Abstracts e59

inappropriate for our population. Ceftriaxone is the pre-ferred choice but usually requires a prolonged inpatientstay. OPAT treatment allows earlier discharge, whichimproves patient choice, and reduces the likelihood ofhospital acquired morbidity.

Conclusions

OPAT with ceftriaxone is commonly and effectively used inthe management of imported enteric fever in Glasgow.

CLOSTRIDIUM DIFFICILE INFECTION IN ELDERLYLANARKSHIRE PRIMARY CAREPATIENTSCATEGORY: LESSON IN MICROBIOLOGY& INFECTION CONTROL

Leigh Williams, Maybeth Magowan, AnneMarie Burns, Irene Winning, Donald InverarityNHS Lanarkshire, Airdrie, United Kingdom

Introduction

The epidemiology of Clostridium difficile infection (CDI) inLanarkshire has changed dramatically in recent years. A ris-ing incidence of CDI during the 1990s and early 21st centuryhas begun to decline. Patient populations, previously con-sidered at less risk of CDI than hospitalized patients, havebeen noted to have an appreciable incidence of CDI suchas the elderly in community settings. We assessed 48 epi-sodes of non outbreak related CDI relating to 45 patientsliving in Lanarkshire in primary care from July to November2008.

Scientific findings

The median patient age was 78 (range 65 to 95 years). 10patients with CDI were resident in Care Homes whilethe rest were resident in their own homes. In 7 cases thepatient died within 30 days of diagnosis of CDI. There wereno significant differences between patients with CDI andmatched controls with diarrhoea regarding hospitalizationrates (p ¼ 0.62), exposure to antibiotics (p ¼ 0.33),exposure to antacids (p ¼ 0.46) or exposure to protonpump inhibitors (p ¼ 0.65). Ribotype 106 was the common-est ribotype identified.

Discussion

Although these elderly patients with CDI had recognizedrisk factors, there was no appreciable difference in riskwhen compared with matched patients with diarrhoea butno CDI. 16% of elderly patients did not survive a month afterdiagnosis of CDI. This audit relates to a period in Lanark-shire when the incidence of CDI was much higher than it iscurrently. In July 2008 NHS Lanarkshire began a multifac-eted programme of antimicrobial stewardship, hand

hygiene and other infection control interventions whichhas resulted in a dramatic fall in the incidence of CDI inboth hospital and community settings.

Conclusions

Elderly patients in primary care in Lanarkshire appear todevelop CDI despite appearing to be at no greater exposureto antibiotics or hospitalization than matched controls withdiarrhoea not due to CDI. It is unlikely though that this workcould be realistically repeated in this health board due tothe infrequency of CDI cases currently detected fromprimary care.

THE BENEFITS OF AN INFECTIOUS DISEASE/RADIOLOGY MULTIDISCIPLINARY TEAMMEETINGCATEGORY: SCIENTIFIC FREE PAPER

Haider Ali, Tom Fletcher, Chris Ryall, NickJ Beeching, Liz Joekes, Penny LewthwaiteRoyal Liverpool University Hospital, Liverpool, UnitedKingdom

Introduction

Multidisciplinary teams (MDT) bring together health-careprofessionals to plan the management of complex clinicalproblems. They now form the cornerstone of cancerservices in almost every discipline, with clear survivalbenefits. However, their use in the management of otherconditions is not well reported.

In Liverpool, the Tropical and Infectious Disease Unit(TIDU) and Radiology Department have held a weekly jointmeeting for over 20 years, attended by clinical staff from 3TIDU ward teams and led by a Consultant Radiologist withan interest in infection. Following detailed review ofradiological investigations and clinical discussion, consen-sus agreement is reached. These sessions, lasting an hourper week, also serve as a useful training forum for staff inall disciplines.

This MDT meeting primarily has a diagnostic purpose,unlike many MDTs which formulate therapeutic decisions. Itaims to improve patient management by narrowing differ-ential diagnoses and focusing further investigation, and tominimise risk to the patient by avoiding unnecessaryinvestigations or treatments. Despite the time resourcesallocated to the MDT, the degree to which the discussionsinfluence the management of infectious disease patientswas unknown prior to this review.

The aim of this study was to determine what impact MDTmeetings have on the clinical management of patients ina tertiary infectious diseases unit. 11 meetings wereanalysed prospectively (at random) during a 6 month periodfrom January 2010 to July 2010. Senior staff involved inmost of the discussion and decision making were not awarewhich meetings were being evaluated.