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Highlights from the 19th ECCMID
Newsdesk
Highlights from the 19th ECCMID The 19th European Congress of Clinical Microbiolgy and Infectious Diseases, attended by more than 8000 delegates in Helsinki, Finland (May 16–19), was the first major infectious diseases meeting to take place since the epidemic of swine-origin influenza virus (SOIV) H1N1 began. This event was marked by a dedicated late-breaker session. Other major themes of the conference were— the seeming perennials—antibiotic resistance, emerging infections, and new diagnostics. It was interesting to see how metagenomics, the subject of a keynote lecture by David Relman (Stanford University, CA, USA), has moved in a few years from a pure research tool to a technology nearing application in the clinical setting. Other highlights from the conference are reported here.
Influenza H1N1
Biomedical Imaging Unit, Southampton General Hospital/Science Photo Library
Speaking at the late-breaker session co-sponsored by The Lancet, Albert Osterhaus (Erasmus Medical Centre, Rotterdam, Netherlands) described the emergence of SOIV as the “most important event in human influenza over the past 40 years”. The virus was formed by reassortment of genes from four strains of H1N1 virus, which have been identified in pigs, birds, and human beings. Markers of severe pathogenicity are missing from SOIV,
Coloured transmission electron micrograph of Clostridium difficile
400
explaining why illness caused by the virus is usually mild. Osterhaus predicted three possible outcomes from emergence of the virus: it could disappear spontaneously, which he thought unlikely; it could cause a mild pandemic, like the 1957 pandemic; or there could be a severe pandemic after mutation or reassortment of the virus. Commenting on preliminary data from patients with SOIV infection, Javier Garau (University of Barcelona, Spain) noted that the high prevalence of diarrhoea and vomiting were unusual clinical features for influenza. The incubation period for disease is 2–7 days with a mean of 3·5 days. In Spain, all patients with the illness had recovered fully.
Clostridium difficile treatment Fidaxomicin (formerly OPT-80; Optima Pharmaceuticals) is a macrocyclic antibiotic intended for treatment of Clostridium difficile infection (CDI). T J Louie (University of Calgary, Alberta, Canada) reported a randomised, non-inferiority, phase III trial of oral fidaxomicin (200 mg twice daily) versus oral vancomycin (125 mg four times daily) in patients with confirmed CDI at more than 100 sites in North America. The primary endpoint was clinical cure, and global cure (clinical cure with no recurrence) was also reported. By per-protocol analysis, 244 (92·1%) of 265 fidaxomicin-treated patients were clinically cured versus 254 (89·8%) of 283 treated with vancomycin (ie, noninferiority endpoint met). Similar results for clinical cure were achieved by the modified intention-to-treat analysis: 253 (88·2%) of 287 given fidaxomicin versus 265 (85·8%) of 309 given vancomycin. Whereas fidaxomicin was comparable to vancomycin in terms of clinical cure, patients treated with fidaxomicin had significantly lower disease recurrence rates and therefore higher global cure rates by both per-protocol and intention-to-treat analyses.
Skin infections in diabetes Oritavancin (Targanta Therapeutics) is a lipoglycopeptide antibacterial with activity against Gram-positive organisms. A pair of randomised, non-inferiority, phase III trials of intravenous oritavancin versus intravenous vancomycin plus oral cephalexin for treatment of skin and skin structure infections in patients with diabetes were described by C S Hartman (Targanta, Indianapolis, IN, USA) and colleagues. Mean duration of treatment was 5·2 days in oritavancin-treated patients compared with 11·3 days in those treated with vancomycin and cephalexin. Clinical cure, the primary endpoint, was achieved by 125 (62·2%) of 201 oritavancin-treated patients versus 61 (62·9%) of 97 given vancomycin plus cephalexin. Rates of cure were, as expected, lower in patients with diabetes than in comparable patients without diabetes. The study authors emphasised the benefits of a shorter course to therapy provided by oritavancin.
Outpatient antimycotic use The objective of the European Surveillance of Antimicrobial Consuption project is to collect data from across Europe on outpatient antimicrobial use. V Andriaessens (University of Antwerp, Belgium) and colleagues reported 2007 data on outpatient systemic antimycotic use in 12 European countries. As measured by defined daily dose per 1000 inhabitants per day (DID), antimycotic use varied substantially between a high of 3·03 DID in Belgium and a low of 0·26 DID in Slovakia. Terbinafine, itraconazole, and fluconazole were the most prescribed drugs. On a nation-by-nation basis, there was no significant correlation between outpatient antimycotic and outpatient antibiotic use.
