SUMMARYWe present the first reported case of ventriculoperitoneal shunt infection secondary to Actinomyces neuii in a paediatric patient. Our patient was managed with temporary shunt removal, intrathecal antibiotics and a prolonged course of intravenous and then oral antibiotics. She went on to make a complete recovery. Subsequent cerebrospinal fluid analysis at 5 months post-treatment demonstrated no evidence of residual infection. BACKGROUND

Pyogenic liver abscesses are rare in children, and show geographical differences in their epidemiology. Mortality rates remain high at 15 %. Liver abscesses caused by anaerobic organisms are rare in a paediatric setting, even more so when complicated by portal vein thrombosis (PVT). A 6-year-old girl, previously fit and well, was admitted with fever, lethargy and weight loss of 2 weeks duration. The patient was febrile on examination and a review of the systems revealed no positive findings. An abdominal ultrasound scan showed multiple interconnecting cystic lesions consistent with liver abscesses, which was confirmed by a computed tomography scan. Aspirate of the abscess was cultured, resulting in the isolation of a non-haemolytic anaerobic organism, which was difficult to identify using conventional phenotypic identification tests. 16S rRNA typing identified the organism as Clostridium clostridioforme. The liver abscess in our patient displayed a particularly aggressive clinical course with extension of the abscess to involve the upper pole of the right kidney and the appendix, which was further complicated by PVT. The role of anaerobic organisms in liver abscesses has been underreported in the past. This case, therefore, highlights the importance of incubating biological samples in anaerobic conditions in order to adequately isolate and identify anaerobic bacteria, particularly those associated with abscesses.

S.aureus is the second most common pathogen causing late onset septicemia in neonatal intensive care units particularly in premature infants with very low birth weight. Poorly developed host defence mechanisms, the necessity for central venous catheters, invasive procedures, poor skin integrity, prolonged total parenteral nutrition, and the use of steroids or antimicrobial agents all increase the risk of staphylococcal infection in premature infants. We describe the changing epidemiology of Staphylococcus aureus infections in NICU at Leeds over 2008–2013 using laboratory and clinical data. Abstract PC.28 Figure Leeds Neonatal Service experienced an increased number of cases of Meticillin resistant Staphylococcus aureus (MRSA) colonisation and bacteraemia in 2008–2009. A series of infection control interventions were implemented stepwise including; asepsis training weekly screening, adoption of the Saving Lives central venous catheter package, daily antiseptic skin washes in neonates >28weeks and 2% Chlorhexidine for skin asepsis prior to invasive procedures. There has been a noticeable success in reduction in MRSA infections and no bacteraemia has been reported since 2009. However, a similar sustained improvement has not been seen in Meticillin sensitive Staphylococcus aureus (MSSA) bacteraemia. A retrospective review was carried out to review MSSA bacteraemia since 2008: 71% cases were seen in neonates under 28weeks (27/38), a vulnerable patient cohort currently excluded from daily skin washes. Given an association between MSSA colonisation and infection, further work should investigate infection control strategies that effectively target the highest risk groups and include active surveillance for MSSA and MRSA with subsequent decolonisation.

The aim of this study was to describe the safe use of repeated intracameral amphotericin B for anterior chamber reactivations after therapeutic penetrating keratoplasty for Fusarium solani keratitis. Methods:A 49-year-old woman monthly soft contact lens wearer with a history of overuse and swimming in her lenses presented with a red painful left eye. Her vision was 0.5 logMAR and there was a poorly demarcated corneal infiltrate. Although corneal scrapes and a corneal biopsy were negative, confocal microscopy showed fungal hyphae. After failure of medical treatment, therapeutic penetrating keratoplasty was performed. Fusarium solani sensitive to amphotericin was isolated. There was pan-azole resistance. The patient was managed with topical amphotericin B, and repeated anterior chamber reactivations were managed with intracameral amphotericin B 5 mg in 0.1 mL on 9 occasions over 5 months after sensitivities were known. Topical cyclosporine was used as the sole immunomodulator postoperatively, with no topical steroid use over the 4-year followup period.Results: There were no episodes of graft rejection and no endothelial, lenticular, or retinal toxicity. The best-corrected visual acuity is 20.1 logMAR and the endothelial cell count is 2160/mm 2 . Conclusion:This report describes the safe and effective use of repeated intracameral amphotericin (cumulative 45 mg) in anterior chamber reactivations after therapeutic penetrating keratoplasty and highlights the role of fungal sensitivity in guiding treatment in refractory cases. It also demonstrated the successful use of topical cyclosporin as the sole postoperative immunomodulatory therapy despite repeated recurrence of infection and consequent increased inflammation in the postoperative period.