%), and sex workers (95%), while 6% hesitated regarding people who inject drugs. About 14–16% associated HIV with promiscuity or irresponsibility.

Conclusion: While attitudes toward people living with HIV were largely positive, some stigma and misconceptions persist. Targeted education and institutional action are needed to promote stigma-free, person-centred care. Comparing these findings with European counterparts may help identify areas for improvement.

ORAL PRESENTATION

#2024234

"'The Guilt is Gone' - 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

Track: Diversity & Inclusion

Background: LA-CAB/RPV enables PLWH to receive bimonthly injections instead of daily tablets. Observational data in non-adherent, viraemic populations; most robustly from Ward 86, San Francisco prompted changes to guideline recommendations. Rana et al. provide first randomized evidence supporting LAI for non-adherent patients (NEJM, Feb 2026), however, their study intiated in suppressed individuals only. We implemented a structured clinical pathway to deliver LA-ART for patients with adherence barriers to conventional therapy, including those with ongoing viraemia. This has been in use in St James Hospital and Galway University Hospital since November 2024.

Methods: This pathway is aligned with evidence-based models. It outlines eligibility criteria, site approval processes, dosing schedules, follow-up requirements. Individuals undergo multidisciplinary eligibility review prior to initiation; 18 screened at SJH and 27 at GUH (12 month analysis).

Results: December 2024 - December 2025, eligibility for LA-CAB/RPV was reviewed for 47 patients across two clinical sites, 10 patients with available virologic data are included in this 12 month analysis. Median age 43 years (IQR 27–57); 70% cisgender women and 60% White Irish. At initiation, 10% experienced homelessness/unstable housing and 30% reported active substance use. All patients transitioned to 8-weekly injections, with a median follow-up of 27 weeks (range 3–48). Seven patients (70%) initiated LA-ART with detectable viremia and three were virologically suppressed. All suppressed patients maintained viral suppression throughout follow-up. Among those with viremia at initiation, median baseline viral load was 32,268 copies/mL and 5/7 (71%) achieved suppression. A median of 1 dose achieved suppression amongst these patients (range 1 – 2 doses). The remaining two patients have improving viral loads. Sixty percent received injections on time consistently. Four patients experienced at least one late injection, accounting for 10 episodes of lateness over the 12-month period. When appointments were missed, LA-ART was administered an average of 3 days late. We have not observed any cases of virologic failure to date.

Conclusion: LA-CAB/RPV offers a transformative strategy for PLWH facing persistent barriers to conventional therapy. Our results show rapid, sustained viral suppression in an adherence-challenged population, including those viraemic at initiation. Ongoing follow-up will evaluate durability of suppression, engagement in care, and implementation challenges. This is the first pathway of its kind in Europe and aligns directly with the conference theme, informing future policy.

ORAL PRESENTATION

#2024233

"RSV hospitalisation in adults: limitations of age-based vaccination strategies."

Principal Presenter: Fiona Murphy

Track: Epidemiology & Population Health

Background:
Respiratory syncytial virus (RSV) is an important cause of hospitalisation and morbidity in adults. In Ireland, National Immunisation Advisory Committee (NIAC) vaccination recommendations are largely age-based and may not fully identify individuals at risk of clinically significant disease. Our aim was to describe the clinical characteristics and outcomes of adults hospitalised with RSV and to assess alignment with current NIAC vaccination criteria.

Methods:
We conducted a retrospective cohort study of adults admitted with PCR-confirmed RSV across two tertiary centres (GUH and SJH). Data collected included demographics, housing status, comorbidities, radiographic findings, complications, and clinical outcomes, including length of stay (LOS), need for respiratory support, ICU admission, 30-day readmission, and in-hospital mortality. Patients were stratified according to NIAC vaccination eligibility and by severe disease, defined as a composite of ICU admission, non-invasive ventilation (NIV) or high-flow oxygen, or death.

Results:
A total of 124 patients were included (median age 75, IQR 63–82; 52% female), with 23% aged <60 years. Most patients were admitted from home (79%), with 19% residing in LTC facilities. Comorbidity burden was modest (median 1, IQR 1–2).RSV infection was associated with substantial morbidity: median LOS was 7 days (IQR 4–12), 44% had abnormal chest radiography, 15% required NIV or highflow oxygen, 6% were admitted to ICU, and in-hospital mortality was 4%. In-hospital complications occurred in 52% of patients, and 30-day readmission occurred in 8%.

Thirty patients (24%) did not meet NIAC vaccination criteria. Although this group had a lower comorbidity burden (p=0.003) and shorter LOS (4 vs 7.5 days, p=0.01), they had significantly higher 30-day readmission rates (17% vs 5%, p=0.04). There were no significant differences between groups in ICU admission, need for respiratory support, or mortality. Severe disease occurred in 18% of patients and was not associated with age, sex, comorbidity burden, or vaccination eligibility. However, in-hospital complications were strongly associated with severe disease (91% vs 43%, p<0.001).

Conclusions:
Approximately one in four adults hospitalised with RSV would not be eligible for vaccination under current NIAC criteria, yet still experience clinically significant morbidity, particularly higher rates of readmission. Traditional risk markers did not predict severe outcomes, highlighting limitations of age-based vaccination strategies. These findings support consideration of broader, risk-based RSV vaccination approaches incorporating measures of clinical vulnerability and healthcare utilisation.

ORAL PRESENTATION

Board No: 1 #2026335

"RDT Screening for BBVs Among Refugees and Applicants Seeking Protection in HSE Dublin and North East – Initial Real-World Experience"

Principal Presenter: Ellen Newman

Track: Epidemiology & Population Health

Background:

In 2023, the National Refugees and Applicants Seeking Protection (RASP) Blood-Borne Virus (BBV)/ Tuberculosis (TB) Screening Implementation Advisory Group was established to appraise the BBV testing options available, and to define end-to-end protocols for each option. It was recommended that lateral flow Rapid Diagnostic Tests (RDTs) should be offered to all of the target group over 16 years. Following a pilot, the Group ultimately recommended using finger-prick capillary RDTs for hepatitis B, and buccal swab RDTs for hepatitis C and HIV testing. The Migrant Health Team of the HSE Social Inclusion Service in Dublin and North East is the first, and thusfar the only one, to implement the RDT BBV screening as part of its Migrant Wrap-Around Healthcare initiative. Here we present the findings from the first 6 months of this service.

Methods:

Weekly RDT BBV testing clinics commenced in September 2025. Finger-prick capillary RDTs for hepatitis B surface antibody testing, and buccal swab RDTs for hepatitis C antibody and HIV antibody testing were offered across 17 different RASP accommodation centres. Questionnaires on service user feedback as well as informal service provider feedback were gathered. Written information material (translated into 11 languages) was offered.

Results:

To date 24 RDT BBV testing clinics have been held across 17 accommodation centres with 278 individuals undergone a set of three RDTs (average 11 individuals per clinic). Of the 278 individuals screened, 10 have had a reactive result for hepatitis B, hepatitis C or HIV (3.6%). Of these, five individuals had reactive RDT for hepatitis B (three new diagnoses and/or not previously linked to care), three had reactive RDT for hepatitis C (one new diagnosis), and two had reactive RDT for HIV (one new diagnosis). No-coinfections were picked up. All those with new BBV diagnoses were linked with the Infectious Diseases Clinic at Beaumont Hospital for confirmatory testing and care. There were no false positive RDTs. Both service user and provider feedback on the testing and referral process has been has been uniformly positive.

Conclusion:

The HSE Dublin and North East RDT BBV screening programme has had 3.6% positivity rate in screening to date. All patients have been appropriately linked to care, supporting efficacy of its end-to-end protocol. Further regional and national roll-out is encouraged by these results. Lastly, this initiative has been recognised nationally by shortlisting it as a Finalist in the Community Care Service category for the Irish Healthcare Awards 2026.

Board No: 2 #2026325

"In At The Deep End; A Case Report of Schistosoma Mansoni"

Principal Presenter: Ciara Anderson

Track: Epidemiology & Population Health

Background:

Schistosoma mansoni is prevalent in tropical and sub-tropical areas, and is a significant cause of morbidity and mortality, infecting 54 million people annually. Infection results from contact with fresh water containing infected snail species. Transmission occurs secondary to contamination of water sources with infected urine or faeces.

Case details:

We present the case of a 42-year-old male, referred to the Infectious Disease outpatient department with a fever of unknown origin following an inpatient stay. His symptoms were predominantly headache, fatigue and fevers – with onset following total immersion in Lake Malawi 2 months prior. His background was significant for type 2 diabetes, hypertension, hypercholesterolaemia and gout.

On admission, his eosinophils were notably 0.7. He underwent numerous investigations for pyrexia of known origin – all of which were negative - including blood borne virus serologies, QuantiFERON, malaria x3, multiple sets of blood cultures, CSF sampling, dengue, chikungunya, Hep E, A and EBV, along with stool OCP, and PCR. A CTTAP was completed which revealed hepatosplenomegaly. Stool ova, cysts and parasites were negative.

During his inpatient admission, a colonoscopy was performed which showed rectal mucosal inflammation with small areas of ulceration. Histological samples were sent for further analysis.

He subsequently attended an infection outpatient appointment where a thorough history was taken which included exposure to Lake Malawi. This was subsequently flagged to histology colleagues. Colonic mucosa showed marked active inflammation, characterized by a dense eosinophil-rich infiltrate and the presence of Schistosoma ova, morphologically compatible with S. Mansoni.

Given the burden of infection, adjunctive steroid cover was offered during praziquantel treatment to manage symptoms. As he also had type 2 diabetes, endocrinology colleagues were consulted to optimise glycaemic control during this initial period.

Further follow-up will include symptom management and colonoscopy to ensure resolution of mucosal changes and exclude any synchronous pathologies.

Discussion points:

The value of detail orientated history taking, exposure history, and epidemiological risk, cannot be overstated, particularly in returning travellers. This ensures timely diagnosis and prevention of complications, but also ensures diagnostic stewardship. This patient’s diagnosis was made through liaison with histopathology colleagues, and discussion surrounding epidemiological risk and clinical suspicion, highlighting the importance of communicative and collaborative working.

Board No: 3 #2026308

"HARP-RSV: Hospitalisation and RSV Patterns in Irish Infants: A Retrospective Three-Season Epidemiological Analysis"

Principal Presenter: Sean Brennan
Keywords: RSV, Virus, Epidemiology

Track: Epidemiology & Population Health

Background

RSV is a leading cause of infant hospitalisation in Ireland. From 2013–2023, infants under one year accounted for ~67% of notified RSV cases, 64% of ED visits, and 69% of hospital admissions among children aged 0–4 years. While premature infants and those with chronic lung disease or congenital heart disease face highest risk, the majority of RSV-related hospitalisations occur in otherwise healthy infants. Ireland's infant RSV immunisation programme — piloted in 2024 and expanded in 2025 — represents a shift in RSV prevention strategy. National surveillance data are essential to evaluate this prophylactic strategy.

Methods

This retrospective, descriptive epidemiological analysis assessed HPSC surveillance data across three consecutive RSV seasons (2023/24, 2024/25, 2025/26). The study population comprised Irish children aged 0-4 years, focusing primarily on infants <1 year. Data collection spanned weeks 40-8 (October-February) each season, capturing confirmed RSV cases, hospital admissions, and incidence rates per 100,000 population. Laboratory-confirmed RSV cases and hospitalisations reported through HPSC national surveillance systems served as main evaluation criteria. Retrospective descriptive analysis identified inter-seasonal variations in mean incidence, hospitalisation impact, and disease burden, with percentage change calculations using 2023/24 as baseline comparator.

Results

RSV seasonality varied across study periods, with delayed onset in 2024/25 versus 2023/24. The 2024/25 pilot season showed substantial RSV burden reduction compared to 2023/24 baseline: cases and hospital admissions in 0-4 years decreased by 28% (4,950 to 3,565) and 30% (3,270 to 2,279), respectively. Mean incidence and hospitalisation rates per 100,000 in <1 year infants were reduced by 45.6% (232.4 to 126.5) and 60.7% (116.3 to 45.7), respectively. The 2025/26 season demonstrated further improvements: mean RSV incidence in infants <1 year decreased 61.4% versus 2023/24 baseline, with hospitalisations reduced by 72.8%.

Conclusion

Substantial reductions in RSV cases, hospitalisations, and incidence rates among infants were observed following introduction of the infant RSV immunisation programme in 2024/25 and its expansion in 2025/26. These findings highlight the programme's significant population-level impact. Increasing public awareness of and its disease burden remains a critical public health priority. This retrospective analysis is limited by single-season baseline comparison, inter-seasonal variability, and unavailable immunisation coverage data for Season 2025/26, making definitive causality challenging to establish. Additional research on viral evolution, environmental factors, and population immunity dynamics is warranted.

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Board No: 4 #2026290

"Hepatitis C Screening In Gay, Bisexual, Other Men Who Have Sex With Men Living With HIV: A Re-Audit"

Principal Presenter: Amy Blair
Keywords: screening, hepatitis C, gbMSM

Track: Epidemiology & Population Health

Introduction

Hepatitis C (HCV) is a leading cause of chronic liver disease worldwide. HCV is a blood borne virus that is most commonly transmitted by sharing needles or other equipment to inject drugs but can also be transmitted through sexual contact. The prevalence of HCV infection is higher in gbMSM living with HIV compared to general population. National guidelines (HPSC) recommend at least annual HCV screening for gbMSM living with HIV, with more frequent screening (every 3–6 months) for those with ongoing high-risk exposures. An audit in our service demonstrated suboptimal screening rates of 27% over a 12-month period (2024).

Aim

To re-audit HCV screening rates among gbMSM living with HIV and assess adherence to national guidelines, as well as changes since the previous audit.

Methods

A retrospective audit was conducted of 70 gbMSM living with HIV attending a tertiary hospital clinic between January and December 2025. Data collected included HCV screening rates and the prevalence of positive sexually transmitted infection (STI) tests within the cohort.

Results

Of the 70 patients, 32 (45.7%) underwent HCV screening, representing an improvement from 27% in the previous audit. The median age was 37.5 years. Of those screened, 31 tested negative for HCV and one sample was not processed. Overall, 54.3% of patients were not screened within the study period. Screening uptake was higher among individuals with at least one positive STI during the year (52%) compared to those without a positive STI result (31.8%).

Discussion

HCV screening rates among gbMSM living with HIV improved following the initial audit but remain below recommended standards. The findings highlight the value of audit and re-audit in promoting awareness, education, and improved clinical practice. However, gaps in adherence persist. Screening rates may be underestimated due to the increasing use of home-based STI testing kits, with data limited to hospital laboratory records. Ongoing efforts including clinician education, dissemination of audit findings, and targeted interventions in outpatient settings are required to improve compliance with national screening guidelines and optimise patient care.

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Board No: 5 #2026301

"An Audit of Cervical Screening, Colposcopy Referrals, and HPV Vaccination Rates Among Women Living with HIV in a Dublin Teaching Hospital."

Principal Presenter: Maeve Fahy

Track: Epidemiology & Population Health

Background: Women living with HIV are at increased risk of cervical intraepithelial neoplasia (CIN), and guidelines recommend annual cervical screening, early colposcopy referral for abnormal results, and HPV vaccination for eligible patients. The National Immunisation Schedule recommends HPV vaccination for all women with HIV under 26 years and those under 45 years with CIN1 or higher. This audit aimed to assess adherence to cervical screening and colposcopy guidelines, evaluate HPV vaccination uptake, and identify barriers to preventative care among women living with HIV attending a Dublin teaching hospital.

Methods: A retrospective review of 50 women living with HIV attending the clinic between July and September 2025 was performed. Data collected included age, country of origin, cervical smear and colposcopy history, CD4 count, viral load, smoking status, HPV vaccination status, and documented reasons for non-attendance. Data were analysed descriptively to assess adherence to current screening and vaccination guidelines.

Results: The mean age of participants was 46 years. Most women (88%) had undetectable viral loads, with a median CD4 count of 712 cells/mm³. Cervical screening was documented in 81.6% of women; however, only 38% met the recommended annual screening interval. Screening was primarily conducted in general practice (62%). Nineteen women were referred for colposcopy, and all attended; CIN 1–3 was identified in 38.7% of those referred. Six women were current smokers. HPV vaccination, introduced to the clinic in 2020, had been received by only one of six eligible women.

Conclusions: While most women had well-controlled HIV, incomplete documentation of annual screening was likely due to poor communication and failure to transfer results between primary care and clinic. All women referred for colposcopy attended. HPV vaccination rates among eligible women were low, pointing to missed prevention opportunities. Attendance issues were mainly patient-related, including a preference for female staff, childcare, transport, embarrassment, and sexual trauma history, rather than access. Strategies such as trauma-informed care, employing female clinicians, and enhanced electronic result-sharing are recommended to improve preventive care.

Board No: 6 #2026296

"“Your Service, Your Say”: Patient Perspectives on HIV Care, Communication, and Stigma at CUH"

Principal Presenter: Andrew Conroy
Keywords: Survey, Stigma, HIV

Track: Epidemiology & Population Health

Background

Advances in HIV care have transformed HIV into a chronic, manageable condition, with increasing emphasis on long-term engagement in care and patient experience. Understanding how people living with HIV (PLWH) perceive outpatient infectious diseases (ID) services is essential to optimising service delivery.

Patient-reported experience measures offer insight into key aspects of care, including accessibility, communication, confiedntiality, the clinical environment and previous experiences of stigma.

Cork has engaged closely with the Fast-Track Cities initiative, which aims to improve HIV care outcomes and promote patient-centred services. This survey evaluates patient experiences of the ID OPD at CUH, including perspectives on service quality and stigma.

Methods

A cross-sectional, anonymous survey was conducted among PLWH attending the CUH ID OPD. The survey was developed in collaboration with Fast-Track Cities partners and included both quantitative and qualitative questions assessing satisfaction with services, accessibility, communication, confidentiality, stigma and overall care experience.

To date, 17 participants have completed the survey. Quantitative responses were summarised using simple counts and percentages, and free-text responses were reviewed to identify common themes

Results

Respondents reported high overall satisfaction with the ID OPD service. Positive themes included strong clinician–patient communication with 16 of 17 respondents feeling they had enough time to discuss results and all respondents feeling they had appropriate privacy. 14 respondents also felt they had a strong say in decisions concerning treatment.

Areas of improvement were identified included aspects such as increased seating and waiting times. 3 of 17 respondents noted not being aware of the Sexual Health Centre services - suggesting another area of improvement as regards patient awareness and education.

While most feedback related to positive service experiences, some participants reported prior negative experiences, with 2 respondents noting having previously experienced stigma within CUH.

Conclusion

PLWH attending the CUH ID OPD report high levels of satisfaction, particularly regarding communication, confidentiality, and the care environment. These findings support the quality of the OPD services in CUH services.

However areas of improvement were identified through giving patients the opportunity to have their say on services. Notably, the experience of previous stigma within CUH was a concerning finding and offers an area for further education and advocacy, for which services like Fast Track Cities serves an essential role.

Continued evaluation of patient perspectives will be important in guiding service development and ensuring high-quality, inclusive HIV care, with the survey still ongoing.

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Board No: 7 #2026295

"What Bugs? – The microbiology of Trauma Associated Infections in the Major Trauma Centre in Dublin"

Principal Presenter: Josephine Hebert

Track: Epidemiology & Population Health

Background

Multidisciplinary meetings (MDTs) are crucial for improving patient outcomes. In the Major Trauma Centre (MTC) in Dublin, Ireland, a new orthopaedic, plastic surgery, and infectious diseases (OPID) MDT discusses complex trauma cases and challenging post-operative complications.

Methods

We performed a retrospective review of patients discussed at the OPID MDT between January 2024 to September 2025 inclusive. Collected data included age, gender, reason for discussion, mechanism of injury, causative organisms in infections, and treatments (antimicrobial and surgical).

Results

67 patients were discussed at the OPID MDT, 52 (77.6%) of whom were male. Most cases involved polymicrobial infections (N=34), while no infection was suspected in 11 cases. On average, in polymicrobial infections, 3 micro-organisms were cultured on average. Gram positive organisms were most common (94/123), in trauma and post-operative cases. Staphylococcus aureus was the most frequently cultured organism (29/123) and was methicillin-sensitive in 24 isolates. It was cultured in polymicrobial infections in 15/34 cases, and caused 45% (13/29) of monomicrobial infections. 16S rDNA PCR was sent on 8 culture-negative samples, detecting bacterial DNA in 3 (37.5%). Aspergillus fumigatus and Candida albicans were the only fungal species isolated, in 3 separate patients. 31 patients presented with open fractures, with only 1 growing a bacteria resistant to perioperative prophylactic antimicrobials per local guidelines.

Discussion

The complexity of cases discussed at the OPID meeting, illustrated by the wide range of pathogens involved, prolonged antibiotic courses and multiple surgeries required emphasizes the importance of OPID MDTs in MTCs and of frequent audits of the microbiological profile of cases and antimicrobials used.

Board No: 8 #2026291

"A One Year Review of Sexually Transmitted Infections in a HIV Clinic Population – An Observational Study"

Principal Presenter: Amy Blair
Keywords: sexually transmitted infection, HIV

Track: Epidemiology & Population Health

Introduction
Sexually transmitted infection (STI) rates among people living with HIV are significantly higher than in the general population, both in Ireland and globally. Recent Health Protection Surveillance Centre (HPSC) data report that 12% of first-time HIV diagnoses were co-infected with at least one STI, with higher rates (23%) among gay, bisexual and other men who have sex with men (gbMSM). Over the past five years, STI diagnoses in Ireland have increased by over 30%, despite an 11% decrease in notifications in 2024. Chlamydia remains the most commonly diagnosed STI, followed by gonorrhoea, with gbMSM accounting for 90% of gonorrhoea, 93% of early infectious syphilis, and 100% of lymphogranuloma venereum (LGV) cases.

Aim
This study aimed to evaluate STI prevalence, characteristics, and screening practices in an HIV clinic population, and assess whether screening adhered to best practice guidelines.

Methods
Data were manually extracted from a pre-existing database of patients testing positive for at least one STI while attending the HIV clinic from January to December 2025. Missing information was obtained via hospital laboratory interfaces. Parameters included patient age, sex, pathogen, number of positive tests, screening frequency, test-of-cure rates, and culture rates.

Results
During the study period, 820 patients attended the HIV clinic. Fifty-six patients tested positive for at least one STI (prevalence 6.8%), including 50 gbMSM and 6 women. Ages ranged from 23 to 71 years, with the most common age group being 30–39. Five patients tested positive on two occasions, and two patients on three occasions. There were 71 positive STI tests in total. Gonorrhoea was most frequent (39.4%), followed by chlamydia (38%), syphilis (21%), and Mycoplasma genitalium (1.4%). Test-of-cure was performed in 68% of gonorrhoea cases, all negative. 50% of gonorrhoea samples were sent for culture, with two positive results.

Discussion
STI prevalence in this HIV clinic cohort was lower than national rates, though factors such as at-home testing and attendance at other clinics may contribute. The cohort testing positive was older than the national average. Despite lower overall prevalence, several patients experienced recurrent STIs, highlighting the ongoing need for targeted awareness, education, and adherence to screening guidelines to prevent STI transmission in people living with HIV.

