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26th European Congress of Clinical Microbiology and Infectious Diseases
News
26th European Congress of Clinical Microbiology and Infectious Diseases The preliminary results of two phase 3 trials (TESEC-05 and TESEC-06) of C-Tb, a novel specific skin test for tuberculosis, were presented by researchers from the Statens Serum Institut (Copenhagen, Denmark). Current tests for Mycobacterium tuberculosis infection, such as the purified protein derivative tuberculin skin test, are easy to use but often result in false positives in people who have received BCG vaccination. Interferon-γ release assays (IGRA) have high specificity but require laboratory facilities. In both trials, the C-Tb test and the tuberculin skin test were given in a double-blind fashion, one to each forearm, and skin indurations were read 2–3 days later. Blood samples were also taken for IGRA testing before skin testing was done. In unexposed controls, C-Tb specificity was equivalent to IGRA and there was no effect of BCG vaccination on C-Tb specificity. C-Tb positivity increased with increasing exposure to M tuberculosis. In patients with confirmed tuberculosis, sensitivity of C-Tb and IGRA was again comparable. “The field-friendliness and high specificity offered by the C-Tb test could allow for improved target treatment of M tuberculosis infection in resource-restrained settings, where IGRAs are too complicated to implement”, the authors concluded.
Prednisone treatment in community-acquired pneumonia Treatment with prednisone results in a shorter time to clinical stability in patients with community-acquired pneumonia (CAP), irrespective of cause, according to a subanalysis of a multicentre, double-blind, randomised placebo-controlled trial previously
published in The Lancet. The main trial showed that prednisone treatment for 7 days shortened time to clinical stability in patients admitted to hospital with CAP. “However, it was unknown from these results whether there might be subgroups of patients in whom adjunct prednisone might be more or less beneficial, or even harmful”, study author Philip Tarr (University of Basel, Basel, Switzerland) told The Lancet Respiratory Medicine. Therefore, the investigators did a subanalysis of patients according to cause of pneumonia (bacterial, pneumococcal, viral, influenza), category of antibiotic treatment (combination treatment with β lactam plus macrolide, β lactam alone, all other antibiotics), and baseline concentration of procalcitonin. Tarr and coworkers showed that the reduction in time to clinical stability in the prednisone group compared with the placebo group was similar across all patient subgroups irrespective of cause, antibiotic treatment, or procalcitonin concentration (p>0·05). “Although we were happy to see no negative effects of prednisone in patients with viral and influenza pneumonia, because a microbiological diagnosis was only made in 30% of participants [221 of 726 patients], some of the patient subgroups were small”, cautions Tarr. Secondary endpoints showed an increased rate of readmission to hospital in patients who were not treated with a macrolide, and pneumococcal pneumonia was associated with increased admission to the intensive-care unit and a longer duration of intravenous antibiotic treatment in the prednisone versus the placebo group.
the results of a pilot, randomised controlled trial of point-of-care testing (POCT) versus routine clinical care in adults presenting at the university hospital with acute respiratory illness. The researchers used the FilmArray Respiratory Panel (BioFire, Salt Lake City, UT, USA) for POCT, which has roughly equivalent diagnostic accuracy to laboratory PCR but is much faster, with results generated in 1 hour. The results showed that POCT improved the detection rate of viruses and increased the appropriate use of neuraminidase inhibitors for influenza. There was also a trend towards shortened hospital stay and reduced antibiotic use in patients with chronic obstructive pulmonary disease who received POCT. “If the findings from our pilot study are replicated in further larger studies, and health economic analyses demonstrate cost effectiveness, then POCT for respiratory viruses might become the new standard of care for adult patients who present to hospital with acute respiratory illness”, senior author Tristan Clark (University of Southampton, Southampton, UK) commented to The Lancet Respiratory Medicine. “This was an internal pilot study performed as part of a larger two season study.
Lancet Respir Med 2016 Published Online April 21, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30068-6 The 26th European Congress of Clinical Microbiology and Infectious Diseases was held in Amsterdam, The Netherlands, on April 9–12, 2016. For the Lancet prednisone trial see Articles Lancet 2015; 385: 1511–18
Adam Jones/Science Photo Library
A novel specific skin test for latent tuberculosis infection
Point of-care testing for respiratory viruses Researchers from the University of Southampton, UK, presented
www.thelancet.com/respiratory Published online April 21, 2016 http://dx.doi.org/10.1016/S2213-2600(16)30068-6
1
News
The results of the full study and a subsequent health economic analysis will be reported shortly.”
