- Email: [email protected]
Highlights from the 23rd ECCMID
Newsdesk
Highlights from the 23rd ECCMID Clinical microbiologists and infectious diseases experts from across Europe and further afield gathered in Berlin, April 27–30. Peter Hayward reports from a conference dominated by resistance.
The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) excellence award, given each year to recognise an outstanding contribution to clinical microbiology and infectious diseases was awarded to Patrice Nordmann (Department of Microbiology, Bicêtre Hospital, South Paris Medical School, France). Nordmann received the award in acknowledgment for his work investigating the emergence of resistance worldwide. Speaking about receiving the award, Nordmann warned that the spread of antibiotic resistance could “risk a paralysis of modern medicine“. Chair of the ESCMID Award Committee, Giuseppe Cornaglia, praised Nordmann’s work on resistance, which “spans the research lab to the hospital bedside”.
Resistance in the environment Several studies presented as posters at the meeting drew attention to the environment as a recipient and reservoir of antibiotic-resistant human pathogens. J Pereira and colleagues (Porto, Portugal) looked for human pathogens in farmed trout, with samples taken from aquaculture facilities and supermarkets. Of 27 samples, 13 contained Escherichia coli, over half of E coli isolates were resistant to at least one antibiotic (nalidixic acid, tetracycline, streptomycin, amoxicillin, sulfamethoxazole, ciprofloxacin, chloramphenicol, or trimethoprim). No extended spectrum β lactamases (ESBLs) were found in Gram negative bacteria, but six of 68 samples carried plasmid-mediated quinolone resistance. Multidrug resistant Hafnia alvei, Citrobacter freundii complex, and Proteus vulgaris were found (P1477). Enterococcus were detected in 22 samples (P1476) www.thelancet.com/infection Vol 13 June 2013
from seven supermarkets and one aquaculture facility. Resistance to tetracycline, erythromycin, chloramphenicol, streptomycin, ciprofloxacin, trimethoprim, and nitrofurantoin were detected, along with genes encoding resistance to mercury and copper. In another study, J Stedt (Uppsala, Sweden) collected faecal samples from seagulls in nine European countries in 2009. 847 ESBLproducing bacteria were isolated from 3158 samples, 737 were E coli. ESBL prevalence was highest in Spain (58%) and lowest in Denmark (0%). Analysis of the CTX-M variants suggested that resistance had spread from people to the environment (P1475).
and neither length of hospital stay nor in-hospital mortality differed. A Batirel (Samsun, Turkey) compared the efficacy of several colistin-based regimens for treatment of multidrugresistant Acinetobacter bacteraemia in a multicentre retrospective study. Between January, 2009, and August, 2012, 214 patients were treated in 27 health centres. 102 received colistin–carbapenem, 69 colistin– sulbactam, and 43 received colistin with another antibacterial agent. Clinical, microbiological, and 14 day survival did not differ between the three groups. Risk factors for death by 14 days included longer hospital stay and previous intensive-care-unit admission.
Treatment of difficult cases In a retrospective study, R K C Fong (Singapore) investigated the treatment of meticillin-resistant Staphylococcus aureus infections with a vancomycin minimum inhibitory concentration of 2 μg/mL (O653). The investigators compared outcomes in patients given standard treatment of vancomycin (54 patients) with those in patients switched to daptomycin (18 patients). 30 day mortality was similar in the two groups (22% vs 28%). “These results seem to contradict previous studies that showed superior outcome with daptomycin“, the researchers claim. M Carugati and colleagues presented results of a comparison of daptomycin and vancomycin for the treatment of endocarditis caused by coagulase-negative Staphylococcus from the International Collaboration on Endocarditis Prospective Cohort Study (O653). 12 patients were treated with daptomycin (six of whom had failed a previous antibiotic regimen), and 57 were treated with vancomycin. Median time to clearance was 3 days in both treatment groups,
Trends in infectious diseases If importance were judged in terms of publications, influenza is perhaps the hottest infectious diseases topic of the past decade. J-S Casalegno (Lyon, France) and colleagues searched Pubmed from January, 2000, to December, 2012, and compiled data for all infectious agents that featured in the titles of more than 1000 records (P1672). The disease with the most
NeilK/Wikimedia Commons
Excellence award
Berlin played host to participants from around the world for ECCMID 2013
481
Newsdesk
records in both 2000 and 2012 was HIV (10 070 records in 2012). E coli and Mycobacterium tuberculosis swapped the second and third slots, respectively, and hepatitis C virus held strong in fourth. Staphylococcus aureus knocked malaria from fifth to sixth, and influenza climbed from ninth to seventh in the list—which may not seem too impressive, but the number of publications records for the virus increased by over 1000% from 2000 to 2012. S aureus and human papillomavirus both increased by over 300%, whereas HIV and E coli increased by a meagre 150%. Unsurprisingly, the influenza publications peaked in 2010, and have shown a slight decline since.