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Board No: 9 #2026285

"Post Exposure Rabies Care in Beaumont Hospital: July 2025-March 2026 – A Retrospective Review"

Principal Presenter: Tess Coyne

Track: Epidemiology & Population Health

Rabies virus is an RNA virus, and member of the lyssavirus genus, of the family rhabdoviridae, and is the causative agent of rabies. Rabies is a zoonotic disease, and transmitted via inoculation of saliva from an infected animal, most commonly via bites, scratches, or salivary contamination of exposed mucous membranes. Rabies virus exists worldwide, and almost all mammals can be infected – in developed countries, where vaccination of domestic dogs is common, most reservoirs for rabies virus exists in wildlife, such as bats, raccoons, skunks and foxes. In less developed countries, dogs account for the majority of rabies infections in humans. An estimated 70,000 human deaths occur as a result of rabies per year worldwide, the vast majority acquired from contact with rabid dogs.

Rabies prone exposures (RPE) can involve any contact with saliva, bites, & scratches from potentially infected animals. Post exposure treatment (PET) is the mainstay of rabies treatment, and consists of a course of rabies vaccinations, with or without rabies immunoglobulin. The course of treatment is dependent on several factors, notably: country of exposure, nature of exposure, prior immunisation, timeline of exposure, and immunosuppression [2].

We conducted a retrospective audit & review of all RPE’s attending Beaumont Hospital from July 2025 – March 2026, and PET administered. Data was collected via retrospective chart review, and stored securely on an internal drive. The Infectious Diseases (ID) nurses had kept a record of all patients attending the ID clinics for PET.

15 patients attended the ID clinic in Beaumont Hospital for review and PET of a RPE between the set dates. We audited PET with regards to vaccine administration, human rabies immunoglobulin (HRIG) administration, and whether treatment was in accordance with Irish National Guidelines (HSPC). Country of exposure, type of animal exposure, category of exposure, and composite rabies risk (CRR) were all recorded. We also noted the proportion of vaccines administered in the Emergency Department (ED), ID clinics, or abroad.

We found high compliance and attendance rates amongst patients attending for PET. Many exposures occurred in developing world countries, and predominantly between July and August, likely representing peak holiday season & exposures in returning travellers. We also found a high rate of compliance with national guidelines in PET regarding vaccination course +/-HRIG. Several areas for improvement were identified - notably, several HRIG administrations within the ED were given intramuscularly rather than to the anatomical region of RPE

Board No: 10 #2026277

"Real-World Evidence of the Adjuvanted RSVPreF3 Vaccine’s Uptake and Effectiveness among Chronic Obstructive Pulmonary Disease Patients in Denmark: a Nationwide Cohort Study"

Principal Presenter: Caroline Waldron
Keywords: RSV, Effectiveness, COPD

Track: Epidemiology & Population Health

Background

To assess the adjuvanted RSVPreF3 vaccine’s uptake, estimate its effectiveness against respiratory syncytial virus (RSV) hospitalization, and describe the occurrence of other relevant clinical outcomes, among adults aged ≥60 years living with chronic obstructive pulmonary disease (COPD) in Denmark. RSV is associated with significant morbidity and mortality, particularly for individuals with COPD. Following RSV vaccines approval in August 2024, the Danish government introduced conditional reimbursement for the adjuvanted RSVPreF3 vaccine for adults aged ≥60 years with COPD.

Methods

A nationwide Danish cohort study was assembled by including all adults aged ≥60 years with COPD from 5 August 2024 to 30 April 2025 to determine the adjuvanted RSVPreF3 vaccine uptake. Vaccinated individuals were matched 1:12 with replacement to unvaccinated individuals. Exact matching on age and sex, and propensity score matching, including region of residence, education, comorbidities, exacerbation history, all-cause hospitalization, and vaccination history were used. Vaccination date was defined as index date with matched unvaccinated individuals assigned the same index date as their vaccinated match. Individuals were followed from 21 days after index date until the earliest of a) event of interest, b) end of data availability (27 August 2025), c) migration, d) receipt of RSV vaccine, or e) death. Vaccine effectiveness was estimated as (1 – incidence rate ratio [IRR]) x 100. Exact confidence intervals (CIs) were based on the Poisson distribution - for zero events, a one-sided upper confidence limit was used.

Results

Among 126,249 adults aged ≥60 years with COPD with valid data on RSV vaccination, the adjuvanted RSVPreF3 vaccine was received by 7,448, corresponding to an uptake of 5.9%. Highest uptake was from September to December involving 5,852 (79%) individuals. The groups were comparable across all covariates after matching with standardized mean differences <0.1. RSV hospitalization rate (95% CI) per 100,000 person-years was 0 (0, 58) among vaccinated individuals and 201 (166, 241) among matched unvaccinated individuals, corresponding to a vaccine effectiveness of 100% (71%, 100%). The occurrence of other relevant clinical outcomes was likewise lower among the vaccinated individuals.

Conclusion

Among adults aged ≥60 with COPD, adjuvanted RSVPreF3 vaccine is highly effective in preventing RSV hospitalizations and RSV-related clinical outcomes such as exacerbations and pneumonias. Incorporating the RSV vaccine into routine COPD management could further improve outcomes.

Funding: GSK (HE-RSV-020).

Encore of RSVVW 2026.

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Board No: 11 #2026289

"Triple Site Sexually Transmitted Infection Testing In Gay, Bisexual, Other Men Who Have Sex With Men Living With HIV: A Clinical Audit"

Principal Presenter: Amy Blair
Keywords: triple site, STI

Track: Epidemiology & Population Health

Introduction
Sexually active gay, bisexual and other men who have sex with men (gbMSM) are more likely to be diagnosed with sexually transmitted infections (STIs) compared to the general population. Chlamydia and gonorrhoea infections are frequently asymptomatic, particularly at extragenital sites. Triple-site testing for sexually transmitted infections (STIs) in gbMSM is considered best clinical practice by the Health Protection Surveillance Centre (HPSC) and other international bodies. This approach involves testing three anatomical sites: urogenital (urine), pharyngeal (throat), and rectal. The aim of triple-site testing is to maximise detection of asymptomatic infections.

Aim
To assess whether triple-site STI testing was performed in line with best practice guidelines.

Methods
Data were manually extracted from a pre-existing database of gbMSM attending an HIV clinic who tested positive for at least one STI between January and December 2025. Information on anatomical sites tested and swabs collected was obtained from the hospital laboratory system. The total number of STI screens, sites tested, and positive laboratory diagnoses were analysed.

Results
A total of 48 gbMSM living with HIV tested positive for at least one STI during the study period, with 54 STI screens performed. Triple-site testing (pharyngeal, rectal, and first-void urine) was completed in 95% of screens. The highest proportion of positive results was from rectal swabs (61.1%), followed by pharyngeal (35.8%) and urogenital samples (17.6%). Most screens identified infection at a single site; however, 23.5% were positive at two sites, and two screens were positive at all three sites.

Discussion
The rate of triple-site testing was high (95%), reflecting good adherence to guidelines. While most infections were detected at a single site, a notable proportion involved multiple sites, highlighting the importance of comprehensive testing. Asymptomatic STIs increase the risk of onward transmission, particularly when extragenital sites are not screened. These findings support the continued use of triple-site testing, with a target of achieving 100% coverage at every STI screening opportunity.

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Board No: 12 #2026276

"Adjuvanted RSVPreF3 Vaccine Effectiveness against RSV-Related Hospitalization among US Adults Aged 60 Years and Older"

Principal Presenter: Caroline Waldron
Keywords: RSV, Vaccine, Hospitalization

Track: Epidemiology & Population Health

Background

This study evaluated real-world effectiveness of adjuvanted RSVPreF3 vaccination in preventing respiratory syncytial virus (RSV)-related hospitalisation in US adults aged ≥60 years.

Methods

A retrospective cohort study used Optum Research Database claims to evaluate the vaccine effectiveness (VE) of adjuvanted RSVPreF3 against RSV-related hospitalisation. Adults aged ≥60 years were identified between August 2023–May 2024. Vaccinated and unvaccinated patients were exact matched 1:4 by age, sex, insurance type, and state of residence, with index date assigned as the vaccination date. Baseline characteristics were measured during the 12-month pre-index period with continuous enrollment. Patients were followed 14-days post-index to first of disenrollment, death, RSV vaccination, or end of the analysis period. Propensity score-based weighting was used to balance characteristics between vaccinated and unvaccinated groups. Cox proportional hazards regression models estimated hazard ratios overall and prespecified subgroups; VE = (1−hazard ratio) x 100%.

Results

The study included 520,440 vaccinated and 2,081,760 unvaccinated individuals (56.9% female; mean (SD) age 74.3 (6.7) years; Charlson Comorbidity Index 1.4 [1.8]). Median (maximum) follow-up was 5.6 (9.7) months. Estimated overall VE (95% confidence interval) was 75.6% (69.8%–80.2%). Subgroups VE estimates: chronic pulmonary disease 72.5% (64.3%–78.8%), cardiovascular disease 72.2% (64.1%–78.4%), diabetes 82.3% (74.2%–87.9%), and immunocompromised conditions 71.4% (57.0%–81.1%).

Conclusion

These real-world evidence results highlight the effectiveness of the adjuvanted RSVPreF3 vaccination in preventing RSV-related hospitalisation in adults aged ≥60 years, including those with comorbidities, and suggest that vaccination is an effective strategy in reducing disease burden.

Funding: GSK (300153).

Encore of RSVVW 2026.

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Board No: 13 #2026275

"Effectiveness of Adjuvanted RSVPreF3 Vaccine in Preventing Major Adverse Cardiovascular Events, Severe Asthma Exacerbations, and Severe COPD Exacerbations Among US Adults Aged 60 Years and Older"

Principal Presenter: Caroline Waldron
Keywords: RSV, Cardiovascular, COPD

Track: Epidemiology & Population Health

Background

This study assessed adjuvanted RSVPreF3 vaccine effectiveness (VE) against MACE and severe exacerbations of COPD or asthma in US adults at risk of these events.

Methods

This retrospective cohort study used Optum Research Database claims to estimate adjuvanted RSVPreF3 VE in US adults aged ≥60 identified between Aug 2023–May 2024. Vaccinated patients’ index date was vaccination date; each was matched 1:4 to unvaccinated controls (assigned same index date as match) by age, sex, insurance type, and state. Baseline characteristics were measured 12 months pre‑index (continuous enrollment required). Follow‑up began 14 days post‑index through first of disenrollment, death, RSV vaccination, or analysis end. Overall and RSV‑related outcomes assessed (occurring during any hospitalisation or RSV‑related hospitalisation, respectively). Propensity score-based weighting balanced baseline characteristics; Cox proportional hazards models estimated hazard ratios (VE = [1 – HR] × 100%).

Results

The analysis included 520,440 vaccinated and 2,081,760 unvaccinated patients (mean [SD] age: 74.3 [6.7] years; 56.9% female). A total of 869,980 (33.4%) had underlying cardiovascular disease (CVD), 362,615 (13.9%) had underlying COPD, and 244,226 (9.4%) had underlying asthma. Among adults with CVD, VE against overall and RSV-related MACE was 20.4% (95% CI: 18.0–22.9%) and 63.1% (41.8–76.6%), respectively. In adults with underlying COPD or asthma, VE against RSV-related severe COPD and asthma exacerbations was 74.4% (59.3–83.9%) and 61.6% (9.1–83.7%), respectively.

Conclusions

Findings suggest a considerable benefit of adjuvanted RSVPreF3 vaccination in preventing RSV-related MACE and severe asthma/COPD exacerbations among adults aged ≥60 years.

Funding: GSK (300153).

Encore of RSVVW 2026.

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Board No: 14 #2026261

"Barriers to Care Experienced by Ukrainian Beneficiaries of Temporary Protection attending an Irish Tertiary HIV Centre"

Principal Presenter: Stephen Connolly

Track: Epidemiology & Population Health

Background
Since the Russian invasion of Ukraine in 2022, Ireland has hosted an estimated 100,000 Ukrainian beneficiaries of temporary protection (BOTP) [1]. Clinical experience has shown that many individuals in this population living with HIV (UBOTPLWH) face multiple barriers to accessing effective care. Our study sought to characterise these barriers to care to inform restructuring of services to adequately accommodate this population.

Methodology
We performed a retrospective, cross-sectional cohort study of adult UBOTPLWH who enrolled in our HIV outpatient service between 01/02/2022 and 01/04/2025, in Cork University Hospital, Cork, Ireland. Descriptive statistics were used to describe the numbers and proportions of patients requiring interpreters, accommodation type, loss to follow-up, retention in care, distance travelled to clinic appointments, and virological outcomes. Statistical analyses were performed with IBM SPSS Statistics (Version 30).

Results
Records for 61 patients were available for analysis, 59% of whom were female. Median age was 44 years (IQR 12 years). Only 21.3% of patients resided in private accommodation, while 14.8% resided in emergency accommodation; patients travelled an average of 61.5 kilometres to appointments (range 1.4–187 km). Interpreters were required for 65.6% of patients. Fifty percent of participants were attending at least one other outpatient service, and 55.7% of patients had been relocated at least once during their time in Ireland, with 13.1% having been relocated two or more times. Twenty-two percent were lost to follow-up, 46% of whom were lost for reasons unclear. Almost 40% of patients had emergency department attendances during the study period, with 5% having five or more attendances. Only 72.9% of patients had an HIV viral load < 50 copies/mL at last follow-up.

Discussion
Our data highlights some of the challenges experienced by UBOTPLWH attending our service, with unstable accommodation, high care needs, and large distances to clinic appointments and language barriers. The impact of these barriers may be reflected in the relatively high proportion of patients with detectable HIV viral loads and frequent ED attendances, which may serve as useful surrogate markers of adequacy of care. Further studies with a comparator group, alongside efforts to restructure services to overcome these barriers to care, are indicated.

Board No: 15 #2026242

"Investigating the pattern and factors influencing rates of MRSA colonisation among people experiencing homelessness and social exclusion"

Principal Presenter: Caitríona O’Sullivan

Track: Epidemiology & Population Health

Background

Internationally, rates of methicillin-resistant staphylococcus aureus (MRSA) colonization and infection are disproportionately high among people who inject drugs (PWID) and people experiencing homelessness and social exclusion (PESE). We describe MRSA colonisation rates among inpatients under the Inclusion Health (IH) service in St James’s Hospital and explore potential factors influencing this.

Methods

Patients admitted under the IH service between April–June 2025 were included. Patient demographics, admission details and MRSA colonisation status were recorded. Frequency of emergency department attendance and hospitalisation over the preceding twelve months, and admission to ICU during their most recent admission were recorded. Social and behavioural factors including alcohol or drug dependency, injection drug use, residence in congregate setting, rough-sleeping, and prior incarceration were recorded. Associations between MRSA colonisation and independent variables were assessed using Chi-square tests.

Results

N=110 patient were included (N=24 female), with median age of 45. More than a quarter of patients reported rough sleeping in the past year, with 76% currently residing in a congregate setting. Nearly 90% had histories of substance dependency. N=19 (17%) were colonised with MRSA. Female gender (p=0.003) and injection drug use in the preceding 12-months (p=0.012) were associated with higher rates of MRSA colonisation. We found no association between recent incarceration, rough sleeping or residing in a congregate setting with MRSA colonisation. 56% of patients received antibiotic therapy during admission, and 37% of patients colonised with MRSA were treated with MRSA-targeted antibiotics. 37% of individuals colonised with MRSA were not in an isolation room upon discharge.

Conclusion

MRSA colonisation rates are high among PESE in an urban Irish setting, reflecting international studies. While there is no hospital-wide or nationwide data allowing a like-for-like comparison, data from another Dublin hospital reports an 8% rate of MRSA colonisation among inpatients, compared to 17% among our patient cohort. Injection drug use was associated with higher rates of colonisation. Notably, females had higher rates of MRSA colonisation, despite epidemiological studies demonstrating higher rates of MRSA colonisation among males. This underscores the need for further analysis of compounding factors that may predispose to MRSA exposure and impaired clearance in this patient cohort. Further research may inform the development of tailored empiric antibiotic strategies, decolonisation recommendations, and earlier implementation of isolation protocols within this vulnerable population, ultimately improving patient outcomes and infection prevention control measures.

Board No: 16 #2026324

"From Report to Action: Audit of EUCAST “Susceptible, Increased Exposure” Reporting and Clinician Interpretation in Ireland"

Principal Presenter: Anne-Marie Dolan

Track: General Infectious Diseases

Background:
The 2019 European Committee on Antimicrobial Susceptibility Testing (EUCAST) redefinition of “I” from “intermediate” to “susceptible, increased exposure” aimed to optimise antimicrobial use through dose-adjusted therapy. However, its clinical impact depends on consistent laboratory implementation and accurate clinician interpretation.

Methods:
A national audit of hospital microbiology laboratory implementation of EUCAST 2019 susceptibility categories was undertaken, including abbreviations used for “susceptible, increased exposure,” presence of dosing guidance on reports, and integration of dosing guidance into antimicrobial guideline apps.

In parallel, a clinician questionnaire assessing interpretation of susceptibility categories was distributed across multiple specialties and training grades in one Irish hospital. Qualitative comments were analysed for recurring themes.

Results:
Nationally, most hospitals have implemented EUCAST 2019 categories, though a small number report partial adoption (Figure 1). “I” remains the predominant abbreviation; however, alternatives including “D” (dose-dependent) and “S*” are used, and one site reports the full phrase without abbreviation (Figure 2). Most laboratories provide dosing guidance on reports or via antimicrobial apps, though depth and consistency vary (Figure 3).

Forty-four clinicians from seven specialties responded to the clinician questionnaire. Willingness to prescribe differed significantly between an antimicrobial reported as “S*” (59.1%) and “I” (43.2%), despite identical definitions.

Qualitative analysis identified persistent clinician confusion surrounding “I”, historical interpretation as “intermediate”, laboratory information system constraints, and lack of national standardisation as key barriers.

Conclusion:
EUCAST 2019 implementation in Ireland is widespread but heterogeneous. Terminology variation, inconsistent dosing guidance, and prescriber misunderstanding may lead to avoidance of effective therapy or unnecessary escalation, potentially contributing to spread of antimicrobial resistance. National standardisation of reporting language, clearer dosing support, and targeted clinician education are required to ensure “susceptible, increased exposure” translates into appropriate antimicrobial selection and dosing rather than therapeutic uncertainty.

Board No: 17 #2026334

"The Bone of Truth"

Principal Presenter: Ellen Newman

Track: General Infectious Diseases

Background:

Fingolimod is a commonly used oral disease modifying agent for Relapsing Remitting Multiple Sclerosis. It acts as S1P receptor modulator causing lymphocyte sequestration in lymphoid tissues and therefore reducing CNS inflammation, but also causing peripheral lymphopaenia, which is a risk for opportunistic infections.

Since its licencing, approximately 21 case reports have been published associating its use with cryptococcosis, the majority of which are described as cryptococcal meningitis.

Case:

In this case, we describe 56 year old woman with a diagnosis of RRMS, on fingolimod for 12 years, who was ultimately diagnosed with cryptococcal osteomyelitis, pulmonary disease, and meningitis.

She was admitted with a pseudoflare of her MS in the context of an alleged UTI, and subsequent imaging found a left sided chest wall mass. She underwent work up for presumed malignancy, with left rib biopsy, and histology showed spherical, non-polarisable bodies within vacuolated spaces, positive on PAS and Grocott stains.

A repeat biopsy was undertaken to enable culture, and grew cryptococcus neoformans. Her serum cryptococcal antigen came back positive, and she underwent lumbar puncture, which revealed a lymphocytic pleocytosis, and again a positive cryptococcal antigen.

Cross sectional imaging showed bilateral pulmonary nodules and an isolated hepatic nodule, which lead to the diagnosis of disseminated cryptococcal disease.

She received induction with four weeks of amphoteracin and flucytosine, without major adverse event, before transitioning to fluconazole. Her fingolimod, which had been held during her work up, was restarted to prevent an immune reconstitution phenomenon, particularly given her CNS disease.

At time of writing, she is planned for indefinite antifungal treatment, and had been discharged to a rehabilitation facility.

Conclusion:

There is only one other published report of cryptococcal osteomyelitis in the context of fingolimod. Fingolimod came onto the market in 2010, and an association with cryptococcal disease was first published in 2015, suggestion risk may increase with drug exposure, and the burden of this disease association is not yet fully known or explored. Promoting awareness and timely screening via culture and antigen testing in the appropriate clinical setting is key for both infection specialists and neurologists.

Board No: 18 #2026332

"Joint Decision making: Outcomes of early oral switch strategies in treating prosthetic joint infections."

Principal Presenter: Marco D Smit

Track: General Infectious Diseases

Background:
Prosthetic joint infection (PJI) remains a complex complication of arthroplasty, requiring surgical intervention and prolonged antimicrobial therapy to achieve cure. Treatment decisions are typically made within a multidisciplinary team (MDT), involving orthopaedic surgeons, infectious diseases specialists, and microbiologists, to optimise both surgical strategy and antimicrobial selection. These decisions are often individualised, taking into account organism susceptibility, surgical findings, patient comorbidity, and the feasibility of different antimicrobial routes. Management has traditionally relied on extended intravenous (IV) antibiotic courses, however the OVIVA trial demonstrated that oral antibiotic therapy is non-inferior to IV therapy for treatment failure at one year, with fewer catheter-related complications and lower healthcare costs. These findings have informed local practice, supporting early oral or oral step-down strategies in selected patients receiving high-bioavailability agents.

Aims:
This retrospective study aimed to evaluate the safety of early oral switch strategies in the management of PJI at a level 4 hospital in the South East of Ireland which were discussed at weekly MDT meetings.

Methods:
Patients were included if they received oral antibiotics within 6 weeks of exchange arthroplasty or within 12 weeks of debridement, antibiotics, and implant retention (DAIR) between January 2024 and March 2025. Patients receiving long-term suppressive therapy were excluded. Outcomes, including reinfection, all-cause readmission at one year, Clostridioides difficile infection (CDI), and significant adverse events, were identified using electronic records.

Results:
A total of 60 patients were treated using an early oral switch strategy. The most commonly prescribed antibiotic was doxycycline (58.8%). Readmissions in the following 12 months were categorised. There were three cases of reinfection (5%). There were no cases of serious adverse reactions requiring readmission.

Discussion:
Early oral switch strategies were not associated with increased reinfection risk, supporting their use in appropriately selected patients. This study is limited by its retrospective design, and lack of specificity in readmission outcomes. These findings support the integration of early oral switch strategies into routine PJI management pathways, provided that robust MDT oversight and follow-up systems are in place.