Prolonged bedaquiline for multidrug-resistant tuberculosis Bedaquiline offers new hope for the treatment of multidrug-resistant (MDR) tuberculosis, but the maximum recommended treatment duration is currently 24 weeks. Lorenzo Guglielmetti (Centre Hospitalier de Bligny, Briis-sous-Forges, France) and colleagues investigated longterm treatment with bedaquiline in 45 patients with MDR or extensively drug-resistant (XDR) tuberculosis. 33 (73%) of 45 patients received bedaquiline for more than 6 months, with a total treatment duration of 360 days (range 31–768). No arrhythmias or symptomatic cardiac events were reported, but bedaquiline was discontinued in three patients because of QTcF prolongation. No increase in liver or cardiac toxicity was recorded in patients receiving
2
prolonged bedaquiline treatment, and favourable treatment outcomes were achieved in 36 (80%) patients. “The results we present show promising efficacy of bedaquiline-containing regimens in a cohort comprising mostly complicated XDR tuberculosis patients, and reassuring safety profile of prolonged bedaquiline a d m i n i s t r a t i o n ”, c o m m e n t e d Guglielmetti. “We therefore advocate the extension of bedaquiline treatment beyond 24 weeks for any MDR/XDR-tuberculosis patient who needs it, according to individual conditions and tuberculosis resistance profile.”
Predicting outcome in patients with sepsis Pierre-Emmanuel Charles (Dijon University Hospital, Dijon, France) presented the results of a prospective cohort study investigating the use of biomarkers to predict short-term clinical outcome in patients with sepsis admitted to the intensive-
care unit. Blood samples were taken from 173 patients with sepsis on admission to intensive care and on day 5, and were analysed for concentrations of four biomarkers— procalcitonin, mid regionalproadrenomedullin (MR-proADM), co-peptine, and pro-endothelin 1 (Pro-ET 1). The primary outcome measure was all-cause death in the intensive-care unit. Concentrations of all biomarkers, except Pro-ET 1, on admission to intensive care were significantly more elevated in non-survivors than in survivors. The strongest correlation was recorded for MR-proADM (p<0·0001). “The day-5 value was even more closely related to survival in the intensivecare unit”, the authors stated. “Thus early and persistent elevation of biomarkers likely to reflect endothelial dysfunction could be helpful in predicting the outcome of septic critically ill patients.”
Rebecca Akkermans
www.thelancet.com/respiratory Published online April 21, 2016 http://dx.doi.org/10.1016/S2213-2600(16)30068-6
26th European Congress of Clinical Microbiology and Infectious Diseases The preliminary results of two phase 3 trials (TESEC-05 and TESEC-06) of C-Tb, a novel specific skin test for tuberculosis, were presented by researchers from the Statens Serum Institut (Copenhagen, Denmark). Current tests for Mycobacterium tuberculosis infection, such as the purified protein derivative tuberculin skin test, are easy to use but often result in false positives in people who have received BCG vaccination. Interferon-γ release assays (IGRA) have high specificity but require laboratory facilities. In both trials, the C-Tb test and the tuberculin skin test were given in a double-blind fashion, one to each forearm, and skin indurations were read 2–3 days later. Blood samples were also taken for IGRA testing before skin testing was done. In unexposed controls, C-Tb specificity was equivalent to IGRA and there was no effect of BCG vaccination on C-Tb specificity. C-Tb positivity increased with increasing exposure to M tuberculosis. In patients with confirmed tuberculosis, sensitivity of C-Tb and IGRA was again comparable. “The field-friendliness and high specificity offered by the C-Tb test could allow for improved target treatment of M tuberculosis infection in resource-restrained settings, where IGRAs are too complicated to implement”, the authors concluded.
Prednisone treatment in community-acquired pneumonia Treatment with prednisone results in a shorter time to clinical stability in patients with community-acquired pneumonia (CAP), irrespective of cause, according to a subanalysis of a multicentre, double-blind, randomised placebo-controlled trial previously
published in The Lancet. The main trial showed that prednisone treatment for 7 days shortened time to clinical stability in patients admitted to hospital with CAP. “However, it was unknown from these results whether there might be subgroups of patients in whom adjunct prednisone might be more or less beneficial, or even harmful”, study author Philip Tarr (University of Basel, Basel, Switzerland) told The Lancet Respiratory Medicine. Therefore, the investigators did a subanalysis of patients according to cause of pneumonia (bacterial, pneumococcal, viral, influenza), category of antibiotic treatment (combination treatment with β lactam plus macrolide, β lactam alone, all other antibiotics), and baseline concentration of procalcitonin. Tarr and coworkers showed that the reduction in time to clinical stability in the prednisone group compared with the placebo group was similar across all patient subgroups irrespective of cause, antibiotic treatment, or procalcitonin concentration (p>0·05). “Although we were happy to see no negative effects of prednisone in patients with viral and influenza pneumonia, because a microbiological diagnosis was only made in 30% of participants [221 of 726 patients], some of the patient subgroups were small”, cautions Tarr. Secondary endpoints showed an increased rate of readmission to hospital in patients who were not treated with a macrolide, and pneumococcal pneumonia was associated with increased admission to the intensive-care unit and a longer duration of intravenous antibiotic treatment in the prednisone versus the placebo group.