In sickness and in health Danish investigators presented some intriguing data about the health
benefits of marriage (P2023). In a population-based case-control study, A Mor (Aarhus, Denmark) and colleagues compared rates of admission to hospital with pneumonia among married and unmarried people. 67 162 patients with pneumonia identified from health-care databases in northern Denmark were compared with 671 620 population contols matched for age and sex, identified from Denmark’s Civil Registration System. 47% of patients were married, 40% widowed or divorced, and 13% had never been married. Compared with married patients, odds ratios for pneumonia were 1·34 in divorced or widowed patients and 1·30 in the never-married group. After adjustment for age, sex, comorbidities, alcoholism, immunosuppressive treatment, urbanisation, and living with
small children, the odds ratios were 1·20 (95% CI 1·17–1·22) and 1·33 (1·29–1·37).
Measles outbreak Introducing a session on measles in Europe, chair A Mankertz (Berlin, Germany) told of an outbreak starting at this year’s Fruit Logistica conference (Feb 6–8) at the International Conference Centre Berlin, the home of ECCMID 2013. 60 000 fruit growers and grocers attended the conference. And a week later three attendees from Berlin developed measles, 2 weeks later cases were identified in Hamburg, all with the D8 Frankfurt strain. By April 29, the outbreak had caused 124 cases in Berlin, and a related case was identified as far away as Sweden.
Peter Hayward
Infectious disease surveillance update For more on hepatitis A from Egypt see http://www.ecdc. europa.eu/en/press/news/ Lists/News/ECDC_DispForm. aspx?List=32e43ee8-e2304424-a783-85742124029a&ID= 907&RootFolder=/en/press/ news/Lists/News For more on meningitis in South Sudan see http://allafrica. com/stories/201305010340. html For more on C difficile in Scotland see http://www.bbc. co.uk/news/ukscotland-22378210 For the HPS Weekly Report see http://www.documents.hps.scot. nhs.uk/ewr/pdf2013/1318.pdf For WHO’s coronavirus update see http://www.who.int/csr/ don/2013_05_06_ncov/en/ index.html For more on coronavirus in France see http://www.cbsnews. com/8301-204_162-57583440/ new-coronavirus-from-middleeast-infects-french-citizen/
Hepatitis A from Egypt 15 confirmed cases of hepatitis A and 89 suspected cases have been reported between November, 2012, and April, 2013, in 14 European countries. All patients had subgenotype IB virus and had travelled to Egypt. Symptoms usually begin 2–6 weeks after exposure to the hepatitis A virus and include dark urine, vomiting, and fatigue. The European Commission, WHO, European Centre for Disease Prevention and Control, and the affected countries are cooperating to monitor the outbreak. Vaccination of contacts of patients should be considered in accordance with national guidance, and hepatitis A vaccination recommendations should be highlighted for people travelling to endemic areas.
Meningitis in South Sudan An outbreak of meningitis in the Upper Nile state of South Sudan has been declared by the Ministry of Health on May 2, 2013, after the 482
disease claimed two lives. At least 38 cases have been recorded since the first patient was admitted to hospital on April 15, 2013. The agegroup most affected are people aged 18–20 years. Of 11 cerebrospinal fluid samples tested by the ministry so far, eight have been positive for Neisseria meningitidis serogroup A, the most prevalent strain in Africa. A mass meningitis vaccination campaign will target over 260 000 people living in the Malakal county and surrounding districts.
C diff in Scotland A new PCR ribotype of Clostridium difficile, designated ribotype 332, has been identified by Health Protection Scotland (HPS). The first cases emerged in December, 2012, and January, 2013, from two patients cared for in the same clinical setting in Scotland. The third case was identified from another hospital in April, 2013, within the same National Health Service board. The three patients had reportedly been severely
unwell as a result of their underlying disorders and died from the C difficile infection. Symptoms of the infection include abdominal cramps and diarrhoea. HPS stated that no immediate changes to surveillance or antibiotic use were necessary.
Novel coronavirus infection WHO continues to receive notification of confirmed cases of infection with the novel coronavirus. On May 3, 2013, two Saudi Arabian patients died and a third was in a critical condition. Patients affected are aged 24–94 years. The first case of the new respiratory virus in France was reported on May 8. Worldwide, 31 cases, including 18 deaths, have been reported since September, 2012. WHO is working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.