Board No: 19 #2026328

"Mind the Gap: Implementation of Infectious Disease Consult Recommendations at an Irish University Teaching Hospital"

Principal Presenter: Eva McParland
Keywords: Infectious Disease, Consultations, Implementation

Track: General Infectious Diseases

Background

Infectious Diseases (ID) consultations at Tallaght University Hospital provide recommendations on antimicrobial therapy, diagnostics, and infection prevention. Their clinical value depends on implementation by referring teams. This study evaluated the uptake of ID recommendations, identified patterns of non‑implementation, and highlighted opportunities for quality improvement.

Methods

A retrospective review of 50 inpatient ID consults from January - March 2026 was conducted using electronic patient records (EPR). A total of 258 recommendations were made across 50 patients. The study was conducted following QI approval ( #5413), results were recorded and analysed using excel.

Results

The most common reason for consult requests was antimicrobial input (40%; n = 20), whereas the most frequent recommendation from ID was a diagnostic test/investigation (53%; n=136). 76% of ID recommendations were made within 24 hours of consultation request (n=38). The median time between consult request to ID recommendation was 22.35 hours.

The median implementation time was 19.15 hours. Implementation speed varied by specialty, from <10 hours (neurology, rheumatology) to 89 hours for other specialties. Times also differed by recommendation type: antimicrobial adjustments were completed rapidly (<20 hours), whereas referrals and follow‑up actions exceeded 100 hours. Overall, 80% (n=206) of recommendations were fully implemented, 18.5% (n=48) of recommendations were not implemented and 1.5% (n=4) partially implemented or pending.

Time to recommendation and implementation varied by specialty, with rapid ID responses (<1 hour) in elective orthopaedics and gastroenterology but longer delays elsewhere. Implementation rates were highest in elective orthopaedics (100%) and adult surgery (91%), and below 50% in other specialties.

Across 52 deviations from recommendations, the most common issue was failure to order and/or follow up tests on the electronic lab system (n=13), alongside failure to complete diagnostic procedures (n=10), unsuitable lab samples (n=7) and failure to complete consult (n=5).

Conclusion

Our key positive finding was that more than three quarters (80%) of recommendations were implemented. System-level improvements could include enhanced training on the electronic lab system and updates, as well as faster laboratory processing times. A key limitation was some ID recommendations that were given by telephone prior to EPR documentation may not have been recorded in the clinical notes. The findings of this study will guide future service improvements and targeted interventions.

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Board No: 20 #2026327

"Infectious screening pre-initiation of Ocrelizumab in patients with Multiple Sclerosis: A single centre audit"

Principal Presenter: Josephine Hebert

Track: General Infectious Diseases

Background

Ocrelizumab is an anti-CD20 monoclonal antibody used in the treatment of multiple sclerosis (MS) which leads to an immunosuppressed state and higher risk for invasive and opportunistic infections. International guidelines recommend that patients commencing Ocrelizumab should have screening for latent infections and should receive appropriate vaccinations.

We aimed to determine whether patients commencing Ocrelizumab in the Mater hospital are undergoing appropriate pre-biologic screening and vaccination as per guidelines.

Methods

This audit was approved by the Mater Misericordiae University Hospital Clinical Audit and Effectiveness committee. Comparative standard guidelines used were American Association of Neurology guidelines (2019), Health service executive MS guidelines version 2 and the National Immunisation Advisory Committee (NIAC) guidelines (2023). A list of all patients who had been commenced on Ocrelizumab in the preceding 12 months was obtained. Data was retrospectively collected from electronic health record including baseline demographics, serological screening for HIV, HAV, HBV, HCV, VZV, measles, mumps and rubella in addition to latent TB screening. Correspondence with patients’ general practitioners (GPs) regarding appropriate vaccination was also reviewed. Data was collected and analyzed using Microsoft Excel.

Results

Overall, 27 patients were included in this audit. 70% (n=19) of patients were female and the median age was 38 years old (IQR: 30, 45). All patients included had an underling diagnosis of MS and had been commenced on Ocrelizumab in the preceding 12 months.

With regards to infectious screening, 100% of patients were appropriately screened for VZV, HIV, HAV IgG, HBsAg, HCV Ab and baseline immunoglobulins. Four (14.8%) patients had appropriate anti-HBc testing with three (11.1%) patients having anti-HBs screening. 26 (96.3%) patients received screening for tuberculosis with Interferon gamma release assay and 2 (7.4%) patients did not receive a chest x-ray. No patients had serological screening for measles, mumps or rubella.

With regards to vaccines, the influenza vaccine was recommended in 18.5% (n=5) of correspondence with the GPs, compared to 11.1% (n=3) of letters recommending pneumococcal vaccines. VZV vaccine was discussed in 1 (3.7%) letter for appropriate primary vaccination.

Discussion

Overall for patients commencing ocrelizumab, compliance with international recommendations was good, however correspondence with GPs regarding appropriate vaccination and standardisation of the pre-Ocrelizumab infectious screen to include HepBcAb and other preventable infections need to be optimised. Repeat audit is being planned following targeted interventions including standarised phlebotomy serological order set and vaccination advice letter for GPs.

Board No: 21 #2026326

"Evaluation of Adherence to the HSE Position Statement on the Use of Dipstick Urinalysis to Assess for Evidence of UTIs"

Principal Presenter: Luis Ferreira
Keywords: UTI, Dipstick, Stewardship

Track: General Infectious Diseases

Background

Urinary tract infections (UTIs) represent a primary driver of global antimicrobial resistance and are a leading cause of antibiotic prescribing. The Health Service Executive (HSE) published a position statement regarding the use of dipstick urinalysis to assess for evidence of UTI in adults. This guidance is predicated on the high prevalence of asymptomatic bacteriuria in older adults, which frequently results in false positives, diagnostic overshadowing, and unnecessary antimicrobial exposure.

This clinical audit evaluates University Hospital Waterford’s (UHW) current compliance with these national HSE guidelines. By analysing the intersection of diagnostic testing and clinical presentation, the study aims to identify gaps in practice and ensure that UTI management for older adults aligns with evidence-based, multisite-validated protocols to reduce the burden of over-treatment.

Methods

A retrospective clinical audit was conducted involving a comprehensive review of patient charts for all adults admitted to the acute setting over a three-day period. The final dataset comprised 72 patients. Data points included the performance of urine dipsticks within 72 hours of admission, the subsequent submission of Mid-Stream Urine (MSU) samples for laboratory culture, the presence of documented clinical symptoms of urinary tract infection, and the initiation of antibiotic therapy.

Results

The cohort consisted of 72 patients (37 male, 51.4%; 35 female, 48.6%) with a mean age of 67.2 years (range 17–92). Notably, 42 patients (66.7%) were aged 65 or older. Only 17 patients (23.6%) presented with documented urinary symptoms, including dysuria, frequency, fever, or suprapubic/renal pain.

Urinalysis via dipstick was performed on 27 patients (37.5%). Critically, of these 27 tests, (70.4%) lacked a documented clinical indication or symptomatic justification. While antibiotics were initiated in 21 patients (29.2%) for various indications, only 7 patients (9.7%) received a final diagnosis of UTI.

Logistic regression analysis revealed strong evidence against an association between symptomatic profile and the decision to perform a dipstick (p<0.001). Furthermore, chi-square tests indicated that there was no significant association between urine dipstick, MSU / MSU findings and diagnosis in this dataset (p=1.0).

Conclusion

The findings demonstrate a distinct lack of correlation between a patient's symptomatic profile and the decision to perform urinalysis. This suggests that urine dipping at UHW is frequently conducted as a reflexive / routine admission procedure rather than a targeted diagnostic tool. These results emphasize the need for education to reduce reflexive testing and improve adherence to national antimicrobial stewardship goals.

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Board No: 22 #2026323

"From life-saving intervention to lethal infection: Fatal cerebral aspergillosis after aneurysm coiling"

Principal Presenter: Anne-Marie Dolan

Track: General Infectious Diseases

Introduction:

Aspergillus fumigatus central nervous system (CNS) infection is a rare, life-threatening, and highly aggressive fungal disease, typically occurring in immunocompromised individuals through hematogenous spread from pulmonary infection or in immunocompetent individuals through direct extension from adjacent structures or inoculation injuries.

Background:

An 81-year-old immunocompetent woman presented initially to another healthcare facility (OHCF) with a few months history of worsening headaches and sudden onset right-sided visual loss. She was transferred to Beaumont Hospital (BH) where she underwent emergency endovascular coil embolisation of a large Distal Cavernous Internal Carotid Artery Aneurysm (DCICA) with extension within the sphenoid sinus. Post procedure, she was transferred back to OHCF where she remained an inpatient

She underwent CT and MRI brain imaging seven weeks later following a fall and new onset upper limb weakness. Imaging demonstrated > 20 rim-enhancing lesions throughout the right cerebral hemisphere concerning for abscesses. The coiled aneurysm within the right sphenoid sinus was attributed as a possible route for infection of the sac and thrombus.

Management:

She was transferred back to BH and underwent drainage of a right sided parietal lobe abscess. Empirical antibacterial therapy was commenced after abscess drainage. Microscopy and fungal staining demonstrated fungal elements and cultures yielded heavy growth of Aspergillus fumigatus with negative bacterial and mycobacterial studies.

Antifungal therapy with liposomal amphotericin B and voriconazole was initiated. Antibacterial therapy was discontinued. Serum β-D-glucan was elevated at 271pg/mL, while serum galactomannan was not detected. Reference laboratory testing confirmed susceptibility to voriconazole and amphotericin B.

Despite initial improvement, her neurological status deteriorated one week post-operatively with new confusion, left-sided weakness, and reduced consciousness. CT angiography demonstrated a large subarachnoid haemorrhage with hydrocephalus likely due to rupture of a new mycotic aneurysm involving the proximal right superior cerebellar artery. An external ventricular drain was inserted and she was transferred to intensive care. However, her condition continued to deteriorate and she died.

Conclusion:

This case highlights the diagnostic and clinical complexity of cerebral aspergillosis in immunocompetent elderly patients. It also shows that the location of aneurysm coiling may act as may act as a portal of entry for invasive fungal infection.

Board No: 23 #2026322

"Hand Infections in a Tertiary Setting: A Retrospective Review of Microbiological Investigation and Management"

Principal Presenter: Katherine McDonald
Keywords: hand, infection, microbiological sampling

Track: General Infectious Diseases

Background

Skin and soft tissue tissues of the hand are a common presentation in tertiary care centres. Optimal management requires early diagnosis, appropriate antimicrobial therapy and surgical intervention if indicated. This audit aimed to evaluate current practice in the management of hand infections, focusing on microbiological investigation, antimicrobial use and adherence to best practice principles.

Methods

This was a retrospective observational analysis using data collected from the electronic record system. Data were anonymised, and included patient demographics, microbiological investigations, treatment and outcomes.

Results

126 patients were included, 85 male (67%) and 41 female (33%). Diagnoses included cellulitis, abscess, tenosynovitis, osteomyelitis and septic arthritis. Risk factors for invasive infection were prevalent, particularly smoking (44%) and diabetes (6%). Median time to presentation from date of injury was 4 days.

Blood cultures were taken in 12 cases (9.5%), with only 25% obtained prior to antibiotic administration. Excluding blood cultures, 100 people (79%) had microbiological samples sent. The most common sample types were wound swabs (n=93, 74%) and joint washout fluid (n=27, 21%).

70 cases yielded positive cultures, with the most common organisms being Staphylococcus Aureus (59%) and Staphylococcus epidermidis (17%). Rare isolates included fungal organisms (2%) and Methicillin-resistant Staphylococcus Aureus (1%). Sensitivity data were available for 58 cases, with antibiotics changed based on culture results in 35 cases (60%).

Prior to presentation, 61 people (48%) had received antibiotics, most commonly flucloxacillin (n=16, 26%). On admission, 124 people (98%) were prescribed antibiotics, most commonly co-amoxiclav (n=64, 52%). Total duration of antibiotics ranged from 0 to 77 days, with a median of 9 days. Tetanus status was undocumented in 67% of cases. 96 people underwent at least one surgical intervention (76%). Recurrence of infection was relatively uncommon (n=9, 7%), and was associated with underlying risk factors or lack of antibiotic rationalisation.

Conclusion

This audit demonstrates that while the overall management of hand infections in a tertiary centre is proactive, with high rates of antibiotic use and surgical intervention, there remain several areas for improvement. Antibiotic prescribing was nearly universal on admission, with co-amoxiclav predominating, reflecting broad-spectrum empirical practice. However, only 60% of cases with available sensitivities underwent antibiotic rationalisation, representing a missed opportunity for more targeted therapy. While microbiological sampling was common, blood cultures were underutilised. Documentation of tetanus vaccination status was poor. Overall, improved adherence to best practice guidelines, including timely microbiological sampling, antibiotic review, and documentation, could enhance patient outcomes and antimicrobial stewardship.

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Board No: 24 #2026320

"Post-Artesunate Delayed Haemolysis Following Treatment of Severe Malaria: A Case Report"

Principal Presenter: Siobhán O'Regan

Track: General Infectious Diseases

Background

Severe plasmodium falciparum malaria is a life-threatening infection. Intravenous artesunate is the recommended first-line therapy and has significantly reduced malaria-related mortality. However, post-artesunate delayed haemolysis is a recognised but uncommon complication. It typically occurs 1-3 weeks after treatment, most often after hospital discharge. Those with higher parasite burden have a higher risk. Mortality is low but there is a risk of undiagnosed severe anaemia.

Methods/Case

A 53-year-old female from Nigeria, resident in Ireland, presented with one week history of headache, fever, malaise and vomiting following recent travel to Nigeria. On presentation, she was febrile and hypotensive. Initial laboratory investigations demonstrated haemoglobin of 13.7g/dL(RR12-15), platelet count of 51x10^9/L (RR150-400, and bilirubin of 24umol/L(RR1-21). Peripheral blood smear confirmed Plasmodium falciparum malaria with a parasitaemia of 10.8%. She was treated with 3 doses of intravenous artesunate followed by completion therapy with artemether-lumefantrine. Parasitaemia cleared rapidly and the patient demonstrated clinical improvement with stabilisation of haemoglobin levels and was subsequently discharged following clinical recovery after 5 days.

Thirteen days after initiation of artesunate therapy, she was seen in the outpatient clinic and reported headache and malaise of one day duration. Repeat laboratory investigations demonstrated a significant acute decline in haemoglobin to 7.9g/dL with blood film appearances suggestive of haemolysis with polychromasia and schistocytes but no recurrent parasitaemia evident. Biochemical evidence of haemolysis included elevated LDH of 948U/L (RR135-214), increased bilirubin of 35umol/L, reduced haptoglobin of <0.10g/L (RR0.3-2.0) and reticulocytosis of 149x 10^9/L(RR50-100). Direct Coombs test was weakly positive with anti-IgG, anti-C3b and C3d antibodies. These finding were consistent with post-artesunate delayed haemolysis.

Results:

The patient’s haemoglobin nadir was 6.3g/dL on day 20 following artesunate therapy initiation. The patient required 3 units of packed red blood cells. As per haematology advice, she received 5 days of 40mg oral prednisolone as well as folic acid replacement. Haemolysis markers gradually improved over the following 2 weeks with supportive management. Haemoglobin levels recovered to 8.7g/dL on day 25 post artesunate therapy and she was discharged home. A full recovery to 11.7g/dL was noted by Day 47.

Conclusion:

Post-artesunate delayed haemolysis is an increasingly recognised complication following treatment of severe malaria with artesunate. Although uncommon, it can result in clinically significant delayed anaemia requiring monitoring and occasionally transfusion. This case highlights the importance of haemoglobin monitoring and appropriate follow-up after treatment of plasmodium falciparum malaria, particularly in non-endemic settings.

Board No: 25 #2026319

"Microbiology and Epidemiology of Adult Liver Abscess in a Tertiary Hospital in Ireland (2009 - 2023)"

Principal Presenter: Saoirse Ní Bhaoill

Track: General Infectious Diseases

Introduction

Pyogenic liver abscesses (PLA) are a potentially life-threatening condition that can arise from a variety of infectious causes. Clinical impact is influenced by underlying aetiology, microbiology and timely intervention. Early diagnosis and prompt treatment initiation are critical in terms of the significant reduction in morbidity and mortality. Patients may present with relatively non-specific symptoms, meaning that clinicians must maintain a high index of suspicion to facilitate swift diagnosis and treatment.

Objectives/Background:

This study aims to provide an in-depth review of all clinical cases of liver abscesses in adult patients at Beaumont Hospital over a 15-year period (2009-2023), focusing on epidemiology, microbiology, and mortality outcomes.

Methods

A fifteen-year retrospective analysis of radiological, laboratory, and medical records of adult patients presenting with liver abscesses to a tertiary referral hospital.

Results

176 patients; 117 were male (66.47%). Mean age at diagnosis 65 years (range 18-96 years). Aetiology: biliary pathology 51.7%, no identifiable cause 15.9%, diverticular disease 8.5%, post-operative intra-abdominal collections 6.5%.

In 50.6%, one or more organisms were cultured. 36.9% of abscesses were not aspirated and of those aspirated 12.5% had no growth in the laboratory. The commonest pathogens isolated were Escherichia coli (n=39), Streptococcus species (n=22) and Klebsiella pneumoniae (n=11). Of note 5.1% (n=9) passed away whilst hospitalised with a confirmed liver abscess.

Conclusion

This study has provided an epidemiological update on liver abscesses in a tertiary level 4 hospital. Biliary disease being the commonest cause and E.coli being the commonest pathogen concurs with recent data. Mortality rate is also consistent with global data estimates of less than 10%.

Board No: 26 #2026317

"Management of Acute Malaria Presentations in Connolly Hospital April-December 2024"

Principal Presenter: Tess Coyne
Keywords: Malaria, General Infectious Diseases

Track: General Infectious Diseases

Plasmodium falciparum malaria accounts for most cases of severe malaria. Imported malaria occurs in those who returning to, or travelling to Ireland from malaria-endemic areas. Diagnosis depends on consideration of malaria, by a high index of suspicion, as well as on-site access to rapid diagnostic tests and timely blood film microscopy for Plasmodium speciation and parasite counting.

89 cases of malaria were notified in Ireland in 2023, mostly P. falciparum infection, the most severe form; a 4.5-fold increase over the last 20 years. The HSE Dublin & North East region has the largest, youngest, most rapidly expanding & most ethnically diverse population in the country. Connolly Hospital sees the second highest number of malaria presentations in the Republic of Ireland.

Methods

We aimed to explore several parameters in patients presenting with malaria to Connolly Hospital, including:

a. Time from registration in ED to time of administration of first dose of antimalarial

b. Time from registration in ED to time of malaria test collection

c. Time from registration in ED to time of positive malaria result

d. Time from collection of blood sample to rapid antigen result time

e. Time from collection of blood sample to resulting of blood film

f. Proportion of patients tested for HIV/other imported pathogens

g. Proportion of patients tested for G6PD

h. Proportion of severe malaria in P. falciparum patients

i. Proportion of malaria that would be reclassified as severe if parasitaemia result was immediately available

A prospective listing of all malaria presentations has been maintained since April 2024. Patients were primarily cared for by various general medical teams. This audit is a retrospective review of 14 episodes in 12 patients presenting to Connolly Hospital with malaria infection, between April 2024 and December 2024.

Results:

Median time from presentation to administration of first dose of antimalarial is suboptimal at 12 hours 44 minutes.

Whilst identification of parasitological diagnosis typically occurs within 2 hours of blood sample collection, median time from presentation in ED to obtaining the parasitological diagnosis is 8 hours 21 minutes based on data collected in this cohort.

75% of patients were screened for oppurtunistic blood borne virology.

P. falciparum accounted for the majority (71%) of cases in this cohort. indeed. 30% of these were classified as being severe, despite a low median parasite of 1.35%. We also observed over-prescribing of IV artesunate as 1st line treatment in uncomplicated malaria.

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Board No: 27 #2026316

"Paediatric outpatient parenteral antimicrobial therapy (OPAT): A 10-year Audit of a National Service"

Principal Presenter: Davina Henderson Davina Henderson
Keywords: OPAT, Paediatric

Track: General Infectious Diseases

Background

Paediatric outpatient parenteral antimicrobial therapy (OPAT) enables children with serious infections to receive parenteral therapy at home. This reduces cost and supports family centred care, but carries clinical risk. In Ireland, the service is nationally accessed via Children’s Health Ireland (CHI). This audit aims to analyse ten years of the Paediatric OPAT service.

Methods

All paediatric OPAT patients between May 2015 and December 2025 were included. Demographics, length of stay, mode of delivery and treatment outcomes/complications were analysed. Practice was evaluated against the national guidelines on the provision of OPAT.
Results

A total of 823 patients were included, 40.2% (331/823) were female. Median age was 9 (IQR 3.6 – 12.9 years). The median length of stay was 10 days (IQR 7-15) and 5.2% (n=43) of patients required more than one hospital admission. Over half the patients were from Dublin, 51.4% (n=415), followed by Kildare, 6.4% (n=52) and Wicklow 4.8% (n=39).

Bone and joint infections were the most common diagnosis at 43.6% (n=357) of cases, followed by intracerebral infection/meningitis, 13.3% (n=109).

A total of 895 lines were used, most commonly peripherally inserted central catheters (PICCs) at 72.8% (n=652/895), followed by peripheral cannulae, 10.2% (n=91/895) and midlines at 9.4% (n=84/895). Other device types were used infrequently - broviac lines 2.7% (n=24/895), hickman lines 0.1% (n=1/895), and portacaths, 0.4% (n=4/895).

No line related complications occurred in 91.7%. Thrombosis was the most common complication (2.2%, n=19), followed by leakage, (1.9%, n=16), infiltration, (1.6%, n=14), and dislodgement, (1.3%, n=11). Line infection occurred in two patients. Midlines had the highest complication rate at 34.5% (29/84).

Ceftriaxone (n = 580) was the most frequently used IV antibiotic, followed by flucloxacillin (n = 152). The majority of care was delivered through self-OPAT (n=537).

Overall outcomes were available for 811 patients, with favourable outcomes in over 96%, including uncomplicated cure in 86.3%, complicated cure in 3.9%, improvement in 5.9%. Treatment failure occurred in 2/811 (0.2%). Of a total of 21,906 antibiotic treatment days, 11,014 (50.3%) were delivered via OPAT. With estimate bed day cost of €1975, this has led to approximate cost savings in excess of 20 million euro over the 10-year period.

Conclusion

This ten-year audit demonstrates that paediatric OPAT is a safe and effective model of care with low complication rates, that adheres to national benchmark standards.

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Board No: 28 #2026315

"Can we predict OPAT failure? The Role of Comorbidity in an Irish University Teaching Hospital."

Principal Presenter: Sinéad Fenlon
Keywords: OPAT, Charlson, comorbidity

Track: General Infectious Diseases

Background

OPAT is an established model of care that allows patient's to receive intravenous antimicrobial therapy in the community, reducing the inpatient length of stay. However unplanned readmissions remain a key challenge. Previous studies have identified comorbidity burden as a potential predictor of adverse outcomes in OPAT patients, highlighting the need for effective risk stratification tools (Stubbs 2023).

Aims and Objectives

To evaluate the association between the Charlson Comorbidity Index (CCI) and hospital readmission in patients receiving outpatient parenteral antimicrobial therapy(OPAT), and to assess whether comormidity burden predicts readmission risk.

