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Highlights from the 3rd ICPIC
Newsdesk
Highlights from the 3rd ICPIC More than 1000 infectious diseases experts from 80 countries gathered in Geneva, Switzerland, for the 3rd International Conference on Prevention and Infection Control (ICPIC).
Stéphane Emonet (University Hospitals Geneva, Switzerland) gave a presentation on rapid molecular diagnosis using femA mecA real-time PCR for staphylococcal bacteraemia. In this prospective single-centre study the objective was to assess if rapid determination of meticillin susceptibility in staphylococcal bacteraemia, using real-time PCR, could reduce the time to targeted antibiotherapy compared with conventional microbiological techniques, thereby avoiding unneeded exposure to vancomycin. Meticillin susceptibility and staphylococcal species were rapidly identified by submitting all blood culture vials with Gram positive cocci to femA_SA, femA_SE, and mecA realtime PCR. 100 patients were randomly assigned to two groups: treatment by physicians immediately aware of the PCR results (group A) or else waiting until results of conventional tests were available (group B). Antibiotic therapy was classed as ideal (targeted), adequate, or inappropriate. The findings were that 85·4% of group A patients were already receiving so-called ideal therapy when the conventional findings became available (56·1% in group B, p=0·004). PCR results were available 3·2 h after Gram stain assessment. Sandra Schneider (Hygiene Institute, Charité, Berlin, Germany) presented an assessment of antimicrobial prescription behaviour in German intensive care units (ICUs). In this study, 16 ICUs in non-university hospitals across Germany were included. Medical records of patients diagnosed with pneumonia were randomly selected in 2012 and retrospectively assessed. 383 medical records were analysed (179 community acquired and 204 hospital acquired pneumonia cases). 40·5% of empirical therapy www.thelancet.com/infection Vol 15 August 2015
regimens were appropriate according to national guidelines. 11·7% regimens involved an excessively broad spectrum or drugs that were not recommended. 47·8% regimens used drugs with too narrow a spectrum. Duration of therapy could only be assessed in 40·7% of cases since the other patients were dismissed or died before recommended end of therapy.
How to keep things clean Hilary Humphreys gave a talk on self-disinfecting and microbiocideimpregnated surfaces. He drew attention to the wide range of chemicals and disinfectants available. The antimicrobial effect of copper has long been recognised for its potential applications in health-care settings as a mechanism to reduce environmental contamination and thus prevent health-care-associated infections. However, although copper surfaces gained attention in the past few years, clinical studies showing a significant effect on patient outcomes are lacking. An intention-to-treat randomised control trial done in 2010–11, recruited 60 patients from the ICUs of three hospitals. Patients were randomly assigned to available rooms with or without copper alloy surfaces and the rates of infection or colonisation by meticillin-resistant Staphylococcus aureus or vancomycin-resistant enterococcus in each type of room were compared. The rate of infection or colonisation was lower in the rooms with copper alloy surfaces than that in standard rooms (0·071 vs 0·123, p=0·20). For infection only, the rate was reduced from 0·081 to 0·034 (p=0·13).
Ebola virus disease Alpha Diallo (Jhpiego, Conakry, Guinea) and colleagues gave a presentation on infection prevention and control
CICG
Antimicrobial stewardship
(IPC) in the context of Ebola virus disease in nine health-care facilities in Guinea. They did an assessment in December, 2014, and January, 2015, in three teaching hospitals, comprising 66 services, and six communal medical centres (CMC). The main assessment method was based on StandardsBased Management and Recognition performance standards for IPC. Data collection consisted of observation, interview, and document review by a team of two assessors per facility, for 2–3 days per facility. In the three national teaching hospitals, among 66 services, one service achieved 75% of performance standards and eight achieved none. 33 of the services achieved below 30% of standards, while 17 scored between 31% and 49% and seven performed at 50–74% of standards. In the six CMC, four achieved standards of between 16% and 20%, one 35%, and one 37%. Insufficient knowledge of IPC, lack of IPC materials and equipment, together with nonobservance of IPC procedures and norms, and poor management of IPC activities, were the key reasons for poor performance.
