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Byline: M. Melzer (1), R.A. Storring (2), L.R. Bagg (2) Keywords: Key words East London; Hospital-based surveillance; Tuberculosis Abstract: From September 1996 to June 1997, in an area bordering East London, we prospectively collected epidemiological, clinical and microbiological data on all patients with newly diagnosed culture-positive tuberculosis and compared these to national data based on notifications. The significant differences were that tuberculosis was diagnoses almost exclusively in non-Caucasian patients (42/47 [89%]) and that there was a high percentage of extrapulmonary tuberculosis (27/47 [57%]) including four cases of tuberculous meningitis and five cases of osteomyelitis. We also observed that 19/27 (70%) of patients with extrapulmonary tuberculosis had normal chest X-rays, 3/17 (18%) sub-Saharan Africans were HIV antibody-positive and drug resistance strains were isolated from sic sub-Saharan Africans and one Caucasian. Figures for treatment failures and mortality compared favorably to national averages at 6 months. National data do not accurately reflect local epidemiology and clinical presentations. Hospital-based surveillance and promoting awareness of local differences is essential to prevent delayed diagnosis, inappropriate management and poor clinical outcome. Author Affiliation: (1) Dept. of Microbiology, St. Thomas' Hospital, Lambeth Palace Rd., London SE1 7EH, UK e-mail: mark.melzer@gstt.sthames.nhs.uk, GB (2) King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, UK, GB Article note: Received: December 7, 1999 * Accepted: January 11, 2000

Background: There is lack of outcome data for bacteraemic patients on specialist renal units. We described demographic, clinical, microbiological data and outcomes for bacteraemic adult renal transplant and non-transplant patients at a London Teaching Hospital. We also assessed the appropriateness of empirical antibiotic policy., Methods: From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia on a specialist UK renal unit. Empirical anti-microbial policy, based upon sites of infection, was piperacillin/tazobactam and amikacin, or meropenem for graft pyelonephritis, and vancomycin and gentamicin for suspected central venous catheter (CVC) associated infection., Results: 113 bacteraemic episodes occurred in 83 patients. One patient had two bacteraemic episodes, one on haemodialysis and another after transplantation so appear in both groups. In the non-transplant group, 30-day mortality was 4/59 (6.8 %), more than the renal transplant group, 0/25 (0 %). While graft pyelonephritis was the predominant cause of bacteraemic episodes in renal transplant patients, 25/36 (69.4 %), there were a variety of other causes in the non-transplant group including uncomplicated line associated bacteraemia, 36/77 (46.8 %), complicated line associated bacteraemia, 11/77 (14.3 %) and bacteraemia unrelated to vascular access sites 19/77 (24.7 %). Overall, commonest isolates were Methicillin-sensitive Staphylococcus aureus 20/77 (26.3 %), and Escherichia coli 28/113 (24.8 %). There were no Methicillin-resistant Staphylococcus aureus isolates and, among Enterobacteriaceae, 15/57 (26.3 %) were extended spectrum beta-lactamase producers., Conclusions: Death only occurred in the non-transplant renal group. Empirical antibiotic treatment with either piperacillin/tazobactam and amikacin, or meropenem was appropriate for renal transplant recipients as most bacteraemic episodes were secondary to graft pyelonephritis. Vancomycin and gentamicin was appropriate empirical antibiotic treatment for non-transplant patients with CVC associated infections, but not optimal for other sites of infection.