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Highlights from the 50th ICAAC
Newsdesk
Highlights from the 50th ICAAC This year’s meeting in Boston, MA, USA (Oct 12–15), was the 50th anniversary of the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); the conference committee marked the occasion by publishing a retrospective of the past 50 years recapping the impact of ICAAC presentations on the major infectious disease topics. Here we present some highlights of this year’s conference.
Conference keynotes The keynote session included speeches from three Nobel Laureates. Peter Doherty, Thomas Steitz, and Barry Marshall talked about the work that gained them the highest scientific accolade. Marshall went on to describe how since being recognised as the pathogen causing gastric ulcers, Helicobacter pylori has been found potentially to have several beneficial roles in human beings and is now being used by scientists to track human migrations with phylogenetic analysis of its genome. See Correspondence page 749
NDM-1 in the spotlight
Nelson48
In keeping with the conference title, antibiotic resistance was at the forefront of the agenda. It is unlikely that an enzyme conferring antibiotic resistance has had an entire ICAAC session devoted to it before, as New
The ICAAC celebrated its half-century in Boston, MA, USA
744
Delhi metallo-β-lactamase 1 (NDM-1) did in Boston—a rapid rise to fame for a resistance mechanism first reported at ICAAC in 2008. In reviewing the global spread of metallo-β-lactamases among Enterobacteriaceae, of which NDM-1 is one such enzyme, Patrice Nordmann (Hôpital de Bicêtre, Le Kremlin Bicêtre, France) called for the screening of all patients hospitalised abroad to be implemented immediately. The international spread of NDM-1 has been associated with patients travelling to the Indian subcontinent for medical treatment, and Nordmann further called for all such medical tourism to be banned. Laurent Poirel (Hôpital de Bicêtre) described an NDM-1 expressing Escherichia coli isolate from the urine of a 67-year-old man from Sydney, Australia, who had been hospitalised in Bangladesh with pneumonia (abstract C1-1333). The E coli was resistant to all antibiotics except tetracycline and colistin. An isolate of Klebsiella pneumoniae expressing NDM-1 was reported by Hanna Sibjabat (University of Queensland, Brisbane, Australia; abstract C1-1332). The isolate came from an 87-yearold woman resident in Australia, who developed a K pneumoniae-infected foot while visiting Punjab, India. Poirel also reported seven NDM-1-producing K pneumoniae isolates from patients admitted from 2007 to 2009 to the Aga Khan Hospital, Nairobi, Kenya (abstract C1-1334). The seven isolates were resistant to all antibiotics apart from colistin; additionally, they were clonally related and related to the first NDM-1-producing isolate reported from a patient in Sweden in 2008. NDM-1 has likely been present in India since 2006, according to an abstract (C2-701) from L M Deshpande (JMI Laboratories, North Liberty, IA, USA) and colleagues. Among 1443 Enterobacteriaceae isolates collected from 14 Indian hospitals during 2006 and 2007, 15 (six E coli, six K pneumonia,
three Enterobacter cloacae) from New Delhi, Mumbai, and Pune carried the NDM-1 coding gene. 13 isolates were susceptible only to tigecycline and colistin, but the other two were resistant even to these antibiotics. Mark Toleman (Cardiff University, Cardiff, UK) commented that because of the misuse of antibiotics “the Indian population is particularly good at educating bacteria [to be resistant]”.
Hand hygiene survey The American Society of Microbiology and American Cleaning Institute presented results of 2010 Handwashing Survey. Since 1996, the surveys have monitored the handwashing practices of Americans by observing behaviour in public washrooms across the USA and through telephone surveys. When the surveys began in 1996, just 68% of people were washing their hands after visiting public bathrooms, this year 85% of people were seen to wash their hands. Just as in 2003 an increase in handwashing was observed in Toronto in the wake of the SARS outbreak, the results of this survey were undoubtedly affected by the 2009 influenza pandemic, although because the survey was done in August after the main threat had passed, improvements in behaviours might be longlasting. Judy Daly (University of Utah, Salt Lake City, UT, USA) praised the benefits of “those 20 s with friction, water, and soap“, in preventing the spread of infectious diseases.