John McConnell www.thelancet.com/infection Vol 9 July 2009
Highlights from the 19th ECCMID The 19th European Congress of Clinical Microbiolgy and Infectious Diseases, attended by more than 8000 delegates in Helsinki, Finland (May 16–19), was the first major infectious diseases meeting to take place since the epidemic of swine-origin influenza virus (SOIV) H1N1 began. This event was marked by a dedicated late-breaker session. Other major themes of the conference were— the seeming perennials—antibiotic resistance, emerging infections, and new diagnostics. It was interesting to see how metagenomics, the subject of a keynote lecture by David Relman (Stanford University, CA, USA), has moved in a few years from a pure research tool to a technology nearing application in the clinical setting. Other highlights from the conference are reported here.
Influenza H1N1
Biomedical Imaging Unit, Southampton General Hospital/Science Photo Library
Speaking at the late-breaker session co-sponsored by The Lancet, Albert Osterhaus (Erasmus Medical Centre, Rotterdam, Netherlands) described the emergence of SOIV as the “most important event in human influenza over the past 40 years”. The virus was formed by reassortment of genes from four strains of H1N1 virus, which have been identified in pigs, birds, and human beings. Markers of severe pathogenicity are missing from SOIV,
Coloured transmission electron micrograph of Clostridium difficile
400
explaining why illness caused by the virus is usually mild. Osterhaus predicted three possible outcomes from emergence of the virus: it could disappear spontaneously, which he thought unlikely; it could cause a mild pandemic, like the 1957 pandemic; or there could be a severe pandemic after mutation or reassortment of the virus. Commenting on preliminary data from patients with SOIV infection, Javier Garau (University of Barcelona, Spain) noted that the high prevalence of diarrhoea and vomiting were unusual clinical features for influenza. The incubation period for disease is 2–7 days with a mean of 3·5 days. In Spain, all patients with the illness had recovered fully.
Clostridium difficile treatment Fidaxomicin (formerly OPT-80; Optima Pharmaceuticals) is a macrocyclic antibiotic intended for treatment of Clostridium difficile infection (CDI). T J Louie (University of Calgary, Alberta, Canada) reported a randomised, non-inferiority, phase III trial of oral fidaxomicin (200 mg twice daily) versus oral vancomycin (125 mg four times daily) in patients with confirmed CDI at more than 100 sites in North America. The primary endpoint was clinical cure, and global cure (clinical cure with no recurrence) was also reported. By per-protocol analysis, 244 (92·1%) of 265 fidaxomicin-treated patients were clinically cured versus 254 (89·8%) of 283 treated with vancomycin (ie, noninferiority endpoint met). Similar results for clinical cure were achieved by the modified intention-to-treat analysis: 253 (88·2%) of 287 given fidaxomicin versus 265 (85·8%) of 309 given vancomycin. Whereas fidaxomicin was comparable to vancomycin in terms of clinical cure, patients treated with fidaxomicin had significantly lower disease recurrence rates and therefore higher global cure rates by both per-protocol and intention-to-treat analyses.
Skin infections in diabetes Oritavancin (Targanta Therapeutics) is a lipoglycopeptide antibacterial with activity against Gram-positive organisms. A pair of randomised, non-inferiority, phase III trials of intravenous oritavancin versus intravenous vancomycin plus oral cephalexin for treatment of skin and skin structure infections in patients with diabetes were described by C S Hartman (Targanta, Indianapolis, IN, USA) and colleagues. Mean duration of treatment was 5·2 days in oritavancin-treated patients compared with 11·3 days in those treated with vancomycin and cephalexin. Clinical cure, the primary endpoint, was achieved by 125 (62·2%) of 201 oritavancin-treated patients versus 61 (62·9%) of 97 given vancomycin plus cephalexin. Rates of cure were, as expected, lower in patients with diabetes than in comparable patients without diabetes. The study authors emphasised the benefits of a shorter course to therapy provided by oritavancin.
Outpatient antimycotic use The objective of the European Surveillance of Antimicrobial Consuption project is to collect data from across Europe on outpatient antimicrobial use. V Andriaessens (University of Antwerp, Belgium) and colleagues reported 2007 data on outpatient systemic antimycotic use in 12 European countries. As measured by defined daily dose per 1000 inhabitants per day (DID), antimycotic use varied substantially between a high of 3·03 DID in Belgium and a low of 0·26 DID in Slovakia. Terbinafine, itraconazole, and fluconazole were the most prescribed drugs. On a nation-by-nation basis, there was no significant correlation between outpatient antimycotic and outpatient antibiotic use.
John McConnell www.thelancet.com/infection Vol 9 July 2009