e50 Abstracts

uncomplicated. DAP was used empirically in 59% but 76%had received prior antibiotic therapy (40 had failed and 22switched due to non-susceptibility). S. aureus was most fre-quently isolated. Mean duration of therapy was 7.5 daysand 49% received concomitant antibiotics. 4 mg/kg 24hwas the most frequently used dose and 25% received DAPin outpatents. Clinical outcomes were success (cure or im-proved) (75%), failure (10%) and non-evaluable (14%). Ad-verse events (regardless of study drug relationship) wereexperienced by 18%.

Discussion

DAP was effective and well tolerated therapy for a range ofpatients with SSTI in the non-clinical trial setting the UK. Alarge proportion of patients who had failed or not toleratedprevious antibiotic therapy were successfully treated withDAP. DAP may be particularly useful in the OPAT settinggiven its once daily administration via IV bolus.

Conclusions

Despite the number of prior antibiotic failures and multipleco-morbidites of these patients the overall clinical successrate in this UK population was 73%. DAP is an emerging anduseful treatment option in SSTI in the UK and particularly inthe OPAT setting.

TREATMENT OF OSTEOARTICULAR INFECTIONSWITH DAPTOMYCIN, UK EXPERIENCECATEGORY:SCIENTIFIC FREE PAPER

R Andrew Seaton 1, Armando Gonzalez-Ruiz 2,EU-CORE Study Group 3

1Gartnavel General Hospital, Glasgow, G12 0YN, UnitedKingdom2Darent Valley Hospital, Dartford & Gravesham NHS Trust,Kent, DA2 8DA, United Kingdom3 on behalf of the, EU-CORE study group, United Kingdom

Introduction

The European Cubicin� Outcomes Registry and Experience(EU-CORESM) is an ongoing, retrospective, post-marketingdatabase of Daptomycin (DAP) use in Europe. Althoughnon-comparative, EU-CORE offers insight into real-life clin-ical experience with DAP in various Gram-positive infec-tions and specific patient types including those withosteoarticular infections such osteomyelitis and septic ar-thritis. We present the data from the first 2.5 years ofDAP use for the treatment of osteoarticular infections inthe UK since marketing authorisation in January 2006.Data from eight participating UK institutions were collectedon patient demographics, antibiotic usage, microbiologicaland clinical outcomes and adverse events from January2006 until August 2009. All received at least one dose ofDAP. Outcomes were assessed by investigators as cured, im-proved, failure and non-evaluable.

Scientific findings

Of 58 pts (mean 66 years), 76% had underlying disease, 41%had foreign body infections and 20% temporary or perma-nent prostheses. Prior antibiotics (predominantly beta-lactams or glycopeptides) were used in 79%. DAP wasused after culture results in 72%. S.aureus (48%) and coag-ulase-negative Staphylococci (10%) were most frequentlyisolated. Mean duration of therapy was 10.1days. 6 mg/kg24h was the most frequently used dose, 45% had concomi-tant antibiotics and 52% received DAP in outpatients. Suc-cess (cure or improved) was observed in 88%, failure 2%(9% non-evaluable). 10% discontinued therapy because ofan adverse event.

Discussion

DAP was used in a range of osteoarticular infections, themajority of which had been pre-treated with other agents.DAP was well tolerated and success as judged at end oftherapy was high. High rates of concomitant antibiotictherapy were used and DAP was used frequently in theOPAT setting.

Conclusions

Overall clinical success rate of 88% in a complex pre-treated population demonstrates the utility of DAP in themanagement of osteoarticular infections. These data addto the evidence that DAP is a useful addition particularly inthe outpatient setting, for the management of orthopaedic-related infections where other long-term treatment optionsmay be limited.

EPIDEMIOLOGY OF CHRONIC HEPATITIS BINFECTION AT A REGIONAL INFECTIOUS DISEASESDEPARTMENT IN SHEFFIELD, UKCATEGORY:SCIENTIFIC FREE PAPER

Ruth Smith 1, Goura Kudesia 2, Alicia Vedio 1,Hanan Al Kindi 2, Mike McKendrick 1

1Department of Infection, Sheffield Teaching Hospitals,Sheffield, United Kingdom2 Sheffield Virology Service, Sheffield Teaching Hospitals,Sheffield, United Kingdom

Introduction

Almost a third of the world’s population is estimated tohave been infected with the hepatitis B virus and 350million have chronic infection. Chronic HBV is higher inthose born in high-endemicity countries, many of whom willhave acquired infection at birth or in early childhood.

Worldwide distribution of hepatitis B is not homoge-neous. Areas of high prevalence, of 10%-20%, include Asia,in particular China, sub-Saharan Africa and the Amazon .North America, Australia and northern, western and centralEurope have low prevalence of 0.2%-0.5%. In the UnitedKingdom, the prevalence of chronic hepatitis B is 0.3%.