Methodology

The project (QI number 60290) was commenced following approval from the hospital QI department. A retrospective cohort of patients discharged on the OPAT service from January 2023 to December 2025 was performed using electronic patient records.

CCI scores was calculated and categorised as low (0-2), moderate (3-4) and high (>5). The primary outcome was hospital readmission during OPAT therapy. Comparitive analysis was performed between admitted and non-readmitted patients and readmission rates across CCI categories were assesssed.

Results

A total of 314 patients were discharged on OPAT over the 3 year period. Of these, 38 patients (12.1%)were readmitted during OPAT.

The meaan CCI scored among readmitted patients was 4.4, compared to 1.5 in those not readmitted, indicating a higher comorbidity burden in those requiring readmission. Readmission rates accross CCI caegories , supprted an association between higher comorbidity burden and risk of readmission.

Conclusion

Higher Charlson Comorbity Index scores were associated with increasd risk of hospital readmission in patients receing OPAT.

CCI can be a useful tool for risk stratification when selecting OPAT canidates and identifying pateints who may benefit from closer monitoring following discharge.

Limitaions include the retrospective design and sample size. Further work is needed to explre additional predictors of readmission in OPAT patients.

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Board No: 29 #2026314

"Influenza vaccine uptake amongst persons living with HIV in an infectious diseases outpatient clinic: a retrospective analysis across a 10-year period"

Principal Presenter: Stephen Kelly

Track: General Infectious Diseases

Introduction:

Influenza is a significant cause of morbidity and mortality worldwide and persons living with HIV (PLWH) are at particularly high risk of influenza-related complications. It is therefore recommended that PLWH receive an annual influenza vaccine. Anecdotally there is increased vaccine hesitancy within the general population including PLWH since the Covid-19 pandemic. We aimed to assess the longitudinal provision of the influenza vaccine in PLWH attending a single-centre outpatient ID service over a ten-year period to assess evidence for a reduction in the uptake of the influenza vaccine in PLWH.

Methods:

All patients attending our HIV clinics are offered same day influenza vaccine dispensed by the ID pharmacy and administered in clinic by a vaccine nurse specialist. To assess provision of Influenza vaccine to PWH in our clinics, we retrospectively reviewed the number of vaccinations dispensed by pharmacy to clinic for each winter season (1st October to 1st March) over a ten year period. The proportion of PLWH vaccinated was estimated by dividing the number of influenza vaccinations provided to our clinic by the total number of PLWH attending our services for antiretroviral therapy that year. Statistical analysis of proportion vaccinated was assessed using Pearsons chi square test.

Results:

The population of PLWH in our outpatient clinic increased from 1015 patients in 2016 to 1794 in 2025 (77% increase). Number of vaccines provided in 2016/2017 was 589, accounting for 58.03% of PLWH attending services; 2017/2018: 465 (39.41%); 2018/19: 633 (54.29%); 2019/2020: 620 (52.63%); 2020/2021: 700 (56.96%). Marked decline in vaccine provision was observed in 2021/2022 with 330 (26.63%) vaccines provided, possibly reflective of reduced in-person visits and increased community vaccine uptake. However only partial recovery was seen in the following four years; 2022/2023: 430(29.4%); 2023/2024: 505 (32.24%); 2024/2025: 560 (32.65%); and 2025/2026: 670 (37.35%).

Analysis of ‘pre-Covid’ (2016/17 – 2019/20) versus ‘post-Covid’ (2022/23 – 2025/26) data demonstrated a significant reduction in vaccine provision in clinic from median 53.5% (Interquartile range 49.3, 55.2) during 2016-2020 to 32.5% (31.5%, 33.8%) in 2022-2026, p<0.001.

Conclusion:

The provision of influenza vaccines in our clinic exhibited a significant decline post the emergence of COVID-19 in Ireland. Further work is needed to assess if this is due to increase provision of Influenza vaccine in community versus a reduction in influenza vaccine uptake in the population of PLWH attending our clinics. Continued education regarding the benefits of vaccination for at risk individuals is needed.

Board No: 30 #2026312

"Care Beyond the Ward: Inclusion Health in Action with Long-Acting Lipoglycopeptides for Pneumonia"

Principal Presenter: Daniel FitzPatrick
Keywords: Inclusion Health, Antimicrobial Resistance, Dalbavancin

Track: General Infectious Diseases

Long Acting Lipoglycopeptide Antibiotics, such as dalbavancin and oritavancin, are licensed in Ireland for the treatment of skin and soft tissue infections. However, their long duration of activity – approximately 14 days – and their spectrum of activity which includes resistant organisms such as MRSA have contributed towards their use in providing effective treatment for infections, while potentially avoiding or shortening inpatient hospital stays.

This is the case of a 48 year old male who presented to the Emergency Department (ED) with a three-day history of a worsening productive cough, dyspnoea and chest pain which is worse on exertion and inspiration. This is on a background of significant mental health issues, including schizophrenia and issues regarding substance abuse. Additionally, this patient is currently of no fixed abode and is an active smoker. These issues result in frequent attendances to the ED, but he often does not stay for further assessment or treatment. On examination, an audible wheeze was appreciated.

While laboratory investigations did not demonstrate significantly raised inflammatory markers, a Chest X-Ray demonstrated right sided hazy opacification, which was demonstrated over multiple recent ED attendances. A sputum sample was acquired, and the patient was admitted under the care of the Infectious Diseases team. However, the patient self-discharged against medical advice prior to full assessment.

Streptococcus Pneumoniae was isolated from the patient’s sputum sample, which demonstrated resistance to tetracycline, penicillin, erythromycin and ampicillin. This isolate was ceftriaxone susceptible. In the context of significant mental health issues which may affect medication compliance, the presence of a resistant organism, and the high risk of morbidity and mortality in this setting, it was decided to provide an infusion of dalbavancin during the patient’s next ED attendance. This dose was kept in the ED, and ED staff were briefed on the management plan for this patient.

Approximately one week following this discharge, the patient re-presented to the ED, and stayed to receive the dalbavancin infusion prior to leaving the hospital. On subsequent presentations, his respiratory symptoms have improved and repeated chest x-rays demonstrated resolution of the previous patchy opacification.

This case stands at the intersection of many areas relevant to the specialty of Infectious Diseases, such as inclusion health and antimicrobial resistance. The use of newer long acting lipoglycopeptide antibiotics in cases such as this could provide an effective method of providing care for patients with susceptible infections, who may have difficulty undergoing treatment through more traditional means.

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Board No: 31 #2026311

"Impact of IV Care Teams on Peripheral Venous Catheter-associated Staphylococcus aureus Bloodstream Infection Incidence, Patient-reported Outcomes and Staff Experience in Hospitals in Ireland."

Principal Presenter: Eimear O’Donovan and Sebastian Vencken

Track: General Infectious Diseases

Background: Peripheral venous catheter (PVC)-associated Staphylococcus aureus bloodstream infections (PVC-SABSI) are associated with significant morbidity, mortality and cost. As primary objective, the effect of intravenous (IV) care teams dedicated to PVC care on the incidence of PVC-SABSI was evaluated. Secondary objectives were the evaluation of the impact of IV care teams on patient and staff experience.

Methods: Eight acute care hospitals in Ireland from January 2022 to December 2024.Difference-in-differences rate of PVC-SABSI. Patient and hospital staff-reported outcomes and experiences assessed via survey.

Results: Introduction of IV care teams reduced the overall hospital PVC-SABSI rate by 61.8% (95% CI, 37.3% - 76.7%). Over a 15-month period, it was estimated that 34.5 PVC-SABSI cases (95% credible interval: 0.3 – 63.9) were prevented in the eight hospitals. 72.5% of patients reported no to mild pain from PVCs inserted by IV care team staff. 91.5% of patients were satisfied or very satisfied with IV care team care. 95% of hospital staff had experience of requesting services from the IV care teams. Benefits to productivity, educational and PVC care practice were reported, but expansion of IV care team staffing numbers and service period were requested.

Conclusion: Introduction of IV care teams to hospitals was associated with reduction in PVC-SABSI rates, were well received by patients and may improve PVC care and staff productivity. Conclusions from the hospital evaluation are constrained by heterogeneity in the timing and extent of IV care team implementation across the hospitals, the possibility of post‑intervention confounders. Conclusions from the patient and staff evaluations were limited by the absence of control groups and the risk of observer/selection bias, despite bias-mitigation procedures.

Board No: 32 #2026304

"Hutchinson’s Teeth : A late clinical manifestation of congenital syphilis"

Principal Presenter: Jennifer Cox
Keywords: Syphilis, Paediatric Infectious Diseases, Congenital infection

Track: General Infectious Diseases

Background:

Syphilis, Treponema pallidum infection is increasing globally; consequentially there is an increase in congenital syphilis (CS). CS can manifest early, before age 2 years, or late thereafter. Clinically, early CS may manifest multisystemically with snuffles, rash, skin desquamation, hepatomegaly and long bone abnormalities. Late signs of CS include Hutchinson's teeth, hearing loss and neurodevelopmental delay. Syphilis serology is routinely performed at the first antenatal appointment and includes Rapid Plasma Reagin (RPR), Treponema pallidum particle agglutination assay (TPPA), and Treponema pallidum IgM.

We present two cases of CS treated at Rotunda Hospital Dublin, with characteristics of Hutchinson’s teeth, a rare late manifestation of CS.

Case Descriptions :

Case 1: Male infant, 37+4 gestation delivered to a woman with no antenatal care. Maternal serology at delivery: syphilis RPR 16; TPPA hi (unquantifiable).

Infant clinical evaluation: growth restriction, excess nasal secretions, respiratory distress and skin desquamation. Serology RPR 8; TP-PA 20, 480. CSF RPR positive. Radiology demonstrated long bone lucencies, classic findings of congenital syphilis. Infant treated with 10 days IV benzylpenicillin. Follow up RPR negative at 6 months; TPPA persistently positive beyond 18 months.

Case 2: Male infant, 33/40 gestation delivered to a migrant in trimester 3 presenting for antenatal care at 31/40 with positive serology (RPR 1:32; TP-PA 1:20, 480. T. pallidum IgM positive), treated with stat dose benzathine penicillin at 32/40.

Infant clinical evaluation: growth restriction, desquamating skin, petechiae, hepatosplenomegaly and respiratory distress. Serology RPR 1:32, TPPA 20,480, CSF: elevated glucose and protein. Radiology demonstrated long bone lucencies and significant pneumonitis consistent with pulmonary syphilis. Infant treated with 10 days IV benzylpenicillin. Follow up RPR negative at 6 months; TPPA persistently positive beyond 18 months.

Both children at 3 years demonstrated dental abnormalities; peg shaped incisors and mulberry molars, features of Hutchinson’s teeth, a late manifestation of CS.

Conclusion:

Hutchinson’s teeth occur due to the invasion of T. pallidum proximate to the dental germ layers during fetal development. This results in 3 main dental abnormalities with peg shaped incisors (Hutchinson’s incisors), Moon’s molars (bud molars) and mulberry molars. These two cases have these distinctive abnormalities in their primary upper teeth, making Hutchinson’s teeth a strong possible diagnosis, with lack of or inadequate maternal treatment contributory despite treatment in the neonatal period.

Hutchinson’s teeth is confirmed if these dental abnormalities persist in secondary dentition. Both patients will be monitored by paediatric infectious diseases and dental services.

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Board No: 33 #2026297

"Strongyloides Stercoralis Hyperinfection in Pregnancy: A Rare and Life-Threatening Presentation"

Principal Presenter: Andrew Conroy

Track: General Infectious Diseases

Background

Strongyloidiasis is a soil-transmitted helminth infection that often remains asymptomatic in immunocompetent individuals but can persist for decades due to autoinfection. In the setting of immunosuppression, commonly corticosteroid exposure, it may lead to hyperinfection syndrome which is associated with significant morbidity and mortality.

Pregnancy is increasingly recognised as a state of relative immunosuppression; however, its role as a precipitant of Strongyloides hyperinfection remains poorly described, with very few reported cases in the literature.

Methods

We describe a case of Strongyloides hyperinfection in pregnancy, with no other immunosuppression noted. Clinical, microbiological, and histopathological data were reviewed, including inpatient and outpatient Infectious Diseases records. Diagnostic workup included blood cultures, serological testing for Strongyloides, and histopathological examination of placental tissue.

Results

A pregnant woman in her second trimester presented with invasive Salmonella bacteremia requiring ICU admission. Following an initial course of appropriate antimicrobial therapy, she experienced an atypical relapse of bacteremia.

Given the recurrence, associated gastrointestinal symptoms, and relevant epidemiological risk factors, larva-mediated bacterial translocation secondary to Strongyloides infection was suspected. Strongyloides serology returned positive, and subsequent histopathological examination of the placenta demonstrated parasitic elements consistent with Strongyloides species.

No conventional risk factors for immunosuppression were identified, including absence of corticosteroid exposure. The patient was managed conservatively during pregnancy and received treatment with Ivermectin in the postpartum period.

The neonate underwent stool ova and parasite testing, with planned follow-up serology at 18 months to evaluate for vertical transmission.

Conclusions

This case highlights pregnancy as a potential, under-recognised risk factor for Strongyloides hyperinfection, likely related to physiological immunomodulation. It also emphasises the importance of considering Strongyloides infection in cases of recurrent or atypical Gram-negative bacteremia, particularly where gastrointestinal symptoms or epidemiological risk factors are present.

Early recognition is critical given the high morbidity associated with hyperinfection syndrome. This case supports maintaining a low threshold for Strongyloides testing in pregnancy in appropriate clinical contexts and underscores the need for greater awareness of this association in non-traditional risk groups.

Board No: 34 #2026293

"Co-trimoxazole- Induced Neurotoxicity: A Case Report"

Principal Presenter: Mbuotidem Udongwo

Track: General Infectious Diseases

Background

Pneumocystis pneumonia (PJP) is an illness caused by the fungal organism pneumocystis jirovecii.

Its infection leads to high mortality rates especially in immunocompromised patients if left untreated.

As per international guidelines, the recommended first line treatment is cotrimoxazole delivered orally or intravenously depending on severity of patient’s symptoms.

Co-trimoxazole- induced neurotoxicity is a severe side effect that has been reported in a few cases worldwide.

Case

Patient is a 73-year-old gentleman with a background medical history of COPD and previous heart transplant on immunosuppression. He had no past medical history of cognitive impairment.

He was admitted with lethargy and shortness of breath. He was later diagnosed with PJP due to a sputum culture positive for PJP infection and findings of ground- glass opacifications on a computed tomography scan of his thorax.

He was started on high dose Co-Trimoxazole (weight based calculated dose 2880mg QDS IV). 3 days into initiation of therapy, patient started showing signs of delirium, including visual and auditory hallucinations, and later, myoclonus.

Laboratory investigations showed worsening renal function with hyperkalaemia. CT brain did not show any acute findings. LP performed was clear.

After ruling out all possible differentials, decision was made to stop treatment with Co-trimoxazole after 7 days due to worsening of patient’s symptoms. Consideration for switching to alternative therapy was dismissed as the patient’s symptoms had improved and there is more documented evidence of drug-drug interactions with alternative therapy.

Upon cessation of cotrimoxazole therapy, the patient’s symptoms resolved gradually, and he returned to his pre-therapy baseline with no residual symptoms.

Conclusion

This case highlights that Co-trimoxazole can cause neurotoxicity at high therapeutic doses, even in short term use. Clinical monitoring is highly recommended as prompt therapy cessation or dose reduction is recommended is the main stay of reversal of symptoms.

Board No: 35 #2026288

"Mycobacterium fortuitum: Diagnostic and Treatment Challenges of Skin Disease in an Immunocompetent Host"

Principal Presenter: Maria Conradie
Keywords: Mycobacterium Fortuitum, Non-tuberculous mycobacterium, Skin and Soft Tissue Infection

Track: General Infectious Diseases

Background

Mycobacterium fortuitum is a rapidly growing non-chromogenic non-tuberculous mycobacterium (NTM), known to cause skin and soft tissue disease. Immunocompetent patients most often present with isolated lesions whereas disseminated and severe disease is associated with underlying immunocompromise. Diagnosis is made based on microbiological investigations, histology and pathognomonic clinical presentation. Treatment requires combination antibiotics with close monitoring for the possibility of drug side-effects.

Methods

A female patient in her thirties presented after sustaining a suspected insect bite to her lower leg that evolved into multiple, rapidly developing subcutaneous nodules and consequential abscesses. Admission was required for surgical drainage. Initial cultures isolated a variety of bacteria including carbapenamase producing enterobacterales (CPE) for which she received extended courses of antibiotics. She showed initial recovery but over the following months, continued to have recurring abscesses that spread along the medial, lymphatic distribution of her leg. This prompted skin biopsy with histological and microbiological re-investigation.

Results

Histological findings of pustular infiltrates and neutrophil microabscess, in conjunction with repeated/consistent isolation of Mycobacterium fortuitum from two temporally distant tissue samples supported the diagnosis. Susceptibility testing demonstrated that the isolate was susceptible to moxifloxacin, co-trimoxazole, linezolid and amikacin with inducible macrolide resistance. The decision was made that, given the laboratory results and clinical course of progressive skin and soft tissue lesions despite multiple courses of antibiotics, M. fortuitum was the likely responsible organism. Treatment was initiated with oral moxifloxacin and co-trimoxazole with intravenous amikacin for 2 weeks. She continues oral treatment with outpatient surveillance and management of minor drug side-effects. Directed anti-mycobacterial therapy has resulted in significant clinical improvement.

Conclusion

M. fortuitum is an atypical organism causing skin and soft tissue disease that often poses diagnostic challenges when environmental contamination is likely and multiple, more common organisms are concomitantly detected. Diagnosis in this case was based on histological appearance of infected tissue, microbiological identification of M. fortuitum and a clinical course of persistent deep seated skin abscess that progressed despite standard antibiotics. Disease that extends beyond the usually found isolated lesions should raise concern for severe or disseminated disease and possible undiagnosed immunosuppression. Treatment requires initial intravenous treatment, usually with amikacin if sensitive, and oral treatment for 6 to 12 months depending on response. Traditional anti-mycobacterial drugs, such as rifampicin, are ineffective due to intrinsic resistance.

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Board No: 36 #2026287

"Septic Hip Arthritis, Femoral Osteomyelitis, Iliopsoas and Splenic Abscesses caused by Metamycoplasma orale in a Patient with Common Variable Immunodeficiency"

Principal Presenter: Brigid Kemerer

Track: General Infectious Diseases

Background

Metamycoplasma orale (M. orale) is an obligate intracellular bacterium commonly found in the human oral cavity. Infection with M. orale is rare but has been reported in patients with inherited and acquired humoral immunodeficiencies.

Case Presentation

A 32-year-old male with a medical history of common variable immunodeficiency presented with a four-month history of gradually worsening atraumatic right hip pain, low grade fevers, unintentional weight loss and night sweats. An MRI right hip with and without contrast revealed evidence suggestive of right proximal femoral osteomyelitis versus neoplastic process, right hip septic arthritis and right iliopsoas myositis. Investigations revealed a leucocyte count of 10.5 x 109/L with neutrophilic predominance(8.65x109/L),CRP of 134 mg/L and hypogammaglobulinemia (IgA <10 mg/dl (reference range: 61-356 mg/dl), IgM < 4 mg/dl (reference range: 37-286 mg/dl), IgG 179 mg/dl (reference range: 776-1590 mg/dl). CT chest, abdomen and pelvis with contrast showed splenomegaly with multiple splenic rim-enhancing collections, a large multiloculated iliopsoas abscess extending to the right hip joint, a right hip joint effusion, presumed septic, and right proximal femoral osteomyelitis with an intraosseous abscess extending into the right acetabulum. He underwent a CT-guided right iliopsoas abscess drain placement which yielded purulent drainage on insertion and was empirically commenced on IV vancomycin, IV ceftriaxone and oral doxycycline. A right hip irrigation and debridement showed significant purulence, destruction of the articular femoral head and acetabular surfaces and multiple loculated fluid collections within the femoral canal. Samples taken from these procedures were negative for gram stain as well as bacterial, fungal and mycobacterial cultures. Further testing with 16s rRNA sequence analysis confirmed Metamycoplasma orale DNA and he was switched to doxycycline monotherapy for a planned duration of at least 6 weeks.

Conclusion

Limited prior case reports have revealed hypogammaglobinulinemia to be a known risk factor for severe, disseminated M. orale infections, including septic arthritis, osteomyelitis and pyogenic infection. Due to the fastidious nature of Mycoplasma, identification of the organism is difficult by traditional culture methods delaying the diagnosis. Diagnosis often depends on molecular testing and should therefore be promptly considered in culture negative abscesses, septic arthritis and osteomyelitis, especially in patients with impaired humoral immunity. Prompt recognition and treatment are important to reduce morbidity and improve clinical outcomes.

Board No: 37 #2026286

"”Meeting the Standard” Management of Staphylococcus Aureus Blood Stream Infection in Naas General Hospital."

Principal Presenter: Irina Popovici
Keywords: Staph Aureus, BSI, management

Track: General Infectious Diseases

Staphylococcus aureus

Background

Staphylococcus aureus bacteraemia (SAB) is associated with significant morbidity with
mortality rates ranging from 10-30%. Cases of SAB managed in Naas General Hospital (NGH)
are increasing annually. Effective management of SAB requires a multifaceted approach
using evidence based interventions. The Scottish Antimicrobial Prescribing Group (SAPG)
have developed quality of care indicators that may be used to measure the quality of care of
various aspects of SAB management in hospitals.

Aim
To review the management of cases of SAB in NGH in 2024 to identify if the care provided
met the quality of care indicators outlined by SAPG and to identify if any aspect of that care
requires improvement.

Methodology
Cases of SAB from 2024 were identified using the NGH Laboratory Information System. A
retrospective chart review was undertaken. Data relating to clinical assessment, source
control, use of echocardiography, repeat blood cultures, specialist consultations and
antimicrobial therapy were collected. An EXCEL database was used for data collection and
analysis.

Results
All 26 cases were discussed with a consultant microbiologist, had appropriate clinical
assessment and discussion regarding source control. All had repeat blood cultures,
appropriate IV therapy and echocardiogram including TOE if indicated. 96% (25/26) of
patients had appropriate antimicrobial agent and duration of treatment. Only 1 patient was
suitable for OPAT. 81% of discharge letters had documentation of SAB included on same.

Conclusion
25/26 (96%) of the patients treated for SAB in NGH were managed as per the best practice
recommendations. Appropriate management of SAB is resource intensive and
interdepartmental cooperation is essential to achieve this standard of care. Documentation
of SAB on discharge letters to GPs should be improved.

Results of this audit will be shared for staff education, to highlight the requirement for
resources and actions required to continue to provide this standard of care.