Nawsheen Boodhun www.thelancet.com/infection Vol 13 June 2013
Highlights from the 23rd ECCMID Clinical microbiologists and infectious diseases experts from across Europe and further afield gathered in Berlin, April 27–30. Peter Hayward reports from a conference dominated by resistance.
The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) excellence award, given each year to recognise an outstanding contribution to clinical microbiology and infectious diseases was awarded to Patrice Nordmann (Department of Microbiology, Bicêtre Hospital, South Paris Medical School, France). Nordmann received the award in acknowledgment for his work investigating the emergence of resistance worldwide. Speaking about receiving the award, Nordmann warned that the spread of antibiotic resistance could “risk a paralysis of modern medicine“. Chair of the ESCMID Award Committee, Giuseppe Cornaglia, praised Nordmann’s work on resistance, which “spans the research lab to the hospital bedside”.
Resistance in the environment Several studies presented as posters at the meeting drew attention to the environment as a recipient and reservoir of antibiotic-resistant human pathogens. J Pereira and colleagues (Porto, Portugal) looked for human pathogens in farmed trout, with samples taken from aquaculture facilities and supermarkets. Of 27 samples, 13 contained Escherichia coli, over half of E coli isolates were resistant to at least one antibiotic (nalidixic acid, tetracycline, streptomycin, amoxicillin, sulfamethoxazole, ciprofloxacin, chloramphenicol, or trimethoprim). No extended spectrum β lactamases (ESBLs) were found in Gram negative bacteria, but six of 68 samples carried plasmid-mediated quinolone resistance. Multidrug resistant Hafnia alvei, Citrobacter freundii complex, and Proteus vulgaris were found (P1477). Enterococcus were detected in 22 samples (P1476) www.thelancet.com/infection Vol 13 June 2013
from seven supermarkets and one aquaculture facility. Resistance to tetracycline, erythromycin, chloramphenicol, streptomycin, ciprofloxacin, trimethoprim, and nitrofurantoin were detected, along with genes encoding resistance to mercury and copper. In another study, J Stedt (Uppsala, Sweden) collected faecal samples from seagulls in nine European countries in 2009. 847 ESBLproducing bacteria were isolated from 3158 samples, 737 were E coli. ESBL prevalence was highest in Spain (58%) and lowest in Denmark (0%). Analysis of the CTX-M variants suggested that resistance had spread from people to the environment (P1475).
and neither length of hospital stay nor in-hospital mortality differed. A Batirel (Samsun, Turkey) compared the efficacy of several colistin-based regimens for treatment of multidrugresistant Acinetobacter bacteraemia in a multicentre retrospective study. Between January, 2009, and August, 2012, 214 patients were treated in 27 health centres. 102 received colistin–carbapenem, 69 colistin– sulbactam, and 43 received colistin with another antibacterial agent. Clinical, microbiological, and 14 day survival did not differ between the three groups. Risk factors for death by 14 days included longer hospital stay and previous intensive-care-unit admission.
Treatment of difficult cases In a retrospective study, R K C Fong (Singapore) investigated the treatment of meticillin-resistant Staphylococcus aureus infections with a vancomycin minimum inhibitory concentration of 2 μg/mL (O653). The investigators compared outcomes in patients given standard treatment of vancomycin (54 patients) with those in patients switched to daptomycin (18 patients). 30 day mortality was similar in the two groups (22% vs 28%). “These results seem to contradict previous studies that showed superior outcome with daptomycin“, the researchers claim. M Carugati and colleagues presented results of a comparison of daptomycin and vancomycin for the treatment of endocarditis caused by coagulase-negative Staphylococcus from the International Collaboration on Endocarditis Prospective Cohort Study (O653). 12 patients were treated with daptomycin (six of whom had failed a previous antibiotic regimen), and 57 were treated with vancomycin. Median time to clearance was 3 days in both treatment groups,
Trends in infectious diseases If importance were judged in terms of publications, influenza is perhaps the hottest infectious diseases topic of the past decade. J-S Casalegno (Lyon, France) and colleagues searched Pubmed from January, 2000, to December, 2012, and compiled data for all infectious agents that featured in the titles of more than 1000 records (P1672). The disease with the most
NeilK/Wikimedia Commons
Excellence award
Berlin played host to participants from around the world for ECCMID 2013
481
Newsdesk
records in both 2000 and 2012 was HIV (10 070 records in 2012). E coli and Mycobacterium tuberculosis swapped the second and third slots, respectively, and hepatitis C virus held strong in fourth. Staphylococcus aureus knocked malaria from fifth to sixth, and influenza climbed from ninth to seventh in the list—which may not seem too impressive, but the number of publications records for the virus increased by over 1000% from 2000 to 2012. S aureus and human papillomavirus both increased by over 300%, whereas HIV and E coli increased by a meagre 150%. Unsurprisingly, the influenza publications peaked in 2010, and have shown a slight decline since.