STIs online The rapidly evolving online environment has had an enormous effect on sexually transmitted infections (STIs). Cornelis Rietmeijer (Colorado School of Public Health, University of Colorado, Denver, CO, USA) discussed the many roles the internet has in STI epidemics. Although dating websites facilitate people
www.thelancet.com/infection Vol 10 November 2010
Newsdesk
meeting for casual sex and might act as hubs for the spread of infection, they also provide valuable opportunities to spread information about safer sex, STI testing and counselling, and treatment. Although we are more used to hearing about the potential harms related to the use of the internet by young people, Ritmeijer also talked about the value of the internet in enabling frank conversation among young adults about issues of sexuality and sexual health (L2-1932).
Hello possums More typically associated with tropical Africa, Buruli ulcer is also endemic in the Bellarine Peninsula, Victoria, Australia, where there have been over 100 confirmed cases. Paul Johnson (Austin Health, Melbourne, VIC, Australia) presented a series of studies in which he investigated possible animal reservoirs of the disease (L1-1326). First, investigators identified Mycobacterium ulcerans DNA in about 0·1% of mosquitoes trapped
in the area. Then noticing close habitation of ringtail possums and people, they looked to the marsupials as a potential source. M ulcerans DNA was common in the faeces of ringtail possums and around 25% of the endemic animals living in the area had symptoms of Buruli ulcer. This research might prompt people working on the disease in other areas to look for animal reservoirs and vectors of the disease.
Peter Hayward, John McConnell
Universal access 2010 On September 28, WHO, UNAIDS, and UNICEF launched the 2010 Towards Universal Access Report summarising a year’s advance towards the UN goal of having 80% of people in need of antiretroviral drugs on treatment by the end of 2010. Despite an extra 1·2 million people being provided with antiretrovirals in 2009 compared with 2008, the change in the WHO recommended CD4 threshold from fewer than 200 cells per mm3 to fewer than 350 cells per mm3 means that the proportion of people in need of drugs declined from 42% at the end of 2008 to 36% at the end of 2009. Although the goal of universal access has been achieved in just eight lowincome and middle-income countries—Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania, and Rwanda—WHO’s HIV/AIDS Director Gottfried Hirnschall (WHO, Geneva, Switzerland) feels there is much good news in the report. “More than 20 countries made really good progress and are now providing treatment to 50–80% of those who need it; this is proof of concept that it can be done, universal access can be reached by 2010.” And even for countries that will not achieve the goal by 2010, the gains made are crucial. “Countries like South Africa and Lesotho have made great strides forward, which, given the burden in this region, is important”, says Hirnschall.
Advances have been in some groups than in others, says Hirnschall. “Large numbers of countries have been successful and have achieved 80% coverage for prevention of mother-tochild transmission.” But some regional differences are clear, with regards to providing treatment to both all patients in need and pregnant women, Hirnschall points out, west and central Africa have not progressed well. David Okello of WHO’s African Regional Office agrees. “The report contains a lot of good and a lot of bad news, and there is mixed achievement across the world.” Africa still bears the greatest burden, and Okello cites challenges to health systems, drug stock-outs, and budget stagnation as concerns for future gains in the region. “Sometimes we have acute stock-outs of essential drugs, and when people go on drug holidays we begin to see resistance to antiretrovirals.” “The fact that many countries will not achieve universal access by the end of this year is not cause to despair”, says Okello. “We need to reveal why we have not reached UN targets.” WHO is now in the process of developing a new HIV/AIDS strategy for 2011–15 to further the progress towards universal access by the deadline for the Millennium Development Goals, Hirnschall told TLID. The strategy, to be announced at the World Health Assembly in May,
www.thelancet.com/infection Vol 10 November 2010
will scale up prevention, optimise the contribution of the HIV response to other MDGs, use leverage of the HIV response to strengthen procurement and health information systems, attempt to address structural and social determinants of health to target delivery to most at risk populations, and will launch what has been dubbed “treatment 2.0”. Hirnschall describes treatment 2.0 as “new regimens, simpler regimens, more resilient regiments, to find different ways to deliver services, broader involvement of community organisation, and scale up of testing and counselling so that people who need treatment know that they need treatment.” Hirnschall, Okello, and others involved in the HIV/AIDS response recognise the importance of integrating HIV goals with other health initiatives to ensure that as treatment and prevention are extended to ever more people quality is not sacrificed for quantity. “It is not just about the numbers”, says Okello, “it is about quality of care, quality of drugs, quality of diagnostics, and quality of services.” Hirnschall concludes: “we cannot play one health priority against another and we need to be strategic in positioning HIV in this context and see how it can contribute to other health outcomes and address other health priorities.”