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Board No: 38 #2026284

"Mycobacterium tuberculosis Induces Immunothrombosis in Macrophages via STAT1-Dependent Mechanisms"

Principal Presenter: Seán Donohue
Keywords: Tuberculosis, Immunothrombosis

Track: General Infectious Diseases

Background:

Immunothrombosis contributes to host defence by promoting microthrombi formation at sites of infection, but when dysregulated it can contribute to immunopathology. Microthrombosis has been observed in postmortem lung specimens from tuberculosis (TB) patients, yet the underlying mechanisms remain poorly understood. Tissue Factor (TF), the initiatory of the extrinsic coagulation pathway, plays a central role in immunothrombosis, while tissue factor pathway inhibitor (TFPI) counterbalances its activity. In other infections, type I interferons have been shown to drive TF expression via STAT1 and JAK1 signalling. This study aimed to determine whether Mycobacterium tuberculosis (Mtb) induces TF expression in macrophages and whether this occurs through a type I interferon-dependent pathway.

Methods:

Human monocyte-derived macrophages (MDMs) and alveolar macrophages (AMs) were pretreated with the STAT1 inhibitor, fludarabine, or the JAK1 inhibitor, upadacitinib prior to infection with either irradiated Mtb (iH37Rv) or avirulent Mtb (H37Ra). Expression of TF (F3) and TFPI genes was assessed by qPCR, TF protein levels by ELISA, and TF procoagulant activity by factor Xa generation assay.

Results:

In MDMs, iH37Rv induced a robust early increase in F3 transcription and TF protein at 3h, with a corresponding increase in TF-dependent procoagulant activity. In contrast, H37Ra infection induced delayed TF expression at 24h. In AMs, iH37Rv similarly induced early TF expression, although responses were more variable and of lower magnitude, while H37Ra effects occurred earlier than that seen with MDMs.

STAT1 inhibition significantly reduced Mtb-induced TF expression and procoagulant activity in MDMs, suggesting a STAT1-dependent pathway. In contrast, JAK1 inhibition had no significant effect. Notably, neither STAT1 nor JAK1 inhibition altered TF expression in AMs, suggesting that TF regulation in these cells occurs independently of canonical type I interferon signalling.

Conclusions:

These findings demonstrate that Mtb induces a procoagulant phenotype in human macrophages through TF upregulation, supporting a role for immunothrombosis in TB. However, the regulatory mechanisms differ between macrophage subsets, with STAT1-dependent signalling in MDMs but alternative pathways in AMs. This highlights compartment-specific regulation of immunothrombosis and may have implications for TB-associated complications, including thrombosis, lung pathology, and impaired drug delivery. Further work is required to define these pathways and their potential as targets for host-directed therapies.

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Board No: 39 #2026280

"Retrospective Audit on Statin Therapy for Cardiovascular Risk Management Among HIV Cohort in University Hospital Waterford"

Principal Presenter: Farah Ismadi

Track: General Infectious Diseases

Background:

HIV patients carry significantly higher risk for cardiovascular disease than general population. REPRIEVE trial demonstrated 35% reduction in major cardiovascular events with Pitavastatin use in HIV patients with low calculated cardiovascular risk. Following this, European AIDS Clinical Society (EACS) Interim Guidance on Use of Statin Therapy recommends annual 10-year cardiovascular risk assessment in HIV patients aged ≥40 years (using SCORE2 or SCORE-OP for European, and AHA/ACC score for non-european). Apart from lifestyle modification, EACS guideline suggests statin as 'indicated' for risk >10%, 'recommended' for 5-10% risk, and to 'consider' statin following shared decision making for <5% risk. Our audit is aimed to assess the number of UHW HIV patient cohort aged ≥40 that; 1. undergone lipid profile testing and 10-year cardiovascular risk assessment, 2. received lifestyle counselling and commenced on statin for cardiovascular risk management.

Methods:

HIV cohort identified from electronic outpatient clinic list. Inclusion criteria includes; age ≥40 and active follow up. Demographic data, lipid profile (total cholesterol & LDL), documented 10-year cardiovascular risk scores (SCORE 2, SCORE2-OP or AHA/ACC score), documentation of lifestyle counselling and statin commencement were collected from electronic and physical records. Data were stored and analysed using Excel.

Results:

87 of HIV cohort are included. 40 are male and 47 female. In total, 76/87 (87.4%) had lipid profile checked, with 63/87 (72.4%) within last 1 year. 46/87 (56.3%) had raised lipid profile. However, 0/87 had calculated 10-year risk assessment. 27/87 (31%) received at least one cardiovascular risk management; 17/87 (19.5%) received lifestyle counselling, 9/87 (10.3%) already on statin in community, 8/87 (9.2%) commenced on statin in clinic, 3/87 (3.4%) planned for statin after lifestyle modification, and 2/87 (2.3%) refused statin. Only 7/87 (8%) received both lifestyle counselling and commenced/already on statin therapy.

Conclusion:

Our data demonstrates majority of HIV cohort received cardiovascular risk assessment in form of lipid profile, which were raised in more than half of the group. However, only a third received at least one form of cardiovascular risk management. In addition, findings also highlight a major gap in calculating 10-year cardiovascular risk scores which assess broader cardiovascular risk components. This suggests a significant proportion of HIV patients remains to potentially benefit from the appropriate cardiovascular risk management. Planned intervention includes periodic departmental NCHD education and electronic chart reminder to assess 10-year cardiovascular risk and suitability for statin therapy in clinic. Re-audit is planned at 6 months to assess improvement in compliance to EACS guideline.

Board No: 40 #2026279

"• Artificial intelligence in infectious diseases and clinical microbiology: a scoping review and evidence map of diagnostic, therapeutic and educational applications"

Principal Presenter: Marco Smit

Track: General Infectious Diseases

Background:

Artificial intelligence (AI) is progressively recognised for its emerging role in diagnosing, treating and monitoring health conditions. AI has been adopted in infectious diseases (ID) and microbiology to contend with mounting data volumes and complexity, which can outstrip human and classical analytical capacity.

Aims:

This large scoping and evidence mapping review aims to explore applications of AI in ID and clinical microbiology. Specific objectives were to synthesize four scopes, addressing the characteristics of AI in clinical infection sciences, and mapping the densities and scarcities of evidence.

Methods:

Following JBI methodology for scoping reviews studies in MEDLINE, Embase and Web of Science were identified based on the inclusion criteria. Citations were managed in EndNote and articles were categorised using the screening platform Rayyan. Data were categorized and synthesized to create four scores and an evidence map.

Results:

2106 articles were retrieved for screening and data extraction, of which 285 were included in this review. Four scopes emerged from the data analysis: Scope 1 covered publications across decades, revealing a rising trend in works associating AI with infectious disease fields. Scope 2 addressed publications by geographic area, underscoring the bulk of output from wealthy nations. Scope 3: Applications of AI were categorised, demonstrating a majority of use for machine learning in diagnostic applications, particularly in intensive care settings. Scope 4: Range of application of AI to specific conditions, with an increased application for use in diagnosing sepsis. Applications varied epidemiology and regional needs. An evidence map demonstrated a broad range of diagnostic and therapeutic applications, but a paucity of applications in education.

Conclusion:

Infectious disease and microbiology generate more data and complexity than humans can interpret alone. AI has increasingly been used to extract patterns to improve diagnosis, control and monitoring of infections. Further research into AI use in education is warranted.

Board No: 41 #2026278

"What’s the Option when OPAT isn't an Option?"

Principal Presenter: Tracy Finnegan

Track: General Infectious Diseases

Background

Meticillin-sensitve staphylococcus aureus (MSSA) is classified as community-acquired, healthcare-associated community-onset or healthcare-associated hospital-onset. Community-acquired MSSA refers to individuals with no previous contact with the health care system, including persons who inject drugs. It is a serious bloodstream infection associated with significant morbidity and mortality. When MSSA is complicated by infective endocarditis (IE) or osteomyelitis, the standard treatment is an intravenous beta-lactam antibiotic for four to six weeks.

Case Presentation

This study presents a 37-year-old patient who was admitted to hospital due to pyelonephritis and back pain. She was diagnosed with community-acquired MSSA bacteraemia, which seeded to her lumbar spine. She had an uncomplicated discitis with osteomyelitis, but there was no adjacent epidural abscess. She also had right-sided infective endocarditis. Her treatment was complicated by a history of social and drug addiction issues, as well as malnutrition.

MRI spine: Developing discitis L5-S1. Grade 2 spondylolisthesis of L5.

TOE: tricuspid valve IE

Microbiology:

Blood cultures: staphylococcus aureus and viridans streptococci.

Urine culture: staphylococcus aureus. All organisms sensitive to oxacillin.

Infectious diseases treatment plan: Initially IV cefazolin 2G QDS and PO metronidazole 400mg TDS for 6 weeks. The plan had to be revised when the patient left the hospital against medical advice after 2 weeks of inpatient treatment. A stat dose of IV dalbavancin 1500mg was given before discharge and was repeated 2 weeks later in outpatients to complete 6 weeks of antimicrobial therapy.

Conclusion

This case examines a patient who had a community-acquired MSSA bacteremia complicated by discitis with osteomyelitis, right-sided infective endocarditis, and a history of intravenous drug use. The initial treatment plan included intravenous cefazolin and oral metronidazole for six weeks while the patient remained hospitalised, as her ongoing intravenous drug use made her unsuitable for treatment under the OPAT service. However, the patient's reluctance to stay as an inpatient necessitated a revision of the treatment plan. OPAT guidelines suggest that long-acting antimicrobial agents, such as dalbavancin, may be beneficial in reducing the reliance on patient compliance. There is evidence indicating that its use is an adequate treatment for spinal infections. This case emphasises the importance of adapting models of care to meet the individual needs of patients.

Board No: 42 #2026271

"Navigating MBL Endemicity: Prescribing Patterns, Diagnostic Delays, and Clinical Outcomes of Last-Line Agents in a High-Endemicity Regional Hospital"

Principal Presenter: Francesco Spada
Keywords: Antimicrobial resistance, Antimicrobial stewardship, MBL

Track: General Infectious Diseases

Background: Southern Italy faces alarming antimicrobial resistance (AMR) rates, heavily straining acute care settings. Metallo-β-lactamase (MBL)-producing pathogens (e.g., NDM/VIM) represent a critical challenge due to high mortality and scarce therapeutic options. In our Regional Hospital, the urgency of life-saving treatments and the structural unavailability of aztreonam significantly influenced prescribing behaviors, driving a widespread reliance on last-line agents like cefiderocol. This study evaluates prescribing patterns, clinical outcomes, and the urgent need for structured Antimicrobial (AMS) and Diagnostic Stewardship.

Methods: A one-year retrospective observational study at San Pio Hospital (Benevento, Italy) analyzed hospital-wide prescriptions of cefiderocol and ceftazidime/avibactam (CAZ/AVI). We cross-referenced clinical indications with active surveillance (rectal swabs) and microbiological cultures. Notably, all evaluated patients initially accessed care through the Emergency Department (ED) before Infectious Diseases admission or consultation.

Results: We observed 120 cefiderocol and 57 CAZ/AVI prescriptions. Surveillance identified 65 patients colonized by MBL-producers (frequently co-expressing OXA-48/KPC). Alarmingly, most cefiderocol prescriptions were empirical, administered for suspected infections based solely on colonization risk, lacking targeted microbiological confirmation.

Only 16 patients had confirmed invasive MBL infections, with 98% of these admitted to the Emergency Medicine / High Dependency Unit (HDU). The primary infection sites were the bloodstream (50%), urinary tract (25%), respiratory tract (12.5%), and intra-abdominal/soft tissues (12.5%). Klebsiella pneumoniae NDM was the predominant pathogen (75%), alongside Pseudomonas aeruginosa (12.5%), Escherichia coli (6.25%), and Providencia stuartii (6.25%).

Crucial diagnostic stewardship gaps emerged: the facility lacks rapid multiplex PCR panels (e.g., FilmArray), and empirical antibiotics were frequently initiated before drawing blood cultures. Consequently, initial empirical treatment was almost universally inadequate. Despite eventual targeted therapies—such as cefiderocol-based combinations—delayed adequate treatment in the invasive cohort resulted in a devastating 68.7% mortality rate, primarily driven by septic shock.

Conclusions: The lack of rapid diagnostics and specific MBL-active agents forced an over-reliance on empirical cefiderocol guided merely by colonization. This creates a dangerous dichotomy: overprescription and increased selective pressure in colonized patients, contrasted by high mortality in invasive cases due to delayed targeted therapy. Breaking this cycle of unguided prescribing is paramount. Aligning with national AMR guidelines, enforcing a strict "cultures before antibiotics" policy, and integrating rapid molecular testing directly at ED triage are essential to optimize early empirical choices and improve survival.

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Board No: 43 #2026270

"Multi-centre study on knowledge, attitudes and perceptions of healthcare workers towards Long Covid"

Principal Presenter: Daniel FitzPatrick
Keywords: Long Covid, COVID-19, Survey

Track: General Infectious Diseases

Background:
Long Covid (LC) occurs in individuals with a history of SARS-CoV-2 infection, usually 3
months from the onset, with symptoms that last for at least 2 months and cannot be
explained by an alternative diagnosis. LC prevalence and pathways of care for patients with
LC vary across jurisdictions. The knowledge and attitudes possessed by healthcare workers
(HCWs) towards LC is unknown.
We aimed to personal experience of LC and knowledge, attitudes and perception (KAP) of LC
among HCWs across two hospital sites.

Methods
HCWs at St James’s Hospital, Dublin (SJH) and University Hospital Galway (UHG) were
invited to complete electronic questionnaires on LC burden and KAP. The KAP survey was
only provided to participants directly engaged in patient care. This was performed in
conjunction with WHO-Europe. Only Irish data is reported here.

Results
There were n=463 HCW responses (277/463, 60% in SJH) to the LC burden survey, with
243/463 (52%) HCWs providing direct patient care. The majority (420/463, 90%) were
employed prior to the COVID-19 pandemic. 44/463 (9.5%) report having had LC, with 31/44
having symptoms for more than 4 years. More than half (26/44, 59%) have not returned to
their pre-COVID health. 27/44 have missed work due to LC, and 10/44 have changed their
work practices due to LC. The strongest predictor of developing LC was number of SARS-
CoV-2 infections (r 2 =0.16, p=0.003).
Of the 243 HCWs providing clinical care who completed the KAP survey, 225 (95%) were
aware of LC, with 82% agreeing that it is a legitimate condition. 63% believed it can occur
after asymptomatic COVID infection, while only 43% believe vaccination reduces the risk.
The majority of respondents were not confident that they could make a diagnosis of LC, 81%
were unaware of management guidelines. 61% feel they do not have the resources to
manage LC patients effectively. The most common barrier to management was the overlap
of LC diagnosis with other conditions.
6% had received either formal or informal training regarding LC management, but 60% were
likely to engage in CME for LC management

Conclusion

The burden of LC in HCWs in this cohort was 9%, with impact on work practices. Most HCWs
recognise LC as a legitimate health condition. There appear to be significant barriers
towards its diagnosis and subsequent management. The majority are willing to receive
formal education regarding LC.

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Board No: 44 #2026267

"Lipid-Lowering Therapy in People with HIV: A Tertiary Centre Audit"

Principal Presenter: Robert Lyons

Track: General Infectious Diseases

Background

People with HIV experience elevated cardiovascular risk due to chronic inflammation, antiretroviral therapy effects, and traditional risk factors. The 2025 ESC/EAS guidelines, informed by REPRIEVE trial data, recommend statin therapy for all people with HIV aged ≥40 years for primary cardiovascular prevention, irrespective of LDL-cholesterol or calculated risk.

Methods

We conducted a retrospective audit of lipid management among patients attending a tertiary Irish HIV outpatient service between October and November 2025, assessing practice against European guidelines. Data collected included demographics, antiretroviral regimens, cardiovascular risk factors, lipid profiles, and lipid-lowering therapy. Cardiovascular risk stratification was performed using ESC guidance and SCORE2/SCORE2-OP tools with HIV-specific adaptations as per 2025 European AIDS Clinical Society (EACS) guidelines. The primary outcome was the proportion of patients aged ≥40 years receiving lipid-lowering therapy.

Results

Data were collected from 188 patients (59% male) with a median age of 45 years (IQR 39–53). All patients were receiving antiretroviral therapy, and 88.3% had an HIV viral load <50 copies/mL. Median CD4 count was 649 cells/mm³ (IQR 469–877). Cardiovascular risk factors were common. Current smoking was documented in 32.6%, diabetes in 7.4%, chronic kidney disease (eGFR <60 mL/min/1.73m²) in 4.8%, and established atherosclerotic cardiovascular disease in 3.7%. Lipid profiles were available for 186 (99%) patients, all within the preceding year. Among 137 patients aged ≥40 years eligible for lipid-lowering therapy, only 45 (32.8%) were receiving treatment: 40 (29.2%) on statin monotherapy and 5 (3.6%) on combination therapy with ezetimibe. No patients received bempedoic acid or PCSK9 inhibitors. Cardiovascular risk stratification classified 33 patients (24.3%) as very high risk, 51 (37.5%) as high risk, and 52 (38.2%) as low/moderate risk. Statin use remained suboptimal across groups (36.4%, 33.3%, and 21.2%, respectively). Among statin-treated patients, guideline-recommended intensity was used in 50% of very high risk, 59% of high risk, and 73% of low/moderate risk patients. LDL-cholesterol target attainment was similar across groups despite differing thresholds: 25% (<1.4 mmol/L), 29% (<1.8 mmol/L), and 27% (<2.6 mmol/L), respectively. Tenofovir alafenamide (TAF) (n=66; 35%) was associated with higher triglycerides than tenofovir disoproxil fumarate (TDF) (n=71; 38%) (median 1.40 vs 1.10 mmol/L, p=0.013).

Conclusion

Substantial gaps in lipid management were identified, with two-thirds of eligible patients not receiving guideline-recommended therapy. Uniformly low LDL-cholesterol target attainment (~27%) across risk groups suggests systemic barriers to treatment initiation and optimisation. Targeted interventions are needed to improve implementation of cardiovascular prevention guidelines in this population.

Board No: 45 #2026264

"Outcomes of the OPAT service of in St. Vincent’s University Hospital during 2025"

Principal Presenter: Aimee McGreal-Bellone

Track: General Infectious Diseases

Introduction:
Outpatient parenteral antimicrobial therapy (OPAT) is a service delivered outside the hospital to patients who need prolonged intravenous antimicrobials. We audited the St. Vincent’s University Hospital’s (SVUH) OPAT program care standards outlined in the 2019 National OPAT Guidelines and our local guidelines.

Methods:
We prospectively collected data from all patients enrolled in SVUH’s OPAT program from January 9th 2025 to November 5th 2025 in our local database. Demographic, infection and treatment characteristics, and outcomes were summarised using descriptive statistics. Univariate analyses were done to identify factors associated with cure.

Results:
Of 212 OPAT referrals, 141 (67%) were male with a median age of 70 years (IQR 60-80). Inpatients were the main source of referral (174, 82%). The primary foci of infection assessed were bone and joint (129, 61%), bacteraemia (29, 14%), intraabdominal (17, 8%), and intravascular-graft (8 (4%). One hundred sixty-eight patients (79%) received antimicrobials based on culture results. Ninety-six (41%) were monomicrobial infections and the most frequently isolated organisms were Staphylococcus aureus (N=59, 28%), Enterococcus species (N=27, 13%), Escherichia coli (N=19, 9%), Streptococcus species (N=13, 6%), and Pseudomonas aeruginosa (N=9, 4%).

Of 157 (74%) discharged on OPAT, only 16 (10%) were self-administered OPAT. Ceftriaxone was the most commonly prescribed antimicrobial (N=110, 52%), followed by Daptomycin (N=22, 10%), Flucloxacillin (N=20, 9%), Ertapenem (N=12, 6%), and Piperacillin-tazobactam (N=10, 5%). Median duration on OPAT was 40 days (IQR 20-43) while median bed-days saved was 20 (IQR 9-33). A delay in discharge (≥2 days from referral) occurred in 77 (35%) cases, but only 21 (10%) of them were OPAT-related.

One hundred six (68%) patients achieved clinical cure, 18 (11%) required chronic oral antimicrobial suppression, and 9 (6%) had worsening infection. In univariate analyses, neither empiric versus culture-based therapy nor infections caused by MDROs were associated with cure rate. Readmission occurred in 18 (8%) of patients, and 19 (9%) discontinued OPAT early. Thirty-four (16%) patients had an adverse event while receiving OPAT, six (4%) had antimicrobial side effects, three (2%) had line complications, and one (1%) had a drug-drug interaction.

Conclusions:
The SVUH OPAT service was associated with favourable clinical outcomes and substantial hospital bed-day savings over the audit period. No variables were significantly associated with cure. Up to 25% of referrals did not require OPAT, underscoring the added value of Infectious Diseases assessment in optimising antimicrobial management, including direct transition to oral therapy where appropriate.

Board No: 46 #2026260

"Nosocomial transmission in a monkeypox virus clade Ib outbreak, August to October 2025"

Principal Presenter: Mark McLoughlin
Keywords: Health Protection, Mpox, Outbreak

Track: General Infectious Diseases

Monkeypox virus (MPXV) clade Ib has caused widespread human-to-human transmission in Central Africa since a Public Health Emergency of International Concern (PHEIC) was declared in August 2024. Importations to non-endemic countries are rising, spreading predominantly via sexual and close household contact. Here, we describe the first outbreak of MPXV clade Ib in Ireland alongside the first documented nosocomial transmission of MPXV clade Ib outside of Africa.

Four epidemiologically linked cases were investigated, occurring in the Dublin and Midlands health region of Ireland between August and October 2025. Cases were defined using Health Protection Surveillance Centre (HPSC) criteria. Laboratory confirmation was achieved using pan-orthopoxvirus, MPXV clade-specific and subclade-specific real-time quantitative PCR (qPCR) assays on clinical swabs. Whole genome sequencing (WGS) was performed on samples from three confirmed cases. Phylogenetic analysis was performed on datasets from the Pathoplexus and GISAID databases.

The outbreak comprised of one probable case (Case 1) and three laboratory-confirmed cases (Cases 2-4). The primary case (Case 1) was a male in his thirties who returned to Ireland from Pakistan in August 2025 and developed mpox-compatible symptoms during travel. He subsequently transmitted the virus through sexual contact to the index case (Case 2), a female in her twenties who was hospitalised with severe, progressive disease. Through prolonged household contact as a parent, Case 2 transmitted the infection to her child (Case 3). Nosocomial transmission occurred through contact transmission when a healthcare worker (Case 4), who provided clinical care to Case 2 in hospital, developed confirmed MPXV clade Ib infection in September 2025. WGS confirmed the three sequenced genomes were genetically identical, supporting a single transmission chain. Phylogenetic analysis demonstrated strong clustering with an international Omani sequence from February 2025. Post-exposure vaccination was administered to close contacts (n=23) across community and hospital settings.

This cluster highlights the ongoing possibility of mpox transmission from travel-associated cases and emphasises the need for a high level of clinical suspicion of mpox in cases with relevant clinical symptoms. Multi-organisational responses, including prompt case identification in both primary and secondary healthcare settings, timely molecular diagnostics and a robust public health system, are imperative to prevent onward transmission events. The findings are relevant in the context of undetected transmission of mpox due to MPXV clade Ib internationally and the rise of autochthonous cases without an associated travel history.