In sickness and in health Danish investigators presented some intriguing data about the health
benefits of marriage (P2023). In a population-based case-control study, A Mor (Aarhus, Denmark) and colleagues compared rates of admission to hospital with pneumonia among married and unmarried people. 67 162 patients with pneumonia identified from health-care databases in northern Denmark were compared with 671 620 population contols matched for age and sex, identified from Denmark’s Civil Registration System. 47% of patients were married, 40% widowed or divorced, and 13% had never been married. Compared with married patients, odds ratios for pneumonia were 1·34 in divorced or widowed patients and 1·30 in the never-married group. After adjustment for age, sex, comorbidities, alcoholism, immunosuppressive treatment, urbanisation, and living with
small children, the odds ratios were 1·20 (95% CI 1·17–1·22) and 1·33 (1·29–1·37).
Measles outbreak Introducing a session on measles in Europe, chair A Mankertz (Berlin, Germany) told of an outbreak starting at this year’s Fruit Logistica conference (Feb 6–8) at the International Conference Centre Berlin, the home of ECCMID 2013. 60 000 fruit growers and grocers attended the conference. And a week later three attendees from Berlin developed measles, 2 weeks later cases were identified in Hamburg, all with the D8 Frankfurt strain. By April 29, the outbreak had caused 124 cases in Berlin, and a related case was identified as far away as Sweden.
Peter Hayward
Infectious disease surveillance update For more on hepatitis A from Egypt see http://www.ecdc. europa.eu/en/press/news/ Lists/News/ECDC_DispForm. aspx?List=32e43ee8-e2304424-a783-85742124029a&ID= 907&RootFolder=/en/press/ news/Lists/News For more on meningitis in South Sudan see http://allafrica. com/stories/201305010340. html For more on C difficile in Scotland see http://www.bbc. co.uk/news/ukscotland-22378210 For the HPS Weekly Report see http://www.documents.hps.scot. nhs.uk/ewr/pdf2013/1318.pdf For WHO’s coronavirus update see http://www.who.int/csr/ don/2013_05_06_ncov/en/ index.html For more on coronavirus in France see http://www.cbsnews. com/8301-204_162-57583440/ new-coronavirus-from-middleeast-infects-french-citizen/
Hepatitis A from Egypt 15 confirmed cases of hepatitis A and 89 suspected cases have been reported between November, 2012, and April, 2013, in 14 European countries. All patients had subgenotype IB virus and had travelled to Egypt. Symptoms usually begin 2–6 weeks after exposure to the hepatitis A virus and include dark urine, vomiting, and fatigue. The European Commission, WHO, European Centre for Disease Prevention and Control, and the affected countries are cooperating to monitor the outbreak. Vaccination of contacts of patients should be considered in accordance with national guidance, and hepatitis A vaccination recommendations should be highlighted for people travelling to endemic areas.
Meningitis in South Sudan An outbreak of meningitis in the Upper Nile state of South Sudan has been declared by the Ministry of Health on May 2, 2013, after the 482
disease claimed two lives. At least 38 cases have been recorded since the first patient was admitted to hospital on April 15, 2013. The agegroup most affected are people aged 18–20 years. Of 11 cerebrospinal fluid samples tested by the ministry so far, eight have been positive for Neisseria meningitidis serogroup A, the most prevalent strain in Africa. A mass meningitis vaccination campaign will target over 260 000 people living in the Malakal county and surrounding districts.
C diff in Scotland A new PCR ribotype of Clostridium difficile, designated ribotype 332, has been identified by Health Protection Scotland (HPS). The first cases emerged in December, 2012, and January, 2013, from two patients cared for in the same clinical setting in Scotland. The third case was identified from another hospital in April, 2013, within the same National Health Service board. The three patients had reportedly been severely
unwell as a result of their underlying disorders and died from the C difficile infection. Symptoms of the infection include abdominal cramps and diarrhoea. HPS stated that no immediate changes to surveillance or antibiotic use were necessary.
Novel coronavirus infection WHO continues to receive notification of confirmed cases of infection with the novel coronavirus. On May 3, 2013, two Saudi Arabian patients died and a third was in a critical condition. Patients affected are aged 24–94 years. The first case of the new respiratory virus in France was reported on May 8. Worldwide, 31 cases, including 18 deaths, have been reported since September, 2012. WHO is working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.
Nawsheen Boodhun www.thelancet.com/infection Vol 13 June 2013