Raffaella Bosurgi 883
Highlights from the 3rd ICPIC More than 1000 infectious diseases experts from 80 countries gathered in Geneva, Switzerland, for the 3rd International Conference on Prevention and Infection Control (ICPIC).
Stéphane Emonet (University Hospitals Geneva, Switzerland) gave a presentation on rapid molecular diagnosis using femA mecA real-time PCR for staphylococcal bacteraemia. In this prospective single-centre study the objective was to assess if rapid determination of meticillin susceptibility in staphylococcal bacteraemia, using real-time PCR, could reduce the time to targeted antibiotherapy compared with conventional microbiological techniques, thereby avoiding unneeded exposure to vancomycin. Meticillin susceptibility and staphylococcal species were rapidly identified by submitting all blood culture vials with Gram positive cocci to femA_SA, femA_SE, and mecA realtime PCR. 100 patients were randomly assigned to two groups: treatment by physicians immediately aware of the PCR results (group A) or else waiting until results of conventional tests were available (group B). Antibiotic therapy was classed as ideal (targeted), adequate, or inappropriate. The findings were that 85·4% of group A patients were already receiving so-called ideal therapy when the conventional findings became available (56·1% in group B, p=0·004). PCR results were available 3·2 h after Gram stain assessment. Sandra Schneider (Hygiene Institute, Charité, Berlin, Germany) presented an assessment of antimicrobial prescription behaviour in German intensive care units (ICUs). In this study, 16 ICUs in non-university hospitals across Germany were included. Medical records of patients diagnosed with pneumonia were randomly selected in 2012 and retrospectively assessed. 383 medical records were analysed (179 community acquired and 204 hospital acquired pneumonia cases). 40·5% of empirical therapy www.thelancet.com/infection Vol 15 August 2015
regimens were appropriate according to national guidelines. 11·7% regimens involved an excessively broad spectrum or drugs that were not recommended. 47·8% regimens used drugs with too narrow a spectrum. Duration of therapy could only be assessed in 40·7% of cases since the other patients were dismissed or died before recommended end of therapy.
How to keep things clean Hilary Humphreys gave a talk on self-disinfecting and microbiocideimpregnated surfaces. He drew attention to the wide range of chemicals and disinfectants available. The antimicrobial effect of copper has long been recognised for its potential applications in health-care settings as a mechanism to reduce environmental contamination and thus prevent health-care-associated infections. However, although copper surfaces gained attention in the past few years, clinical studies showing a significant effect on patient outcomes are lacking. An intention-to-treat randomised control trial done in 2010–11, recruited 60 patients from the ICUs of three hospitals. Patients were randomly assigned to available rooms with or without copper alloy surfaces and the rates of infection or colonisation by meticillin-resistant Staphylococcus aureus or vancomycin-resistant enterococcus in each type of room were compared. The rate of infection or colonisation was lower in the rooms with copper alloy surfaces than that in standard rooms (0·071 vs 0·123, p=0·20). For infection only, the rate was reduced from 0·081 to 0·034 (p=0·13).
Ebola virus disease Alpha Diallo (Jhpiego, Conakry, Guinea) and colleagues gave a presentation on infection prevention and control
CICG
Antimicrobial stewardship
(IPC) in the context of Ebola virus disease in nine health-care facilities in Guinea. They did an assessment in December, 2014, and January, 2015, in three teaching hospitals, comprising 66 services, and six communal medical centres (CMC). The main assessment method was based on StandardsBased Management and Recognition performance standards for IPC. Data collection consisted of observation, interview, and document review by a team of two assessors per facility, for 2–3 days per facility. In the three national teaching hospitals, among 66 services, one service achieved 75% of performance standards and eight achieved none. 33 of the services achieved below 30% of standards, while 17 scored between 31% and 49% and seven performed at 50–74% of standards. In the six CMC, four achieved standards of between 16% and 20%, one 35%, and one 37%. Insufficient knowledge of IPC, lack of IPC materials and equipment, together with nonobservance of IPC procedures and norms, and poor management of IPC activities, were the key reasons for poor performance.
Raffaella Bosurgi 883