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Board No: 47 #2026255

"Antimicrobial stewardship microlearning for community pharmacists – a pilot project."

Principal Presenter: Ellen Martin

Track: General Infectious Diseases

Background/Objectives:

Optimising community pharmacist engagement in AMS is a key priority. Most antibiotics are dispensed through community pharmacies. Role expanding to include Common Conditions Service.

Challenge: high proportion community pharmacists job stress/burnout.

2024: Need was identified to extend AMS education to community pharmacists in accessible and time efficient manner. Pilot aimed to assess impact and potential benefits of delivering AMS education using microlearning for community pharmacists

Methods:

HSE AMRIC collaborated with community pharmacist colleagues to develop five short and focussed videos (<10 minutes). Community pharmacists’ input key to tailoring messaging with subsequent creation of AMS leaders.

Use of HSE YouTube links. Shared with 49 community pharmacists weekly via email. Pre and post intervention survey completed.

Results:

· Survey participants: Preintervention n=10, postintervention n=8.

· Increase perceived AMS knowledge (3.1 to 3.6) and confidence implementing AMS (2.9 to 3.8).

· 75% rated extremely useful, 25% useful.

· All stated microlearning positively impacted their engagement in AMS.

· Survey highlighted examples of patient safety benefits – prompted review long-term antibiotics, improved confidence delivering AMS.

· YouTube views post pilot: ranged from 19 to 40 across five videos. Currently: 310 to 100.

Conclusion:

Microlearning videos represent a novel, feasible, cost-effective, and time efficient approach to providing AMS education. Content creation, audio recording, video editing, and subtitle generation completed in-house by HSE AMRIC. AMS education accessible via single click with potential to reach all community pharmacists via sharing on multiple digital platforms. Learnings transferable to other healthcare professional groups and topics.

Board No: 48 #2026249

"Audit of OPAT (Out-Patient Parenteral Antimicrobial Therapy) Service Efficiency: Time to Treatment Initiation"

Principal Presenter: Dylan Yin Kai Chan (1)
Keywords: OPAT

Track: General Infectious Diseases

Background: Established in 2013, the Irish OPAT service serves as a safe and effective way for clinically stable patients to receive intravenous antibiotics in step-down facilities such as nursing homes or their own home. This study aimed to investigate the efficiency of the OPAT service in Tallaght University Hospital (TUH), identify specific reasons for any delays encountered and recommend steps moving forward to improve its efficiency.

Materials and Methods: The principal method used in this study was analysis of data obtained from patients referred to the OPAT service between October and December 2024 (n=30). This was via the physical medical records used in TUH and Synergy, an Electronic Patient Record. The National OPAT Portal was used to access information regarding referral to OPAT, and treatment commencement. Data obtained from these sources was recorded using an Excel spreadsheet, and delays were identified.

Results: The overall mean waiting period was 2.03 days (Median = 1, SD = 2.04). The most common referring specialty was Adult Orthopaedics (n=9, 30%) and the most common reason for referral was Osteomyelitis (n=7, 23.3%). Mean PICC line insertion time was 1.58 days. The most common cause of delay was changes in treatment plan and insertion of PICC line (n=3, 37.5%).

Conclusion: Our study suggests that the TUH OPAT service efficiency is relatively efficient when compared to other Irish hospitals (Mean = 2.03 days), due to good coordination with Interventional Radiology.

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Board No: 49 #2026246

"Pseudoainhum in a Patient with Leprosy in Ireland: A Diagnostic Challenge"

Principal Presenter: Cian Lenihan
Keywords: Leprosy, Pseudoainhum, Skin-soft-tissue-infection

Track: General Infectious Diseases

Background
Leprosy is rare in Europe, and clinicians in non-endemic settings may have limited familiarity with its complications. One uncommon manifestation is pseudoainhum, a fibrotic constriction band around a digit that may lead to distal swelling, ulceration, and eventual auto-amputation. Differentiating pseudoainhum from lepra reactions or secondary infection can be challenging, particularly where local experience is limited.

Case Presentation
A 33-year-old Haitian man, resident in Ireland since 2022, was diagnosed in 2024 with multibacillary leprosy after presenting with multiple nodular skin lesions and right ulnar neuropathy. Skin biopsy and polymerase chain reaction confirmed Mycobacterium leprae. He commenced standard multidrug therapy with a planned 12-month course, alongside corticosteroids for neuritis, with improvement in skin lesions and stabilisation of neuropathy.

After 10 months of treatment, he developed pain, swelling, and erythema of the right middle finger on the neuropathy-affected side, progressing to ulceration. A localised type 2 lepra reaction was initially considered, although he had no systemic features. Incisional biopsy showed a nonspecific ulcer with granulation tissue and mild lymphocytic infiltrate, without granulomas or acid-fast bacilli on Ziehl–Neelsen staining. Over the following 10 days, worsening swelling and purulent discharge suggested secondary bacterial infection. Surgical drainage yielded Staphylococcus aureus and Streptococcus dysgalactiae on culture; acid-fast bacilli were seen on smear, but mycobacterial cultures were negative. Radiographs showed no osteomyelitis. Further debridement demonstrated circumferential soft tissue necrosis without tendon sheath or bony involvement, and a split-thickness skin graft was applied. Expert consultation supported pseudoainhum as the underlying diagnosis.

Discussion
Pseudoainhum likely developed in the context of leprosy-related neuropathy, with repeated unnoticed trauma or neurotrophic change leading to fibrotic constriction, distal swelling, ulceration, and superimposed bacterial infection. The lesion initially mimicked a localised lepra reaction or abscess. This case highlights the diagnostic difficulty of new focal lesions during treated leprosy and the importance of considering structural complications as well as immunological reactions and infection.

Conclusion
Pseudoainhum is a rare but important complication of leprosy that may be under-recognised in non-endemic settings. Early recognition, multidisciplinary input, infection control, and timely surgical intervention may help preserve tissue and prevent auto-amputation while multidrug therapy continues.

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Board No: 50 #2026245

"HIV-associated Cerebral Toxoplasmosis in Ireland: A Case Series Highlighting Diagnostic and Therapeutic Complexities"

Principal Presenter: Cian Lenihan
Keywords: HIV, Toxoplasmosis, Neuroradiology

Track: General Infectious Diseases

Background: Cerebral toxoplasmosis remains an opportunistic cause of brain lesions in people with advanced HIV. We describe three cases over 12 months at Cork University Hospital, Ireland, highlighting heterogeneity of imaging and clinical course complicating diagnosis and follow-up.

Case presentation: Three adults presented with focal neurology and severe immunosuppression (CD4 92, 20 and 5 cells/µL) with positive Toxoplasma gondii immunoglobulin G.
Case 1 presented with gait ataxia; computed tomography (CT) showed multiple irregular hyperattenuating ring-enhancing lesions with oedema and calcific foci at the grey–white junction and basal ganglia.
Case 2 presented following Pneumocystis jirovecii pneumonia (PJP) with headache and foot drop; CT suggested a solitary 2.3×1.7 cm right frontal lesion, but magnetic resonance imaging (MRI) demonstrated additional lesions with mural nodularity and small haemorrhagic foci.
Case 3 presented with subacute cognitive change; CT showed a dominant 2.3×1.8 cm left thalamic lesion compressing the third ventricle with obstructive hydrocephalus; MRI confirmed multifocal disease and subsequent resolution of hydrocephalus after treatment.

All received pyrimethamine–sulfadiazine with folinic acid; corticosteroids were used for mass effect. Two patients developed sulfonamide hypersensitivity and were switched to pyrimethamine–clindamycin with additional PJP prophylaxis. Antiretroviral therapy (ART) was started during acute treatment (day 0–12); no evidence of immune reconstitution inflammatory syndrome was observed. Response varied widely: delayed radiological response until ~6 weeks (Case 1) complicated by psychosis and later status epilepticus, partial regression by 3 weeks (Case 2), and rapid clinical and radiological improvement by 3 weeks (Case 3).

Discussion: These cases demonstrate that CT may under-estimate lesion burden, and atypical features (hyperattenuation, calcification, haemorrhage, solitary deep lesions and hydrocephalus) can further mimic malignancy or primary central nervous system lymphoma. MRI was essential for lesion characterisation and for documenting response when clinical change was subtle. Neither clinical nor radiological response was predictable. Drug toxicity and psychosocial barriers complicated management.

Conclusions: In people living with advanced HIV and focal brain lesions, cerebral toxoplasmosis should remain a leading differential, even with atypical imaging and when response to therapy is not always readily apparent. Empiric therapy, early MRI, follow-up imaging, monitoring for drug toxicity, and multidisciplinary support are key to optimising outcomes.

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Board No: 51 #2026241

"Persistent Bacteraemia in a Cirrhotic Patient With an Endovascular Device and Severe Antimicrobial Hypersensitivity"

Principal Presenter: Alison O'Shea
Keywords: Bacteraemia, Cirrhosis, Endovascular devise

Track: General Infectious Diseases

Persistent Bacteraemia in a Cirrhotic Patient With an Endovascular Device and Severe Antimicrobial Hypersensitivity

First Authors: Alison O’Shea¹, Hayley Power¹

¹These authors contributed equally and share first authorship.

Background

Persistent bacteraemia presents significant diagnostic and therapeutic challenges, particularly in patients with cirrhosis, intracardiac devices and restricted antimicrobial options due to hypersensitivity. This case illustrates the complexity of evaluating recurrent bacteraemia when conventional imaging fails to localise a source.

Case Presentation

A woman in her 70s with cirrhosis, type 2 diabetes and a left atrial appendage occlusion device presented after an unwitnessed fall, long lie and sepsis. She reported several weeks of fatigue, abdominal discomfort and gastrointestinal upset. Initial investigations revealed acute kidney injury, deranged liver function tests and Escherichia coli bacteraemia. Empirical piperacillin–tazobactam was narrowed to cefuroxime based on susceptibilities; however, after one dose she developed respiratory arrest requiring intubation and ICU admission, necessitating strict avoidance of beta‑lactams.

Investigations

Despite escalation to meropenem and later aztreonam, she had persistent E. coli bacteraemia with minor antibiogram variation. CT imaging suggested possible cholecystitis, but no definitive source was identified. Two transoesophageal echocardiograms showed no infective endocarditis or peri‑device leak. Repeated cultures later grew Corynebacterium striatum on multiple samples, supporting true bacteraemia. PET‑CT demonstrated no FDG‑avid focus.

Management

Therapy was repeatedly adjusted, including meropenem, aztreonam, metronidazole, linezolid and vancomycin. Given ongoing bacteraemia and the presence of an intracardiac device, a multidisciplinary endocarditis meeting concluded that an occult device‑related infection was the most plausible source despite negative imaging. She commenced prolonged daptomycin and was discharged to a supervised facility for completion.

Discussion

This case highlights the diagnostic uncertainty of persistent bacteraemia in cirrhotic patients with multiple potential infection sources. It underscores the pathogenic potential of C. striatum in immunocompromised hosts and the limitations of echocardiography in detecting device‑related infection. Severe beta‑lactam hypersensitivity significantly constrained antimicrobial decision‑making, necessitating close multidisciplinary coordination.

Conclusion

Persistent bacteraemia in complex patients requires broad diagnostic consideration, careful antimicrobial stewardship and coordinated multidisciplinary care.

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Board No: 52 #2026239

"Inpatient Care Use and RSV associated Disease severity in the Phase 2b/3 Trial of Clesrovimab versus Palcebo in Healthy Infants (CLEVER)"

Principal Presenter: Ciara Mulhern

Track: General Infectious Diseases

To evaluate the impact of clesrovimab on inpatient care use and RSV-associated disease severity compared to placebo in the phase 2b/3 CLEVER trial of clesrovimab in healthy infants.

Clesrovimab is a long-acting RSV-neutralizing antibody approved for the prevention of RSV lower respiratory tract disease in neonates and infants born during or entering their first RSV season. In the CLEVER trial, a single dose of clesrovimab reduced the incidence of RSV-associated medically attended lower respiratory infection (MALRI) and RSV-associated hospitalization in healthy infants, with a safety profile comparable to placebo.

Healthy preterm and full-term infants entering their first RSV season were randomized 2:1 in a double-blind manner to receive a single intramuscular 105 mg dose of clesrovimab or placebo on day 1. RSV surveillance was conducted through day 180. The proportions of participants in the clesrovimab and placebo groups with RSV-associated MALRI admitted to inpatient care between days 1-180 were evaluated. Intensive care unit (ICU) admission for the overall population in each group was evaluated during the same timeframe. For each treatment group, RSV acute respiratory infection cases from days 1-180 were analyzed to determine the proportions of participants meeting criteria for moderate or severe RSV-associated disease endpoints.

The efficacy population included 2,398 participants in the clesrovimab group and 1,201 in the placebo group. Through day 180, 19 of 77 participants with RSV-associated MALRI (24.7%; 95% confidence interval [CI], 15.6%-35.8%) in the placebo group and 3 of 64 (4.7%; 95% CI, 1.0%-13.1%) in the clesrovimab group required inpatient care. Four of 1,201 participants (0.3%) in the placebo group and none of 2,398 participants (0.0%) in the clesrovimab group were admitted to the ICU for RSV in the same period. A higher proportion of participants with RSV-associated acute respiratory infections from days 1-180 in the placebo group than in the clesrovimab group met criteria for RSV-associated hospitalization (18.8% vs 6.8%), RSV-associated lower respiratory infection hospitalization (18.2% vs 3.1%), and severe MALRI (7.8% vs 1.2%).

In the CLEVER study, a single dose of clesrovimab was associated with reduced RSV disease severity among RSV cases in the treatment group compared to RSV cases in the placebo group, as evidenced by less use of inpatient and intensive care and a lower proportion of acute infections meeting criteria for moderate to severe RSV-disease endpoints.

Board No: 53 #2026238

"Acyclovir-induced neurotoxicity mimicking viral encephalitis in an older adult"

Principal Presenter: Mariam Ghoneem

Track: General Infectious Diseases

Background
Intravenous acyclovir is the treatment of choice for suspected herpesvirus central nervous system (CNS) infection. However, acyclovir-induced neurotoxicity is a recognised but under-appreciated complication, particularly in older patients and those with renal impairment. The clinical presentation may closely mimic viral encephalitis, creating a diagnostic challenge and risking prolonged exposure to the offending agent.

Methods
We describe a clinical case of an older adult admitted to hospital who developed Varicella zoster virus ophthalmicus complicated by acute neurological deterioration while receiving intravenous acyclovir. Clinical assessment, laboratory investigations, neuroimaging, antimicrobial prescribing records, and multidisciplinary team documentation were reviewed retrospectively. Renal function trends were analysed in relation to antiviral exposure, and neurological progression was assessed using documented Glasgow Coma Scale (GCS) scores. Infectious Diseases and Renal specialist input was obtained during the admission.

Results
An 86-year-old woman developed Varicella zoster virus ophthalmicus during a prolonged hospital admission and was commenced on intravenous acyclovir at encephalitic dosing (approximately 10 mg/kg) due to concern for possible CNS involvement. Baseline renal function was normal (creatinine ~80 µmol/L; eGFR ~75 mL/min/1.73 m²).

Following initiation of acyclovir, renal function deteriorated progressively, with creatinine rising to a peak of 341 µmol/L and eGFR declining to a nadir of 10 mL/min/1.73 m². In parallel, the patient developed worsening encephalopathy, progressing from confusion to reduced consciousness, with a documented GCS nadir of 3/15. No focal neurological deficits were observed. Magnetic resonance imaging of the brain showed no evidence of encephalitis. Cerebrospinal fluid examination was not performed due to clinical frailty, lack of radiological support for encephalitis, and subsequent improvement following intervention.

After multidisciplinary review, including Infectious Diseases and Renal teams, acyclovir-induced neurotoxicity was suspected and antiviral therapy was discontinued. Renal function improved rapidly following cessation, with creatinine decreasing to 77 µmol/L, eGFR to 60 mL/min/1.73 m² within days and further recovery thereafter. Neurological status improved in parallel, with complete resolution of encephalopathy and return to baseline cognition.

Conclusion
This case highlights acyclovir-induced neurotoxicity as an important differential diagnosis in patients treated empirically for suspected viral encephalitis, particularly in the setting of acute kidney injury. Close monitoring of renal function, ongoing clinical reassessment, and early multidisciplinary involvement are essential to prevent severe, reversible neurological toxicity during antiviral therapy.

Board No: 54 #2026247

"Screening for Blood Borne Viruses in a Pilot Migrant Health Clinic"

Principal Presenter: Gemma Farmer
Keywords: Migrant Health

Track: Diversity & Inclusion

Background:
Screening for Blood Borne Viruses (BBV), including HIV, Hepatitis B and Hepatitis C, is recommended for migrants arriving in Ireland from countries with high BBV prevalence (1). Communicable diseases disproportionately affect marginalised patient groups, including migrants seeking protection which leads to poor health outcomes and public health risk. A newly established Migrant Health Clinic (collaboration and integration of inclusion health service at Tallaght University Hospital with the HSE Community Response for Vulnerable People team) aims to address difficulties accessing healthcare which are experienced by migrants seeking protection. We aimed to assess compliance with national recommendations for BBV screening for migrants seeking protection and assess the prevalence of HIV, hepatitis B and hepatitis C infection.

Methods:
We carried out a retrospective review of patient data from clinic attendances between 2nd of April and 10th December 2025. We assessed if BBV screening had been completed prior to clinic review and assessed rates of infection in this population. All data was anonymised prior to analysis.

Results:
59 patients attended the clinic from 19 countries between April and December 2025. 19% (11 patients) had BBV testing completed prior to attending the clinic. BBV screening results were available for 42 patients. 25% (15) of patients in the clinic had a positive result. 3 patients had active Hepatitis C infection, 1 patient had a diagnosis of HIV (which was previous known) and 13 patients had Hepatitis B core antibody positive, indicating resolved Hepatitis B infection.

Conclusion:
Migrants seeking protection in Ireland face difficulties accessing healthcare. This pilot clinic review demonstrates this population in Ireland have low levels of BBV screening completed despite national targets and high levels of BBV (2). National and international guidelines aim to eliminate hepatitis and HIV as public health threats by 2030 (3, 4). This data highlights the need for increased focus on BBV screening and access to appropriate treatment for migrants seeking protection in Ireland.

References
1. European Centre for Disease Prevention and Control. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA.
2. Teymur Noori et al. Strengthening screening for infectious diseases and vaccination among migrants in Europe: What is needed to close the implementation gaps? Travel Medicine and Infectious Disease, Volume 39, 2021.
3. World Health Organization Global Hepatitis Report 2017. Geneva 2017.
4. Recommended 2030 targets for HIV. Joint United Nations Programme on HIV/AIDS, Geneva, 2025.

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Board No: 55 #2024231

"An unfortunate series of events : diagnosing Fusobacterium pyogenic abscess"

Principal Presenter: Mustapha Kamal Aziz

Track: General Infectious Diseases

Liver abscess can be defined as an localized infection in the liver caused by microorganisms which in returnscauses the formation of abscesses. Pyogenic liver abscess tend to present with fever and would result in sepsis if not treated properly. The usual organism that would cause pyogenic liver abscesses include Escherichia
coli, Klebsiella spp., Enterococcus spp. and Streptococcus spp.

Fusobacterium spp are generally regarded as normal flora in the human body more so in the human oral cavity or gastrointestinal tract. We discuss here an unusual presentation of a 40 years old gentleman who presented to our facility with fever and abdominal pain for 2 weeks associated with nausea/vomiting after returning from Amsterdam.

The only significant medical history this patient had was that he was known to have inflammatory bowel disease. He initially had a raised D-dimer on arrival hence a CT Pulmonary Angiogram was performed whereby showed inhomogenous round hypodensities on the liver. He proceeded to have a CT abdomen/pelvis with contrast which showed multiple enhancing liver lesions.

Case was discussed with radiology team and they proceeded to do an aspirate. He was covered with cefuroxime and metronidazole at this stage for empirical coverage as per local antimicrobial guidelines. Blood cultures were negative to date and aspirate showed staphylococcus hominis from enrichment broth but was deemed insignificant. Sample was then sent to UK for 16S rDNA which showed Fusobacterium sp. however no differentiation of subspecies was available.

Patient was then treated with 6 weeks of intravenous ceftriaxone under OPAT but due to CT abdomen/pelvis showed slow improvement, his treatment was then extended for another 4 weeks (10 weeks in total).

Board No: 56 #2026272

"Trichophyton indotineae in Ireland: A Case Series of Three Patients with Antifungal-Resistant Dermatophytosis"

Principal Presenter: Anne O Toole
Keywords: Trichophyton, Dermatophytosis

Track: General Infectious Diseases

Background

Trichophyton indotineae is an emerging dermatophyte of global concern, characterised by extensive, inflammatory, and treatment-refractory tinea infections. Originally endemic to South Asia, it has now been identified across 41 countries, with European isolates accounting for 24.3% of reported cases. Resistance to terbinafine - the standard first-line systemic antifungal - is documented in up to 72% of isolates in endemic regions, with rising rates in non-endemic regions. Accurate identification requires molecular diagnostics, as conventional culture cannot reliably distinguish T. indotineae from closely related Trichophyton species. We present three cases identified at University Hospital Galway, which to our knowledge are among the first reported cases of T. indotineaein Ireland.

Methods

A retrospective case series was conducted of patients presenting to the Dermatology service at University Hospital Galway between 2024 and 2025 with recalcitrant dermatophytosis. Diagnosis was confirmed by mycological culture with species-level identification by molecular sequencing. Antifungal susceptibility testing was performed in all cases.

Results

Three patients of South Asian origin (one male, two females; ages 17–43 years) presented with longstanding, pruritic, annular, scaly plaques affecting multiple body sites. All had histories of treatment failure with terbinafine and/or topical antifungals prior to confirmed diagnosis. Case 1, a 33-year-old Indian woman with a four-year history of tinea corporis, demonstrated terbinafine and fluconazole resistance; she achieved complete clinical resolution following eight weeks of itraconazole combined with topical adjuncts. Case 2, a 43-year-old Pakistani man with longstanding tinea corporis, had pan-sensitive T. indotineae and responded well to eight weeks of itraconazole 200mg daily. Case 3, a 17-year-old Bangladeshi female with recurrent, fluconazole-resistant T. indotineae, experienced a prolonged and refractory course with poor response to multiple extended courses of itraconazole. She ultimately achieved clearance following topical application of griseofulvin oral solution, a novel approach informed by an incidental observation in a prior case.

Conclusion

These cases highlight the importance of considering T. indotineae in patients with recalcitrant dermatophytosis, particularly those with links to endemic regions. Early molecular diagnosis, antifungal susceptibility testing, and prolonged itraconazole-based therapy are central to management. The response to topical griseofulvin in a highly refractory case warrants further investigation. Clinicians in Ireland should maintain awareness of this emerging pathogen.

