1. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm Pervasive infection threats in acute healthcare, including Gram-negative bacteria 30/06/15 Jon Otter, PhD FRCPath Imperial College Healthcare NHS Trust Blog: www.ReflectionsIPC.comwww.ReflectionsIPC.com Twitter: @jonotter Email: jon.otter@imperial.nhs.ukjon.otter@imperial.nhs.uk

2. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed MRSA bacteraemia, England 2001-2013 1.Mandatory reporting, 2001 2.‘Gettting ahead of the curve’, 2002 3.‘Winning ways’, 2003 4.‘Towards cleaner hospitals’, 2004 5.‘Cleanyourhands’, 2004 6.Targets introduced, 2004 7.Cleanliness improvement, 2005 8.‘Going further faster’, 2006 9.Root cause analysis, 2006 10.Revised national guidelines, 2006 11.Deep clean, 2007 12.Screening elective admissions, 2008 13.Universal screening, 2010 12 3 456456 7 8 9 10 11 12 13

3. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed CDI cases, 2004-2013 C. difficile infection (CDI), England 2004-2013 1.Mandatory reporting, 2004 2.Targets, 2007 3.Revised guidelines, 2009 1 2 3

4. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed E. coli and MSSA bacteraemia, England

5. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed Invasive MRSA (EARS-Net)

6. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm THE END OF ANTIBIOTICS IS NIGH

7. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm What’s the problem? “CRE are nightmare bacteria.” Dr Tom Frieden, CDC Director “If we don't take action, then we may all be back in an almost 19th Century environment where infections kill us as a result of routine operations.” Dame Sally Davies, Chief Medical Officer “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again.” David Cameron, Prime Minister, UK “The rise of antibiotic-resistant bacteria, however, represents a serious threat to public health and the economy.” Barack Obama, President USA

8. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm Rising threat from MDR-GNR % of all HAI caused by GNRs. Hidron et al. Infect Control Hosp Epidemiol 2008;29:966-1011. Peleg & Hooper. N Engl J Med 2010;362:1804-1813. % of ICU HAI caused by GNRs. Non-fermentersAcinetobacter baumannii Pseudomonas aeruginosa Stenotrophomonas maltophilia EnterobacteriaceaeKlebsiella pneumoniae Escherichia coli Enterobacter cloacae

9. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed What’s the problem? Resistance

10. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed EnterobacteriaceaeNon fermenters OrganismAmpC / ESBLCPEA. baumannii Attributable mortality Moderate Massive (>50%) Minimal Shorr et al. Crit Care Med 2009;37:1463-1469. Patel et al. Iinfect Control Hosp Epidemiol 2008;29:1099-1106. Falagas et al. Emerg Infect Dis 2014;20:1170-1175. What’s the problem? Mortality

11. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed Rapid spread Clonal expansion GI carriage Horizontal gene transfer What’s the problem? Global domination!

12. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed Invasive carbapenem-resistant K. pneumoniae i.e. CRE (EARS-Net)

13. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm Emergence of CPE in the UK PHE AMRHAI, 24/01/14 Courtosy of Dr Neil Woodford

14. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm Colistin resistance in Italy Monaco et al. 2014; Euro Surveill 2014;19:pii=20939. Survey of 191 CRE from 21 labs across Italy. 43% Colistin resistant K. pneumoniae. Range = 10-80% for the 21 labs.

15. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed CRE in the USA CDC NHSN / NNIS data. MMWR 2013;62:165-170. National survey of Enterobacteriaceae in 2001 (n=2,631) and 2011 (n=6,573).

16. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed CRE in the UK and US

17. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm Understanding the enemy PathogenCRE 1 MRSAVREC. difficile Resistance++++++/- Resistance genesMultipleSingle n/a SpeciesMultipleSingle HA vs CAHA & CAHA At-risk ptsAllUnwell Old DecolonisationNoYesNo Virulence++++++/-+ Environment+/-++++++ 1.Carbapenem-resistant Enterobacteriaceae.

18. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 20pt (Optional SLIDE SUB-TITLE: 18pt) 1ST LEVEL BULLET: 14pt SUB-BULLETS: 12pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Overall content limit Limit for title Do not exceed 20mm Limit for content Do not exceed MDR- GNR Toolbox Hand hygiene Cleaning / disinfection HCW screening Decol. Cohorting staff / patients Note flaggingEducation Env. screening Contact precautions Active screening Antibiotic stewardship Tacconelli et al. Clin Microbiol Infect 2014;20 Suppl 1:1-55.

19. 30mm 10mm logo safe area 10mm logo safe area EDITING NOTES All copy must stay within the content limit guidelines. Any image added to a slide with text should be formatted to be in-keeping with the width guidelines. A safe area of 10mm must be applied around the logo. 10mm GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA 10mm Limit for content Do not exceed Limit for title Do not exceed 25mm Pervasive infection threats in acute healthcare, including Gram-negative bacteria 30/06/15 Jon Otter, PhD FRCPath Imperial College Healthcare NHS Trust Blog: www.ReflectionsIPC.comwww.ReflectionsIPC.com Twitter: @jonotter Email: jon.otter@imperial.nhs.ukjon.otter@imperial.nhs.uk