the results of a pilot, randomised controlled trial of point-of-care testing (POCT) versus routine clinical care in adults presenting at the university hospital with acute respiratory illness. The researchers used the FilmArray Respiratory Panel (BioFire, Salt Lake City, UT, USA) for POCT, which has roughly equivalent diagnostic accuracy to laboratory PCR but is much faster, with results generated in 1 hour. The results showed that POCT improved the detection rate of viruses and increased the appropriate use of neuraminidase inhibitors for influenza. There was also a trend towards shortened hospital stay and reduced antibiotic use in patients with chronic obstructive pulmonary disease who received POCT. “If the findings from our pilot study are replicated in further larger studies, and health economic analyses demonstrate cost effectiveness, then POCT for respiratory viruses might become the new standard of care for adult patients who present to hospital with acute respiratory illness”, senior author Tristan Clark (University of Southampton, Southampton, UK) commented to The Lancet Respiratory Medicine. “This was an internal pilot study performed as part of a larger two season study.
Lancet Respir Med 2016 Published Online April 21, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30068-6 The 26th European Congress of Clinical Microbiology and Infectious Diseases was held in Amsterdam, The Netherlands, on April 9–12, 2016. For the Lancet prednisone trial see Articles Lancet 2015; 385: 1511–18
Adam Jones/Science Photo Library
A novel specific skin test for latent tuberculosis infection
Point of-care testing for respiratory viruses Researchers from the University of Southampton, UK, presented
www.thelancet.com/respiratory Published online April 21, 2016 http://dx.doi.org/10.1016/S2213-2600(16)30068-6
1
News
The results of the full study and a subsequent health economic analysis will be reported shortly.”
Prolonged bedaquiline for multidrug-resistant tuberculosis Bedaquiline offers new hope for the treatment of multidrug-resistant (MDR) tuberculosis, but the maximum recommended treatment duration is currently 24 weeks. Lorenzo Guglielmetti (Centre Hospitalier de Bligny, Briis-sous-Forges, France) and colleagues investigated longterm treatment with bedaquiline in 45 patients with MDR or extensively drug-resistant (XDR) tuberculosis. 33 (73%) of 45 patients received bedaquiline for more than 6 months, with a total treatment duration of 360 days (range 31–768). No arrhythmias or symptomatic cardiac events were reported, but bedaquiline was discontinued in three patients because of QTcF prolongation. No increase in liver or cardiac toxicity was recorded in patients receiving
2
prolonged bedaquiline treatment, and favourable treatment outcomes were achieved in 36 (80%) patients. “The results we present show promising efficacy of bedaquiline-containing regimens in a cohort comprising mostly complicated XDR tuberculosis patients, and reassuring safety profile of prolonged bedaquiline a d m i n i s t r a t i o n ”, c o m m e n t e d Guglielmetti. “We therefore advocate the extension of bedaquiline treatment beyond 24 weeks for any MDR/XDR-tuberculosis patient who needs it, according to individual conditions and tuberculosis resistance profile.”
Predicting outcome in patients with sepsis Pierre-Emmanuel Charles (Dijon University Hospital, Dijon, France) presented the results of a prospective cohort study investigating the use of biomarkers to predict short-term clinical outcome in patients with sepsis admitted to the intensive-
care unit. Blood samples were taken from 173 patients with sepsis on admission to intensive care and on day 5, and were analysed for concentrations of four biomarkers— procalcitonin, mid regionalproadrenomedullin (MR-proADM), co-peptine, and pro-endothelin 1 (Pro-ET 1). The primary outcome measure was all-cause death in the intensive-care unit. Concentrations of all biomarkers, except Pro-ET 1, on admission to intensive care were significantly more elevated in non-survivors than in survivors. The strongest correlation was recorded for MR-proADM (p<0·0001). “The day-5 value was even more closely related to survival in the intensivecare unit”, the authors stated. “Thus early and persistent elevation of biomarkers likely to reflect endothelial dysfunction could be helpful in predicting the outcome of septic critically ill patients.”
Rebecca Akkermans
www.thelancet.com/respiratory Published online April 21, 2016 http://dx.doi.org/10.1016/S2213-2600(16)30068-6