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Board No: 57 #2026274

"Implementing and Validating a Provider Down Emergency Response Procedure in a National High-Level Isolation Unit: A Simulation-Based Quality Improvement Study"

Principal Presenter: Stephenn Hernandez
Keywords: NHLIU, NIU, HCID

Track: Other

Background

Collapse of a healthcare worker wearing high-level personal protective equipment (PPE) in a High-Level Isolation Unit (HLIU) represents a rare but high-consequence emergency requiring rapid extraction while preserving infection prevention and control (IPC) measures. Such events present operational challenges including contamination risk, communication barriers in PPE, and complex team coordination. Although provider down procedures are described in international biocontainment units, structured validation within national HLIU settings remains limited.

Methods

A draft Provider Down standard operating procedure (SOP) was developed using international biocontainment guidance and adapted to the National High Level Isolation Unit (NHLIU) Red–Yellow–Green zoning or unidirectional flow system. Validation was conducted using Zone 3 of the SimZones framework, focusing on team and system performance in the clinical environmen. Cycle 1 baseline testing involved a full in-situ simulation of a healthcare worker collapse in high-level PPE within the Red Zone. Data sources included observer tools, timing metrics, breach logs, participant feedback, video review, and structured hot and cold debrief sessions. Findings were analysed using a Plan–Do–Study–Act approach to identify latent safety threats and inform protocol refinement.

Results

Cycle 1 simulation established baseline response metrics and identified several system-level vulnerabilities. Recognition of the Provider Down event occurred at 1 min 20 sec, with responder donning requiring 5 minutes for the first responder and up to 9 minutes for the full team. Transfer from the Red Zone to the Transition Zone occurred in 1 min 03 sec, followed by PPE decontamination (3 min 55 sec) and PPE cut-down (5 min 02 sec). Log-roll transfer to the clean area required 49 sec, with final transfer completed in 1 min 51 sec.

Key vulnerabilities included communication barriers from powered air-purifying respirator noise, uncertainty in PPE cut-down sequencing, responder donning delays, manual handling risks, and environmental constraints affecting zone transitions. Positive findings included clear recognition of the event, effective leadership by the NHLIU coordinator, and controlled movement between zones.

Conclusion

Simulation-based testing enabled system-level evaluation of a proposed Provider Down procedure within a national HLIU. The exercise identified operational, human factors, and IPC risks not evident during protocol development and informed targeted refinements. Further simulation cycles are planned prior to implementation to strengthen operational reliability in high-risk, low-frequency emergencies.

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Board No: 58 #2026265

"An Audit Of Antimicrobial Prophylaxis For Portacath Insertion."

Principal Presenter: Louise Lyons

Track: Other

Background:

Prophylactic antibiotics are widely used in interventional radiology for many procedures including placement of tunnelled central venous catheters, portacaths, and nephrostomies in addition to tumour ablation and embolisation. In our department, currently three consultants perform portacath insertions, with differing antibiotic prophylaxis regimens: two routinely prescribe prophylactic teicoplanin while one does not. Teicoplanin is chosen as it covers a range of Gram-positive bacteria including staphylococcus aureus, although it is recognised that Teicoplanin does not cover against all microbes such as Pseudomonas aeruginosa and only covers against some strains of VRE.

We audited these practices to identify the difference, if any, in portacath infection rates between these two practices. For the purposes of this audit, infection was defined as the presence of clinical signs of local infection, such as swelling, erythema and purulent discharge or blockage.

Methods:

Data was retrospectively collected from the 1st of January to the 30th of September 2025 using the Picture Archiving and Communication System (PACS). The data was cross-referenced with TPro-generated clinical letters. These data were subsequently cross checked with blood culture results from iLab.

Results:

In a nine-month period, 168 portacaths were inserted: 118 patients received prophylactic antibiotics (Teicoplanin) and 50 received none.

None of the 168 port insertions were associated with microbiology-proven infections in the first 30 days post portacath insertion. Infections following this period are more likely related to line care rather than infection introduced at the time of insertion.

Of the 168 portacaths inserted, 3 were removed, 2 of which were removed because of superinfection.

Of the infected portacaths removed, one which had been inserted with prophylactic cover had microbiology-proven infection with pseudomonas aeruginosa grown from a wound swab.

The second portacath removed (which had been inserted without antibiotic prophylaxis) had positive blood cultures for mixed growth Gram-negative bacilli; however, this was presumed to have been seeded from an identified septic source in the abdomen.

Discussion:

This audit demonstrates that there was no microbiology-confirmed infection within 30 days from portacath insertion regardless of prophylactic status. The infections that did occur beyond the 30-day window involved organisms that are not covered by teicoplanin. These findings support the hypothesis that routine antibiotic prophylaxis is not required for portacath insertions.

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Board No: 59 #2026256

"Engaging all pharmacists in antimicrobial stewardship through the development of Pharmacist Antimicrobial Stewardship Network (PAMS-net)"

Principal Presenter: Ellen Martin

Track: Other

Background and Objectives

Engaging all healthcare professionals in antimicrobial stewardship (AMS) is key to improving patient safety and reducing harm associated with inappropriate antimicrobial use and reducing antimicrobial resistance (AMR).

Pharmacists have significant impact promoting responsible use of antimicrobials in many settings: community, hospital, academia, regulatory. A need was identified for a more joined up approach to AMS across the pharmacy profession to support shared learning and maximise pharmacists’ involvement in AMS.

Methods or Approach

· HSE AMRIC, Irish Institute of Pharmacy (IIOP) partnership established.

· Virtual focus group February 2022 to explore needs.

· PAMS-net working group established June 2022.

· Network launch in collaboration with key stakeholders and working group members.

· PAMS-net webpage, discussion forum and regular educational webinars available to all registered pharmacists. Webinars open to Pharmacy students.

· Baseline member survey to identify resource and support requirements.

· Monitoring of new registrations and discussion forum engagement overtime.

Key Results:

· PAMS-net launched August 2022

· Quarterly meetings of PAMS-net working group.

· Four educational webinars hosted to date.

· 282 members (data: April 2025).

· Diverse representative of members from every corner of the pharmacy profession (Figure 1).

· Wide spread of AMS knowledge and confidence implementing AMS across membership (Figure 2).

· To date: 1,339 discussions viewed and 275 posts to the PAMS-net discussion forum.

· Educational event June 2025 survey 11/12 respondents stated: joining PAMS-net /posts in the discussion forum had increased engagement/participation in AMS in their day-to-day practice.

Conclusions and Implications:

HSE AMRIC, IIOP and PAMS-net working group collaborated to create inclusive network to empower AMS engagement across pharmacy profession. Sharing AMS knowledge and learning both across and within all settings is key to tackling the global public health threat of AMR.

Future plans are to continue to grow membership, conduct survey to inform future direction based on the needs of the members, maintain two-way engagement and provide further AMS education.

Board No: 60 #2024232

"HIV, HLH, & Histoplasmosis; a Case Report."

Principal Presenter: Stiofán Mac Giolla Catháin
Keywords: Histoplasmosis, Case Report, Opportunistic Infections

Track: Other

Background: This case report examines the complex care considerations in a university student originally from Gambia presenting with advanced HIV who was diagnosed with a diverse catalogue of opportunistic infections. This patient’s case has themes of advanced pathophysiology, complex pharmacology with drug-drug interaction considerations, and holistic multidisciplinary care.

Case presentation: A 25-year-old university student from Gambia presents to an acute hospital with fevers, weight loss, profuse diarrhoea, fatigue and shortness of breath. Pneumocystis jiroveci pneumonia is diagnosed after CT Thorax shows typical pathology with a raised Beta D Glucan. Blood borne virus screening is positive for HIV with a CD4 cell count of 35 (<1%). Further investigation reveals viraemia with CMV, EBV, and adenovirus. Antiretrovirals are started 10 days after HIV diagnosis is confirmed. Haemophagocytic lymphohistiocytosis (HLH) is subsequently diagnosed with a H score of 188 and immune reconstitution inflammatory syndrome (IRIS) suspected as the HLH trigger. Empiric treatment for mycobacterial infection is commenced, and blood cultures are subsequently positive for Mycobacterium avium intracellulare. Stool PCR is positive for cryptosporidium. Histoplasma antigen is positive in urine and cerebrospinal fluid and treatment is commenced for central nervous system histoplasmosis. Fungaemia is recognised with positive PICC line blood cultures for Candida kursei for which caspofungin is commenced. Therapeutic drug monitoring is done to assess levels of multiple anti-infectives with sub therapeutic levels for rifabutin and posaconazole encountered.

Discussion: Multiple synchronous opportunistic infections are diagnosed in a frail cachectic patient presenting with complications of advanced HIV infection. In this case, IRIS is the trigger for the life-threatening complication of HLH. Further investigation revealed a diverse catalogue of opportunistic infections. The simultaneous management of cryptosporidiosis, MAI infection, EBV/CMV viraemia, CNS histoplasmosis, and bowel failure posed multiple challenges relating to drug-drug interactions, subtherapeutic plasma drug concentrations, and complications of invasive therapies. A patient-centred holistic approach to care was taken throughout his prolonged and continued hospitalisation with some positive milestones of recovery.

Conclusion: Complications of advanced HIV including opportunistic infections warrant timely diagnosis and treatment to preserve life and prevent morbidity. The simultaneous management of multiple opportunistic infections in the context of HLH as in this patient’s case presents a valuable opportunity for learning for HIV physicians

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Board No: 61 #2026283

"Early Switch to CAB+RPV LA in Treatment-Naive Adults With HIV-1: Month 11 Outcomes From VOLITION"

Principal Presenter: Lorraine Glynn
Keywords: Long-acting injectable therapy, Treatment-naive HIV-1 / early switch strategy, Shared decision-making / patient preference

Track: Virology

1Orlando Immunology Center, Orlando, FL, USA; 2ViiV Healthcare, London, UK; 3Fundación Huésped, Buenos Aires, Argentina; 4Clinical Department, L’Actuel Medical Clinic, Montreal, QC, Canada; 5Faculty of Medicine, Universidad San Sebastián, Chile; 6Infectious Diseases Unit, Internal Medicine Department, J. M. Morales Meseguer General University Hospital, Murcia, Spain; 7Infectious Diseases and Artificial Intelligence Group, Biomedical Research Institute of Murcia Pascual Parrilla-IMIB, Murcia, Spain; 8Department of Internal Medicine, Faculty of Medicine, University of Murcia, Murcia, Spain; 9Centre Hospitalier Universitaire d’Orléans, Orléans, France; 10Infectious Diseases Unit, IRCCS, San Raffaele Scientific Institute, Milan, Italy; 11Department of Gastroenterology, Hepatology, and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; 12GSK, Bengaluru, Karnataka, India; 13ViiV Healthcare, Durham, NC, USA; 14ViiV Healthcare, Montreal, QC, Canada; 15GSK, Dublin, Ireland

*Presenting on behalf of the authors.

Background: Long-acting cabotegravir + rilpivirine (CAB+RPV LA) and daily oral dolutegravir/lamivudine (DTG/3TC) are integrase strand transfer inhibitor–based, antiretroviral therapy (ART) regimens with different indications, modalities, and dosing schedules. VOLITION (NCT05917509) is the first study to evaluate an optional CAB+RPV LA switch, based on participant choice, immediately after attaining virologic suppression with DTG/3TC in adults with HIV-1 naive to ART. Median time to suppression on DTG/3TC was 4.1 weeks (95% CI: 4.1–4.3). We present VOLITION Month 11 (M11) outcomes for participants opting for a switch to CAB+RPV LA.

Methods: VOLITION, a phase 3b, multicenter, non-randomized, open-label study, enrolled adults naive to ART with plasma HIV-1 RNA ≥1000 copies/mL receiving DTG/3TC during a suppression phase of up to 16 weeks. After reaching virologic suppression (HIV-1 RNA <50 copies/mL) anytime from Week 4 to 16, eligible participants were offered the choice to switch to CAB+RPV LA, dosed Q2M, at the next study visit (Day of Choice [DoC]) or to continue DTG/3TC. A co-primary endpoint was the proportion with HIV-1 RNA <50 copies/mL per Snapshot algorithm at M11 with CAB+RPV LA. Participant experience and safety were assessed.

Results: At DoC, 129/151 (85%) participants switched to CAB+RPV LA, among whom 51% were Hispanic/Latine, 33% were Black or African American, and 26% were women. At M11, 113 (88%) had HIV-1 RNA <50 copies/mL, six (5%) had HIV-1 RNA ≥50 copies/mL, and 10 (8%) had no virologic data per the modified Snapshot algorithm. The observed virologic suppression rate at M11 was 95% (n=113/119 with available virologic data in-window). One (<1%) participant had confirmed virologic failure (CVF) with integrase strand transfer inhibitor and non-nucleoside reverse transcriptase inhibitor resistance. Top reasons for switching were avoiding missed doses (n=103, 80%), not needing pills for travel (n=88, 68%), and convenience (n=82, 64%). Moreover, the participants reported high treatment satisfaction (HIV Treatment Satisfaction Questionnaire score of 57.6 at DoC; 62.5 at M11). Long-acting CAB+RPV was well tolerated and no new safety signals were identified; drug-related adverse events (excluding injection site reactions) occurred in 13 (10%) participants.

Conclusion: Most participants naive to ART switched to CAB+RPV LA after achieving virologic suppression on daily oral therapy, demonstrating the importance of choice in addressing individualized needs. Empowering people to choose their preferred treatment through shared decision-making can enable treatment success, as shown by high rates of virologic suppression, low rates of CVF with resistance, and high treatment satisfaction at M11 with CAB+RPV LA.

Word count (limit 400): 400

Prior presentation: Data included in this abstract have previously been presented in full at the Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO; Poster 526.

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Board No: 62 #2026262

"Antiretroviral therapy regimen changes upon moving to Ireland among people living with HIV from Ukraine, findings from an Irish cohort study of Ukrainians in Ireland under the Temporary Protection Directive"

Principal Presenter: Cian Carey
Keywords: HIV, Antiretroviral therapy, Temporary Protection Directive

Track: Virology

BACKGROUND
Since 2022, over 112,000 Ukrainian refugees have arrived in Ireland under the Temporary Protection Directive. Given the higher prevalence of HIV in Ukraine, HIV services in Ireland have experienced a significant increase in enrolment. Moreover, the availability of antiretroviral therapy (ART) in many parts of the country has been interrupted by the ongoing war. Furthermore, in contrast to the European Union, where it is not available, the fixed-dose, single-tablet combination ART regimen tenofovir disoproxil/lamivudine/dolutegravir (DTG/TDF/3TC, or “TLD”) is Ukraine’s most frequently prescribed drug combination, and accounts for up to 80% of treatment regimens nationwide. It remains unclear what is the optimal ART selection for patients transferring care from Ukraine in these circumstances.

METHODS
We included people living with HIV (PLHW) from Ukraine who were reviewed in the infectious disease’s clinic in CUH and had arrived in Ireland since 2022. We collated data pertaining to their antiretroviral regimens before and after moving to Ireland. We subsequently examined changes made to antiretroviral regimens after arriving in Ireland.

RESULTS
Fifty-nine PLWH from Ukraine were included. Of these 9(15%) were newly diagnosed in Ireland, and 8(13%) were previously diagnosed with HIV but were not taking ART on arrival in Ireland. The most frequently prescribed ART regimen among new arrivals from Ukraine was DTG/TDF/3TC (“TLD”), in 28(69%) patients. Integrase inhibitor-based regimens accounted for 37(73%) initial ART regimens. Thirty-four (83%) patients who were already taking ART had their regimen modified upon review in the CUH HIV clinic. ART regimens were most frequently changed to DTG+TDF/emtricitabine (FTC) (71%, n=24). A further 6(10%) were commenced on the dual DTG/3TC regimen. Of the 18 patients not previously on treatment for HIV, 10(56%) were initiated on DTG+TDF/FTC, and 4(22%) on Bictegravir/Tenofovir Alafenamide/FTC (BIC/TAF/FTC).

CONCLUSION
HIV services in Ireland have experienced a significant increase in enrolment since the arrival of Ukrainian refugees under the Temporary Protection Directive. Many of them are taking ART regimens which are not available in Ireland and thus require alternative treatments. DTG+TDF/FTC is the most frequently prescribed regimen for this cohort.

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Board No: 63 #2026282

"Injection Site Reactions More Common and Bothersome With Single Doses of Lenacapavir vs Cabotegravir"

Principal Presenter: Lorraine Glynn

Track: Virology

1ViiV Healthcare, Durham, NC, USA; 2ViiV Healthcare, London, UK; 3ViiV Healthcare, Madrid, Spain; 4Ark Clinical Research, Long Beach, CA, USA; 5GSK, London, UK; 6GSK, Durham, NC, USA; 7GSK, GCC, Bengaluru, India; 8ViiV Healthcare, Rueil-Malmaison, France; 9GSK, Dublin, Ireland

*Presenting on behalf of the authors.

Background: Differences in injection site reaction (ISR) profiles are an important consideration when choosing long-acting injectables (LAIs). Nodules and indurations are of interest given their potential for long-lasting inflammatory effects and inadvertent disclosure of therapy if visible, yet data remains lacking on their characteristics. The CLARITY study (NCT06970223) provides detailed ISR evaluation after 1 dose each of cabotegravir IM (CAB) and lenacapavir SC (LEN) injections.

Methods: CLARITY is an open-label, randomized crossover study (CAB IM and LEN SC) in 63 adults without HIV. The primary endpoint was ISR acceptability 7 days after injection using the Perception of Injection (PIN) questionnaire. Secondary endpoints evaluate participant preference and ISR incidence, severity and duration through 6-month follow-up. Size and inflammatory components of ISRs are assessed using a combination of 2D photography and 3D ultrasound. We report detailed visible/palpable ISR events of interest ≤190 days after administration of each drug.

Results: We enrolled 63 diverse participants including 33% female, 38% Hispanic, and 29% Black. Previously this study showed higher ISR acceptability and preference for 1 dose of CAB over LEN. Frequency (LEN, n=642 vs CAB, n=150) and grade (≥ grade 2 LEN 52% vs CAB 30%) of ISRs were higher with LEN vs CAB injections. Participants experienced more visible/palpable ISRs of interest with LEN vs CAB, with induration reported in 87% (54/62) vs 20% (12/61) and nodules in 100% (62/62) vs 57% (35/61), respectively. After 190 days, total visible nodules (CAB, 5 vs LEN, 78) and indurations (CAB, 10 vs LEN, 84) were higher with LEN. By modified DAIDS grading criteria (nodules assigned to equivalent induration DAIDS grading criteria where ISRs <2.5 cm in diameter or <6.25 cm2 in surface area were classified as grade 1 to allow size comparison), 33 CAB and 98 LEN nodules were grade 1, while 2 CAB and 26 LEN nodules were grade 2. Of indurations, 10 were grade 1 and 2 were grade 2 after CAB injections, and 92 were grade 1 and 2 were grade 2 after LEN injections. Across all PIN domains (bother, movement, sleep, acceptability) and individual item assessments (anxiety before/after injection, pain, satisfaction, willingness to continue), participants reported better scores for CAB vs LEN.

Conclusion: The CLARITY study found significant differences in ISRs between CAB and LEN after 1 dose each, including more long-lasting, visible, and bothersome ISRs with LEN. These data are critical for informing individuals and their providers regarding LAIs.

Prior presentation: Data included in this abstract have previously been presented in full at the Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO; Poster 988.

Board No: 64 #2026259

"Patient-Reported Outcomes after 52 Weeks of Twice-Yearly Lenacapavir, Teropavimab, and Zinlirvimab"

Principal Presenter: Conor Moran

Track: Virology

Background: Lenacapavir (LEN), an HIV-1 capsid inhibitor, in combination with the broadly neutralising antibodies teropavimab (TAB) and zinlirvimab (ZAB), is being evaluated as a twice-yearly (Q6M) treatment regimen for HIV-1 in a Phase 2 open-label study (NCT05729568). We report Week (W) 52 patient-reported outcomes (PROs) assessing treatment preference, treatment satisfaction, and health-related quality of life (HRQoL).

Methods: Virologically suppressed adults (HIV-1 RNA <50 copies/mL) receiving oral antiretroviral therapy (ART) for ≥12 months, with HIV-1 highly susceptible to TAB and ZAB, were enrolled. Participants were randomised 2:1 to switch to subcutaneous LEN 927 mg (with oral LEN loading) plus intravenous TAB 2550 mg and ZAB 2550 mg administered Q6M, or to continue baseline (BL) daily oral ART. PRO instruments included the HIV Treatment Preference Questionnaire (HIVTPQ), HIV Treatment Satisfaction Questionnaire–Status (HIVTSQstatus), and HIV Dependent Quality of Life (HIVDQoL) questionnaire. Descriptive statistics and complete-case analyses were conducted for participants receiving LEN, TAB, and ZAB who completed questionnaires at BL, W26, and W52; Wilcoxon signed-rank tests were applied to continuous outcomes.

Results: Among 53 participants receiving LEN, TAB, and ZAB, 85% were male, 53% were White, 91% were from the United States, and the mean (SD) age was 44 (14) years; 42/53 completed ≥1 PRO questionnaire at BL, W26, and W52. At W52, 32/42 (76%) participants preferred LEN, TAB, and ZAB over daily oral ART (HIVTPQ: strong preference, n=29; moderate preference, n=3), and 38/42 (91%) reported that LEN, TAB, and ZAB would improve adherence compared with daily oral ART. Mean (SD) HIVTSQstatus scores increased from 58 (8) at BL to 62 (8) at W52 (n=41; p=0.03). At W52, the highest proportions of participants reporting being “very satisfied” were for HIV-1 control (37/41; 90%), treatment flexibility (33/41; 80%), and understanding of HIV-1 (33/41; 80%). HIVDQoL scores improved following the switch from oral ART, with 34/37 (92%) and 36/37 (97%) participants reporting good-to-excellent HRQoL at BL and W52, respectively; 6/37 (16%) and 14/37 (38%) reported excellent HRQoL.

Conclusion: Consistent with W26 findings, participants demonstrated moderate-to-strong preference for the first all-injectable twice-yearly regimen over daily oral ART, with higher treatment satisfaction and improved HRQoL maintained through W52 following the switch to LEN, TAB, and ZAB.

Board No: 65 #2026252

"Efficacy and Safety of Doravirine/Islatravir (100/0.25mg) in Adults with HIV and Renal Impairment"

Principal Presenter: Claire O'Dwyer

Track: Virology

BACKGROUND Renal impairment (RI )is a common comorbidity in PLWH. The availability of safe and effective ARVs in people with RI is important, especially as the population of PLWH ages. DOR/ISL, an investigational once-daily HIV treatment, had a favorable renal safety profile in prior studies with DOR/ISL (100/0.75mg). This post hoc analysis of 2 Phase 3 studies, which included participants with creatine clearance >30 mL/min, evaluated DOR/ISL efficacy and safety in virologically suppressed PLWH with RI.