See Leading Edge page 737
Peter Hayward 745
Highlights from the 50th ICAAC This year’s meeting in Boston, MA, USA (Oct 12–15), was the 50th anniversary of the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); the conference committee marked the occasion by publishing a retrospective of the past 50 years recapping the impact of ICAAC presentations on the major infectious disease topics. Here we present some highlights of this year’s conference.
Conference keynotes The keynote session included speeches from three Nobel Laureates. Peter Doherty, Thomas Steitz, and Barry Marshall talked about the work that gained them the highest scientific accolade. Marshall went on to describe how since being recognised as the pathogen causing gastric ulcers, Helicobacter pylori has been found potentially to have several beneficial roles in human beings and is now being used by scientists to track human migrations with phylogenetic analysis of its genome. See Correspondence page 749
NDM-1 in the spotlight
Nelson48
In keeping with the conference title, antibiotic resistance was at the forefront of the agenda. It is unlikely that an enzyme conferring antibiotic resistance has had an entire ICAAC session devoted to it before, as New
The ICAAC celebrated its half-century in Boston, MA, USA
744
Delhi metallo-β-lactamase 1 (NDM-1) did in Boston—a rapid rise to fame for a resistance mechanism first reported at ICAAC in 2008. In reviewing the global spread of metallo-β-lactamases among Enterobacteriaceae, of which NDM-1 is one such enzyme, Patrice Nordmann (Hôpital de Bicêtre, Le Kremlin Bicêtre, France) called for the screening of all patients hospitalised abroad to be implemented immediately. The international spread of NDM-1 has been associated with patients travelling to the Indian subcontinent for medical treatment, and Nordmann further called for all such medical tourism to be banned. Laurent Poirel (Hôpital de Bicêtre) described an NDM-1 expressing Escherichia coli isolate from the urine of a 67-year-old man from Sydney, Australia, who had been hospitalised in Bangladesh with pneumonia (abstract C1-1333). The E coli was resistant to all antibiotics except tetracycline and colistin. An isolate of Klebsiella pneumoniae expressing NDM-1 was reported by Hanna Sibjabat (University of Queensland, Brisbane, Australia; abstract C1-1332). The isolate came from an 87-yearold woman resident in Australia, who developed a K pneumoniae-infected foot while visiting Punjab, India. Poirel also reported seven NDM-1-producing K pneumoniae isolates from patients admitted from 2007 to 2009 to the Aga Khan Hospital, Nairobi, Kenya (abstract C1-1334). The seven isolates were resistant to all antibiotics apart from colistin; additionally, they were clonally related and related to the first NDM-1-producing isolate reported from a patient in Sweden in 2008. NDM-1 has likely been present in India since 2006, according to an abstract (C2-701) from L M Deshpande (JMI Laboratories, North Liberty, IA, USA) and colleagues. Among 1443 Enterobacteriaceae isolates collected from 14 Indian hospitals during 2006 and 2007, 15 (six E coli, six K pneumonia,
three Enterobacter cloacae) from New Delhi, Mumbai, and Pune carried the NDM-1 coding gene. 13 isolates were susceptible only to tigecycline and colistin, but the other two were resistant even to these antibiotics. Mark Toleman (Cardiff University, Cardiff, UK) commented that because of the misuse of antibiotics “the Indian population is particularly good at educating bacteria [to be resistant]”.
Hand hygiene survey The American Society of Microbiology and American Cleaning Institute presented results of 2010 Handwashing Survey. Since 1996, the surveys have monitored the handwashing practices of Americans by observing behaviour in public washrooms across the USA and through telephone surveys. When the surveys began in 1996, just 68% of people were washing their hands after visiting public bathrooms, this year 85% of people were seen to wash their hands. Just as in 2003 an increase in handwashing was observed in Toronto in the wake of the SARS outbreak, the results of this survey were undoubtedly affected by the 2009 influenza pandemic, although because the survey was done in August after the main threat had passed, improvements in behaviours might be longlasting. Judy Daly (University of Utah, Salt Lake City, UT, USA) praised the benefits of “those 20 s with friction, water, and soap“, in preventing the spread of infectious diseases.