Abstracts e51

HBV has a circular and partial double-strand DNAgenome. Based on nucleotide differences of 8% or more inthe complete genome, HBV has been classified into eightgenotypes from A to H .Genotypes show distinct variation intheir geographic distribution. Recent data suggest that HBVgenotypes may play an important role in the progression ofHBV-related liver disease.

Sheffield is a city of over half a million people. There hasbeen an increasing number of patients referred withchronic hepatitis B infection, largely reflecting movementinto the city by migrants from endemic countries. Thisstudy was undertaken to better define the epidemiology ofthis cohort. We used a computerised HBV database toidentify epidemiological details on 322 patients registeredbetween January 2004 and December 2009.In addition 37samples were genotyped for HBV using both a commercialand an in-house sequencing method to create a phyloge-netic tree.

Scientific findings

Twenty five patients were born in the UK. The largest group(144) was from Africa. China and Somalia were the mostrepresented single countries with 52 and 41 casesrespectively.

The transmission mode was unknown in 137 cases, but118 of these had come from endemic countries. The routesof infection were: sexual (23 cases; 8 UK born); parenteral(26 cases; two IDU infections were both in UK born);vertical (89);childhood (47). HIV co-infection was seen in26 patients.

The genotypic data showed the presence in Sheffield of6 (genotype A,B,C,D,E and G) out of the 8 existing HBVgentotypes.

Discussion

The epidemiology of the Sheffield cohort of patientscorrelates well with worldwide trends in hepatitis B. Thismay reflect the fact that patients from recognised highprevalence areas are more likely to be screened forhepatitis B.

China was the most common single country of birth with16% of the cohort born there. 42% were from differentcountries in sub-Saharan Africa where Hepatitis B also hashigh prevalence rates of between 10% and 20% of thepopulation.

Genotype analysis performed on 12% of the cohortconfirmed the presence of HBV genotypes associated withwide geographical distribution of the virus.

Conclusions

There was an expanding cohort of patients from 2004-2009.The group is relatively young with a modal age group of 30-39, and international in origin with 92% being bornoverseas.

It is evident from our data that there are a number ofdifferent genotypes circulating in Sheffield and this con-firms the ethnic diversity of the local population. This

provides a strong argument for doing baseline HBV geno-typing were management protocols to become dependenton genotypes.

HIV co-infection in 8% of the group emphasises theimportance of screening for all blood borne viruses at thesame time.

UTILITY OF SPA TYPING IN UNDERSTANDINGEPIDEMIOLOGY OF STAPHYLOCOCCUS AUREUSBACTERAEMIA ISOLATES IN A SINGLE UNIVERSITYHOSPITALCATEGORY: SCIENTIFIC FREE PAPER

Giovanni Satta, Clare Ling, TimothyD McHugh, Susan HopkinsCentre for Clinical Microbiology, University CollegeLondon, Royal Free Campus at Royal Free Hampstead NHSTrust, Pond Street, NW3 2QG, London, United Kingdom

Introduction

Background - Staphylococcus aureus (SA) is well known asa leading cause of human disease and nosocomial infec-tions. In the United Kingdom around 12500 SA bacteraemia(SAB) cases occur each year of which approximately 30% dieand around 50% suffer complicated infection. The emer-gence of meticillin-resistant SA (MRSA) still represents a ma-jor infection control problem and the appearance of somecommunity-acquired strains (caMRSA) and healthcare asso-ciated meticillin sensitive SA (MSSA) are of great concern.In addition approximately two thirds of MSSA bacteraemiasare healthcare associated, predominantly relating to cen-tral venous catheters or surgical site infection. Thus, under-standing the epidemiology of all SA is an invaluableinfection control tool.

Study aim - The primary hypothesis was to test whetheran outbreak had occurred in the past year among clinicalareas with high rates of SA infections, in particular Renaland Haematology units. The secondary hypothesis was todetermine whether patients with multiple SABs (>30 dayinterval and blood culture negative between episodes)were relapses or re-infections.

Methods - We have collected 80 SA isolates from bacter-aemias from November 2008 to November 2009 at a Univer-sity Hospital in NW London (Royal Free Hampstead NHSTrust). Spa typing has been performed as previously de-scribed by Shopsin et al, 2000. A cluster was defined astwo or more cases geo-temporally related, where sameward/clinical team was considered as geographically re-lated and within 30 days as temporally related.

Scientific findings

Results - 75 individuals accounted for 80 separate SAB; 3individuals had 2 SAB and 1 individual had 3 SAB events. 87%were MSSA and 13% were MRSA. The overall mortality ratewas 15%. Median age was 52 years (34-70). 62% were maleand 38% female. We identified 37 different spa types, withtype t002 as the most frequent (9% of isolates), followed bytypes t008 (5%), t127 and t021 (4% each). Using the pre-