METHODS P051 and P052 evaluated PLWH who switched to DOR/ISL (100/0.25mg) from baseline antiretroviral therapy (bART) or bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Data from P051/P052 DOR/ISL participants were pooled; analyses included within-group comparisons for participants with mild (60 to <90mL/min/1.73m2) and moderate (30 to <60mL/min/1.73m2) RI vs those with normal (≥90 mL/min/1.73m2) renal function at baseline for HIV RNA <50 copies/mL, CD4+ T-cell count, drug-related adverse events (DR-AEs), and serious AEs, and between-group comparisons for estimated glomerular filtration rate (eGFR) by creatinine and cystatin C (to account for potential effects of certain ARVs on tubular creatinine secretion).

RESULTS Of 707 DOR/ISL participants at baseline, >90% had normal renal function or mild RI based on eGFR-creatinine (36.5% normal, 54.0% mild RI, 9.5% moderate RI). In the DOR/ISL group, rates of HIV RNA <50 copies/mL (93.4%, 93.2%, 97.0%), mean change in CD4+ T-cell count (20.3, 17.9, 4.6 cells/mm3), DR-AEs (10.5%, 12.3%, 7.5%), and serious AEs (4.7%, 6.0%, 4.5%) were generally similar for those with normal renal function, mild RI, and moderate RI at Week 48, respectively. Among participants with mild or moderate RI who switched to DOR/ISL, renal function remained stable at Week 48 per eGFR (by creatinine and cystatin C). eGFR-creatinine improved in all renal function categories in those who switched to DOR/ISL vs the bART and BIC/FTC/TAF groups, consistent with inhibitory effects of some ARVs on creatinine secretion, while mean change in eGFR-cystatin C was comparable across all groups

CONCLUSIONSl DOR/ISL had a similar efficacy and safety profile in participants with mild or moderate RI compared to those with normal renal function. For participants in all renal function categories, switching to DOR/ISL did not adversely impact renal function through Week 48.

Board No: 66 #2026281

"EBONI M12 Results: High Real-World Effectiveness and Acceptance of CAB LA for PrEP in Black Women"

Principal Presenter: Lorraine Glynn
Keywords: Pre-exposure prophylaxis (PrEP), Long-acting injectable prevention, Implementation and patient acceptability

Track: Virology

1Faebris Medical & Community Education, Atlanta, GA, USA; 2ViiV Healthcare, Durham, NC, USA; 3Abounding Prosperity, Inc, Dallas, TX, USA; 4Whitman-Walker Institute, Washington, DC, USA; 5GSK, Bangalore, India; 6GSK, Collegeville, PA, USA; 7ViiV Healthcare, London, UK; 8GSK, Dublin, Ireland

*Presenting on behalf of the authors.

Background: Black women accounted for approximately half of all HIV diagnoses among US cisgender and transgender women in 2023. Uptake and persistence of oral PrEP is low among Black women, and less than 20% persist after 6 months. We report outcomes through Month (M) 12 with long-acting cabotegravir (CAB LA) from the EBONI (NCT05514509) study, the first study of implementation in US Black women evaluating CAB LA for PrEP.

Methods: EBONI is a phase 4 hybrid real-world effectiveness and implementation science study evaluating integration of CAB LA across 20 practice sites for Black cisgender and transgender women. HIV incidence, persistence, safety, and tolerability were utilized as clinical assessments. At M12, implementation questionnaires (IQs) assessed injection pain, local reactions (LRs), and acceptability of CAB LA.

Results: Between January 2023 and September 2025, 163 women initiated CAB LA and 99 completed M12 IQs. A quarter (25%) were transgender women, and median age was 35 (IQR=29-42) years. Nearly half (44%) had no oral PrEP use in the 6 months before initiating CAB LA. CAB LA persistence was 74% at M6 and 57% at M12 (n=93/163), where 69%-89% received injections during the ±7-day window through M12. Most participants (61%; n=100/163) were of childbearing potential, 6% (n=6/100) of whom became pregnant. Every-2-month clinic visits were deemed very acceptable (83%), with women noting benefits including improved provider relationships and increased screenings for health conditions like diabetes or high blood pressure. Frequency of HIV (94%) and STI (92%) testing was acceptable; 15 STIs were detected through M12 (gonorrhea, n=7; chlamydia, n=7; syphilis, n=1) in 13 women (8%; n=5 cisgender women, n=8 transgender women). During EBONI, no instances of HIV acquisition occurred. Injection pain and LRs were both found acceptable (87% and 84%, respectively). After the first injection, pain decreased for subsequent injections. Daily activities were resumed immediately after the injection appointment for most (88%) participants. Drug-related adverse events (AEs; 3%, n=5/163) were rare, and 2% (n=3) discontinued due to AEs. In EBONI, 95% of women would recommend CAB LA; 86% reported “very positive” feelings about receiving CAB LA.

Conclusion: EBONI provides compelling evidence that CAB LA for PrEP remains highly effective and acceptable in real-world settings. Instances of discontinuation may emphasize variability in care continuity or perceived PrEP need. Rare AEs, no HIV acquisition, persistence relative to oral PrEP, and ancillary clinical benefits reported in EBONI underscores how CAB LA can fulfill the needs of diverse populations.

Prior presentation: Data included in this abstract have previously been presented in full at the Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO; Poster 1081.

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Board No: 67 #2026251

"Switch to DOR/ISL (100/0.25 mg) QD from BIC/FTC/TAF: 96-Week Update from a Blinded Phase 3 Study Switch to DOR/ISL (100/0.25 mg) QD from BIC/FTC/TAF: 96-Week Update from a Blinded Phase 3 Study"

Principal Presenter: Claire O'Dwyer

Track: Virology

Background:

The NNRTI doravirine (DOR) and the investigational nucleoside reverse transcriptase translocation inhibitor (NRTTI) islatravir (ISL) have complementary mechanisms of action and resistance profiles. The primary analysis of the MK8591A-052 study in people living with HIV-1 demonstrated that switching to DOR/ISL 100 mg/0.25 mg was noninferior to continuing bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in maintaining virologic suppression at Week 48. Here we present Week 96 efficacy and safety data from this study.

Methods:

Phase 3, double-blind clinical trial (NCT05630755) in adults with HIV-1 RNA <50 copies/mL for ³3 months on BIC/FTC/TAF, CD4+ T-cell count ≥50 cells/mm3, and no prior therapy failure or known DOR resistance. Participants were randomized 2:1 to switch to DOR/ISL (100/0.25 mg) or continue BIC/FTC/TAF. Discontinuation was required for confirmed decline in total lymphocytes (≥30% and <1.0 x109/L) or CD4+ T-cells (≥30% and either <350 cells/mm3 if ≥350 at baseline or <200 cells/mm3 if ≤349 at baseline). The proportion of participants with HIV-1 RNA ≥50 copies/mL (FDA snapshot) at Week 96 was a secondary endpoint. Other virologic outcomes (HIV-1 RNA <50 and <200 copies/mL), safety, and tolerability through Week 96 were also assessed.

Results:

Overall, 342 participants were switched to DOR/ISL and 171 continued BIC/FTC/TAF. At Week 96, 5 (1.5%) participants on DOR/ISL vs 2 (1.2%) on BIC/FTC/TAF had confirmed HIV-1 RNA ≥50 copies/mL (difference: 0.3%, 95% confidence interval: -2.8, 2.4); 2 (0.6%) vs 0, respectively, had discontinued due to lack of efficacy; and 3 (0.9%) vs 1 (0.6%), respectively, had discontinued for other reasons with HIV-1 RNA ≥50 copies/mL at discontinuation. Proportions of participants with adverse events (AEs) through Week 96 were similar between groups. The Week 96 DOR/ISL AE profile was similar to Week 48 with no new safety findings. There were no differences between arms in CD4+ T-cell or total lymphocyte count (TLC) changes through Week 96. In both groups, 0.6% (DOR/ISL n=2, BIC/FTC/TAF n=1) discontinued due to protocol-specified decreases in CD4+ T-cell and/or TLC counts.

Conclusions:

DOR/ISL (100/0.25 mg) maintained a high rate of virologic suppression and had similar efficacy to BIC/FTC/TAF at Week 96. DOR/ISL demonstrated an AE profile comparable to BIC/FTC/TAF and did not adversely affect lymphocytes. These findings are consistent with the study’s primary Week 48 results.

Board No: 68 #2026244

"HIV Clinical Characteristics at Enrolment Among Ukrainian Beneficiaries of Temporary Protection Attending an Irish HIV Service"

Principal Presenter: Cian Lenihan
Keywords: HIV, Migrant, Inclusion

Track: Virology

Background: Since 2022, people in receipt of temporary protection from Ukraine have entered Irish HIV services. Forced migration may disrupt antiretroviral therapy (ART) and access to opportunistic infection prophylaxis. We describe HIV clinical characteristics at enrolment to a regional Irish HIV service.

Methods: A retrospective chart and laboratory review of adults (≥18 years) from Ukraine living with HIV enrolled in Cork University Hospital (CUH) HIV outpatient service was performed. Data collected included years since diagnosis, viral load (VL) and CD4 T lymphocyte count (CD4) at first enrolment to HIV care in Ireland, genotypic resistance results and documented resistance-associated mutations (RAMs), and indication for co-trimoxazole prophylaxis. Descriptive statistics were used. Local institutional approval was obtained (CUH clinical audit and quality improvement committee), and the project was conducted in accordance with local governance requirements.

Results: Sixty-one people were included (36 women; mean age 46.6 years). Mean time since HIV diagnosis was 11.4 years; eight (13%) were diagnosed in Ireland. At enrolment to HIV care in Ireland, 40/61 (66%) had a suppressed VL (below assay detection), indicating sustained ART adherence despite displacement. Among those with detectable VL (19/61; 31%), values ranged from 63 copies/mL to 10 6.2 copies/mL; VL was unavailable in two. Mean CD4 at enrolment was 582.6 cells/mm³ (median 546.5; range 2–1569). Genotypic resistance testing was documented in 32/61 (52%); RAMs were identified in 3/32 (9%), while 29/32 (91%) had no RAMs detected. Co-trimoxazole prophylaxis was indicated in eight (13%); only four (50%) had access at enrolment.

Conclusion: Most people arriving from Ukraine entered care with preserved immune function and high rates of viral suppression, highlighting resilience and continuity of ART during conflict-related migration. However, gaps in access to essential prophylaxis were identified and warrant targeted systems to ensure timely prescribing and dispensing at first contact with services.

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Board No: 69 #2026258

"Once-Weekly Islatravir Plus Lenacapavir Maintains HIV-1 Suppression Through 96 Weeks: Phase 2 Study"

Principal Presenter: Conor Moran

Track: Virology

Background: Islatravir (ISL), a nucleoside reverse transcriptase translocation inhibitor, combined with lenacapavir (LEN), a capsid inhibitor, provides a complete, oral once-weekly antiretroviral regimen. In a Phase 2 study (NCT05052996), once-weekly ISL+LEN achieved 94.2% virologic suppression at Week (W) 48 in virologically suppressed (VS) adults with HIV-1. We report efficacy, safety, and adherence outcomes through W96.

Methods: This randomised, open-label, active-controlled study enrolled VS adults receiving bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). Participants were randomised 1:1 to B/F/TAF or ISL 2 mg + LEN 300 mg once weekly. After 48 weeks, all participants had the option to enter an extension phase where they received ISL+LEN for 48 weeks; those in the continuous and switch groups received ISL+LEN for a total of 96 weeks and 48 weeks, respectively. For this analysis, baseline was defined as the last assessment prior to the first dose of ISL+LEN. Outcomes assessed at W96 included HIV-1 RNA ≥50 copies/mL, adherence by pill count, adverse events (AEs), CD4+ T-cell and lymphocyte counts, weight, and body mass index (BMI).

Results: Ninety-seven participants received ISL+LEN (median age 40 years; 18.6% female), including 52 in the continuous group and 45 in the switch group. No participants had HIV-1 RNA ≥50 copies/mL at W96 or at discontinuation, and no emergent resistance to ISL or LEN was detected. Mean adherence was high across treatment groups (99.3% and 98.6%, respectively). Study drug-related AEs occurred in 10 participants (19.2%) in the continuous group (dry mouth [n=2], nausea [n=2]) and in 2 participants (4.4%) in the switch group (fatigue [n=1], sleep disorder [n=1]). Two participants discontinued due to unrelated AEs in the continuous group and no participants in the switch group discontinued due to AEs. There were no serious drug-related AEs or deaths. CD4+ T-cell and lymphocyte counts showed no clinically significant changes from baseline through W96 in either group; median weight and BMI changes were modest and comparable across groups.

Conclusion: Through W96, once-weekly oral ISL+LEN maintained virologic suppression with good tolerability, supporting a complete once-weekly oral regimen for HIV-1. Phase 3 studies (ISLEND-1, NCT06630286; ISLEND-2, NCT06630299) are ongoing.

Board No: 70 #2026240

"Chronic Hepatitis B Treatment And Monitoring Audit"

Principal Presenter: Ahmed Hamad
Keywords: Chronic Hepatitis B, OPD, Quality Improvement

Track: Virology

Background

Chronic hepatitis B virus (HBV) infection remains a major global public health challenge, associated with significant morbidity, mortality, and risk of hepatocellular carcinoma (HCC). International guidelines emphasise structured monitoring, risk stratification, and timely antiviral treatment to prevent disease progression. Regular clinical audit is essential to ensure adherence to evidence-based standards and optimisation of patient outcomes. This audit evaluated compliance with European Association for the Study of the Liver (EASL) 2017 Clinical Practice Guidelines for the investigation, monitoring, and treatment of chronic HBV infection within a tertiary Infectious Diseases outpatient service in University Hospital Waterford (UHW).

Methods

A retrospective clinical audit was conducted of adult patients attending the Infectious Diseases outpatient clinic with chronic HBV infection over a 12-month period. Data were collected from medical records, laboratory systems, imaging databases, and electronic clinical platforms. Standards assessed included EASL treatment eligibility criteria, virological and biochemical monitoring, fibrosis assessment, imaging surveillance, co-infection screening, and treatment initiation. Non-invasive fibrosis assessment tools (FIB-4 score, ultrasound, and Fibroscan) were evaluated in place of liver biopsy. Compliance was measured against predefined audit criteria, with quantitative analysis using descriptive statistics (frequencies and percentages). No inferential statistical testing was performed due to the small sample size.

Results

Thirteen patients were included. HBV DNA and serum ALT were recorded in 100% of patients. HBV DNA ≥2,000 IU/mL was identified in 2/13 patients (15.4%), and ≥20,000 IU/mL in 1/13 (7.7%). ALT above the upper limit of normal occurred in 1/13 patients (7.7%), with ALT >2× ULN in 1/13 (7.7%). Non-invasive fibrosis assessment was performed in 12/13 patients (92.3%). No patient required liver biopsy based on FIB-4 scoring. HIV screening was completed in 12/13 (92.3%), hepatitis C in 12/13 (92.3%), hepatitis A in 9/13 (69.2%), and hepatitis D in 9/13 (69.2%). Imaging surveillance (ultrasound/Fibroscan) within 12 months was achieved in 8/13 (61.5%). Alpha-fetoprotein testing was performed in 13/13 (100%), with 12/13 (92.3%) within the preceding 12 months. Three patients (23.1%) met EASL treatment criteria (Standard 5) and all were appropriately commenced on antiviral therapy.

Conclusion

This audit demonstrates strong adherence to EASL guidelines for the investigation, monitoring, and treatment of chronic HBV infection. Non-invasive tools effectively replaced liver biopsy for disease staging, and treatment decisions were guideline-concordant. Identified gaps included suboptimal imaging surveillance intervals and incomplete viral co-infection screening. Streamlined imaging pathways and structured monitoring protocols may further enhance quality of care and long-term outcomes in this cohort.

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Board No: 71 #2024236

""The Platinum clinic", a collaborative HIV and geriatric medicine clinic for older people living with HIV in Dublin, Ireland"

Principal Presenter: Clara O'Flaherty

Track: Virology

Background: The first of its kind in Ireland, the Platinum Clinic was first established in St.James’ Hospital, Dublin in 2021. A collaboration between HIV and Geriatric Medicine specialists, the clinic is aimed at those living with HIV aged ≥65 years or experiencing frailty, recognising the ageing population living with HIV, their increased risk of multi-morbidity and the need to support them in successful ageing. We undertook a review of the clinic with the aim of describing demographics, interventions and outcomes of the population reviewed.

Methods: Following institutional approval, electronic records were reviewed of patients seen in Platinum Clinic between April 2021-March 2025. Data was analysed in Microsoft excel.

Results: Over this time, 58 individuals were reviewed across 70 episodes of care. 78%(45/58) were cis-male. Mean age was 70. The most common reason for referral was multi-morbidity(71%), followed by memory concerns(17%), falls/mobility issues(5%), loneliness(5%) and other(2%). Median years since HIV diagnosis was 23(IQR 13-31). 97% (56/58) had an undetectable viral load. The most common co-morbidities were hyperlipidaemia(62%), hypertension(60%) and osteoporosis(41%). Mean number of co-medications was 6. Where recorded, median Rockwood clinical frailty score was 3(Range 0-7). Median number of interventions following review was 2(Range 0-7). Following initial review 13%(8/63 unique referrals) were planned for further follow up in the platinum clinic. 35%(22/63) were referred to one or more other geriatric services for follow up including; bone health clinic(13%), memory clinic(8%), general geriatric clinic(6%), day hospital(4%), movement disorder clinic(2%) and community geriatrics(2%). 70%(44/63%) were discharged back to routine HIV clinic care.

Conclusions: The introduction of a combined HIV, geriatrics service allows for comprehensive assessment of older people living with HIV and streamlines access to interventions and services which promote successful ageing. Anecdotally the service has been well received by patients and providers. It is an important introduction considering the growing population ageing with HIV.

Board No: 72 #2026250

"Switch to DOR/ISL (100/0.25 mg) QD from Oral ART: Week 96 Update from an Open-Label Phase 3 Study"

Principal Presenter: Claire O'Dwyer

Track: Virology

Background: In an open-label, phase 3, randomized clinical study (MK-8591A-051; NCT05631093) in virologically suppressed adults with HIV-1, switching to the fixed combination of doravirine with islatravir (DOR/ISL 100/0.25 mg) once daily showed non-inferior efficacy to continuing oral antiretroviral therapy (ART) and was well tolerated at Week 48. We report on efficacy and safety results through Week 96.

Methods: After Week 48 of the comparative portion of the study, all participants receive open-label DOR/ISL (100/0.25 mg) through Week 144. Discontinuation is required for participants with clinically significant confirmed viremia (CSCV; 2 consecutive HIV-1 RNA ≥200 copies/mL 4 [±1] weeks apart) or confirmed decline from baseline in total lymphocytes (≥30% and <1.0x109/L) or CD4+ T-cells (≥30% and either <350 cells/mm3 if ≥350 at baseline, or <200 cells/mm3 if <350 at baseline).

Results: On Day 1, 366 participants switched to DOR/ISL (Group 1) and 185 continued their baseline ART (bART; Group 2). Mean age was 49.8 (±12.3) yrs; 39.7% were female at birth, 45.4% Black, and 14.5% Hispanic or Latino/a; median time since HIV diagnosis 13.3 (IQR 7.2-20.4) yrs. bART was InSTI-based (64.2%), NNRTI-based (30.3%), or PI-based (5.4%) with median duration 3.8 (IQR 2.0-6.3) yrs. At Week 48, 177 participants (95.7%) in Group 2 switched from bART to DOR/ISL, for a total of 543 on DOR/ISL. At Week 96, HIV-1 RNA was ≥50 copies/mL in 9 participants: 7 (1.9%) from Group 1 and two (1.1%) from Group 2, while virologic suppression was maintained in 92.6% and 96.6%, respectively. One participant in Group 1 (and none in Group 2) had CSCV after Week 48 and was discontinued. No participant developed treatment-emergent resistance to either DOR or ISL through Week 96. Adverse event rates in Group 2 (Weeks 48-96) were similar to those in Group 1 (Weeks 0-48). Mean % change (from start of DOR/ISL) in CD4+ T-cell and total lymphocyte counts were comparable across the groups at Week 96, with no discontinuations due to decreased CD4+ T-cell or total lymphocyte count. Mean weight change after starting DOR/ISL was similar across the treatment groups, with a greater change seen in participants who switched from weight-suppressive bART containing efavirenz and/or tenofovir disoproxil fumarate.

Conclusions: Switching to DOR/ISL (100/0.25 mg) maintained a high rate of viral suppression over 96 weeks with no emergent resistance to DOR or ISL. DOR/ISL was well tolerated and did not adversely affect lymphocyte counts.

Board No: 73 #2026273

"Disseminated Fusarium solani Infection Presenting with Cutaneous Nodules, Fungemia and Endogenous Endophthalmitis in Profound Neutropenia"

Principal Presenter: Sobul Ali
Keywords: Fusarium Solani, Neutropenia, Cutaneous

Track: Other

Background
Disseminated fusariosis is a severe opportunistic infection seen in patients with hematological malignancies and prolonged neutropenia.Fusarium species can be detected in blood cultures and may present with characteristic cutaneous lesions, which can be an early sign of disseminated infection. The condition carries a high mortality, particularly in patients with persistent neutropenia.

Methods
Clinical information obtained through review of the patient’s medical chart, including microbiology, dermatology and ophthalmology assessments, imaging studies to assess for other sites of invasive fungal disease, and laboratory investigations during admission for febrile neutropenia.

Results
A patient with refractory acute myeloid leukemia receiving chemotherapy developed persistent febrile neutropenia with prolonged neutropenia from late June to end of August. Laboratory investigations showed profound pancytopenia (white cell count 0.02 ×10⁹/L, absolute neutrophil count 0.02 ×10⁹/L, platelet count 13 ×10⁹/L). Blood cultures grew Fusarium solani. During admission, multiple tender erythematous subcutaneous nodules developed at different time points on the arms, neck and scalp. The lesions varied in size, with the largest measuring approximately 2 × 3 cm, and were felt to be deeper than they appeared. Initially thought to represent excoriation, dermatology review and biopsy confirmed angioinvasive fungal infection. Serum β-D-glucan was elevated and rising (11 pg/mL, 282 pg/mL, >523 pg/mL). The patient later developed right eye pain and redness, and ophthalmology confirmed endogenous fungal endophthalmitis, with PCR detecting Fusarium solani complex. CT imaging did not show additional sites of invasive fungal disease, and echocardiography and cryptococcal antigen were negative. The patient also had concurrent bacterial infections requiring broad-spectrum antimicrobial therapy. Treatment included liposomal amphotericin B and intravenous voriconazole, with intravitreal voriconazole for ocular involvement. The patient required high-dependency care, granulocyte colony-stimulating factor, and granulocyte transfusions. Due to clinical severity, the patient was transferred to hospice care. Following treatment and neutrophil recovery, hospice correspondence confirmed clinical improvement and discharge, with weight gain and stable residual nodules. The patient later died in the community due to relapse of the underlying acute myeloid leukemia.

Conclusion
This case highlights the importance of recognizing cutaneous nodules as an early sign of disseminated fusariosis in neutropenic patients. Early dermatology involvement and skin biopsy can aid diagnosis. Even in severe illness with multiple infections, appropriate antifungal therapy together with immune recovery may lead to clinical improvement.

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