STIs online The rapidly evolving online environment has had an enormous effect on sexually transmitted infections (STIs). Cornelis Rietmeijer (Colorado School of Public Health, University of Colorado, Denver, CO, USA) discussed the many roles the internet has in STI epidemics. Although dating websites facilitate people
www.thelancet.com/infection Vol 10 November 2010
Newsdesk
meeting for casual sex and might act as hubs for the spread of infection, they also provide valuable opportunities to spread information about safer sex, STI testing and counselling, and treatment. Although we are more used to hearing about the potential harms related to the use of the internet by young people, Ritmeijer also talked about the value of the internet in enabling frank conversation among young adults about issues of sexuality and sexual health (L2-1932).
Hello possums More typically associated with tropical Africa, Buruli ulcer is also endemic in the Bellarine Peninsula, Victoria, Australia, where there have been over 100 confirmed cases. Paul Johnson (Austin Health, Melbourne, VIC, Australia) presented a series of studies in which he investigated possible animal reservoirs of the disease (L1-1326). First, investigators identified Mycobacterium ulcerans DNA in about 0·1% of mosquitoes trapped
in the area. Then noticing close habitation of ringtail possums and people, they looked to the marsupials as a potential source. M ulcerans DNA was common in the faeces of ringtail possums and around 25% of the endemic animals living in the area had symptoms of Buruli ulcer. This research might prompt people working on the disease in other areas to look for animal reservoirs and vectors of the disease.
Peter Hayward, John McConnell
Universal access 2010 On September 28, WHO, UNAIDS, and UNICEF launched the 2010 Towards Universal Access Report summarising a year’s advance towards the UN goal of having 80% of people in need of antiretroviral drugs on treatment by the end of 2010. Despite an extra 1·2 million people being provided with antiretrovirals in 2009 compared with 2008, the change in the WHO recommended CD4 threshold from fewer than 200 cells per mm3 to fewer than 350 cells per mm3 means that the proportion of people in need of drugs declined from 42% at the end of 2008 to 36% at the end of 2009. Although the goal of universal access has been achieved in just eight lowincome and middle-income countries—Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania, and Rwanda—WHO’s HIV/AIDS Director Gottfried Hirnschall (WHO, Geneva, Switzerland) feels there is much good news in the report. “More than 20 countries made really good progress and are now providing treatment to 50–80% of those who need it; this is proof of concept that it can be done, universal access can be reached by 2010.” And even for countries that will not achieve the goal by 2010, the gains made are crucial. “Countries like South Africa and Lesotho have made great strides forward, which, given the burden in this region, is important”, says Hirnschall.
Advances have been in some groups than in others, says Hirnschall. “Large numbers of countries have been successful and have achieved 80% coverage for prevention of mother-tochild transmission.” But some regional differences are clear, with regards to providing treatment to both all patients in need and pregnant women, Hirnschall points out, west and central Africa have not progressed well. David Okello of WHO’s African Regional Office agrees. “The report contains a lot of good and a lot of bad news, and there is mixed achievement across the world.” Africa still bears the greatest burden, and Okello cites challenges to health systems, drug stock-outs, and budget stagnation as concerns for future gains in the region. “Sometimes we have acute stock-outs of essential drugs, and when people go on drug holidays we begin to see resistance to antiretrovirals.” “The fact that many countries will not achieve universal access by the end of this year is not cause to despair”, says Okello. “We need to reveal why we have not reached UN targets.” WHO is now in the process of developing a new HIV/AIDS strategy for 2011–15 to further the progress towards universal access by the deadline for the Millennium Development Goals, Hirnschall told TLID. The strategy, to be announced at the World Health Assembly in May,
www.thelancet.com/infection Vol 10 November 2010
will scale up prevention, optimise the contribution of the HIV response to other MDGs, use leverage of the HIV response to strengthen procurement and health information systems, attempt to address structural and social determinants of health to target delivery to most at risk populations, and will launch what has been dubbed “treatment 2.0”. Hirnschall describes treatment 2.0 as “new regimens, simpler regimens, more resilient regiments, to find different ways to deliver services, broader involvement of community organisation, and scale up of testing and counselling so that people who need treatment know that they need treatment.” Hirnschall, Okello, and others involved in the HIV/AIDS response recognise the importance of integrating HIV goals with other health initiatives to ensure that as treatment and prevention are extended to ever more people quality is not sacrificed for quantity. “It is not just about the numbers”, says Okello, “it is about quality of care, quality of drugs, quality of diagnostics, and quality of services.” Hirnschall concludes: “we cannot play one health priority against another and we need to be strategic in positioning HIV in this context and see how it can contribute to other health outcomes and address other health priorities.”
See Leading Edge page 737
Peter Hayward 745