With about 8000 delegates from 100 countries, this year's European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Vienna, Austria (April 10–13) rivaled in size the Interscience Conference on Antimicrobial Agents and Chemotherapy, the major North American infectious diseases meeting.
This year's recipient of the award for excellence in clinical microbiology and infectious diseases at ECCMID was the eminent virologist Albert Osterhaus (Erasmus Medical Centre, Rotterdam, Netherlands). At the 2009 meeting, Osterhaus said that a likely outcome of the then emerging influenza H1N1 outbreak was a mild pandemic, a remarkably accurate prediction.
Speaking at the opening press conference, Osterhaus speculated that the reassortment between swine influenza viruses previously found separately in pigs in Eurasia and North America, which generated the pandemic H1N1 strain, had taken place in people rather than pigs because the latter do no cross the oceans. However, at a session devoted to the pandemic, Ilaria Capua (Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy) suggested that influenza viruses might spread via the international meat trade. Capua noted that viruses see receptors, not “how much hair you have on your body, or whether you have feathers”, and she called for interdisiplinary collaboration to understand how influenza viruses migrate across species and continents as one evolving gene pool.
Other research highlights from the conference are reported below.
Microarray diagnosis
Non-culture methods for detecting infection were one of the principal strands of the meeting. A typical example was the poster presentation (abstract P654) by F Renois and colleagues (University of Reims, France) describing PCR-DNA microarrays for detection of viral upper respiratory tract infections. The authors tested prospectively by commercial microarray systems 95 nasal swabs or nasopharyngeal aspirates from adults (57) or infants (38) with influenza-like illness. 30 samples were positive for pandemic influenza A H1N1 and 35 for other respiratory viruses including rhinoviruses, parainfluenza virus, influenza A H3N2, coronavirus, and bocavirus. Ten cases of mixed viral infection were detected, including five among the H1N1 group, but there did not seem to be an association between a particular infection with a one virus or mixed infection and severity of disease.
Hand hygiene
Randomised trials of interventions to improve hand hygiene are uncommon. D Mertz and colleagues did a cluster randomised trial (O466) of the effect of multi-facted interventions on compliance with hand hygiene in 30 units in three hospitals in Hamilton, Ontario, Canada. 15 units were assigned to the intervention, which included performance feedback, teaching seminars, and posters, and 15 to usual practice. Adherance to hand hygiene was significantly more often observed in the intervention than control group (48·2% of opportunities vs 42·6%), and improved significantly from baselines in both groups. However, the intervention did not result in a difference between the groups in incidence of meticillin-resistant Staphylococcus aureus infection among patients.
C Fuller and colleagues (University College London, UK) reported than glove use may be a barrier to good hand hygiene (O467). During a randomised trial (of which glove use was not a part), the authors observed more than 1700 occasions of glove use among health-care workers. Hand-hygiene compliance was lower when wearing gloves (42·6%) than when not wearing them (51·2%).
Norovirus and mortality
A retrospective analysis by Lars Gustavsson and colleagues (Gothenburg, Sweden; P1168) of 539 hospitalised patients age 60 years and older with a stool sample positive for norovirus genogroup II found in-hospital, 30 day, and 90 day mortality of 5·9%, 8·5%, and 16·7%, respectively. Mortality increased with age, and was higher in patients with underlying disorders (immune suppression, renal failure, diabetes, heart failure, malignant disease, systemic inflammatory disease, or other significant chronic illness) than in those without. Norovirus infection thus seems to cause excess mortality in elderly people, although no data were given from comparable uninfected patients.
Resistant organisms in Europe
As part of the European Antimicrobial Resistance Surveillance System, B M Roede (University of Amsterdam, Netherlands) and colleagues collected data from 33 countries on resistance patterns among isolates of Escherichia coli and Klebsiella pneumoniae (O127). In ten countries, 25–50% of E coli were resistant to fluoroquinolones, resistance to which has increased in 19 countries over the past 4 years. Over the same period, the proportion of E coli resistant to third-generation cephalosporins has increased in 21 countries, and combined resistance to more than one antibiotic increased in 19 countries. Whereas carbapenem resistance among K pneumoniae is still absent in 21 countries, three countries reported rates above 10%. Nine countries had K pneumoniae isolates resistant to fluoroquinolones, third-generation cephalosporins, and aminoglycosides.
The 20th ECCMID was held at the Austria Center Vienna
© 2010 IAKW AG/Schauer
MALDI-TOF
The rise of MALDI-TOF (matrix assisted laser desorption/ionisation-time of flight mass spectrometer) was one of the most obvious themes of the congress. This new diagnostic tool is fast becoming a staple in clinical microbiology laboratories, using spectrometric signatures of bacterial species to speed up identification of causes of infection. A session dedicated to the technology looked at new approaches to improving its clinical use. T Jensen and colleagues (Odense, Denmark) compared conventional identification with MALDI-TOF and using a double-layered spectrometric reference technique for the identification of bacterial isolates from blood and urine (O534). MALDI-TOF reliably identified Enterobacteriaceae (apart from Shigella), Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Haemophilus influenzae, Staphylococcus, Enterococcus faecalis, and Enterococcus faecium to the species level. However, many anaerobes and streptococci were unidentified. A Ingbretsen and colleagues (Oslo, Norway), however, found in a study focusing on anaerobes alone (O542) that MALDI-TOF more successfully identified pathogens than did either of two automated techniques. As more species are characterised in detail with mass spectrometry, the accuracy of MALDI-TOF should increase.
The tie is high
A much underappreciated barometer of social change is the attitude of patients to their doctors' attire. Previous investigations have shown that between 1991 and 2008, patients' opinion of whether doctors should wear neckties swung from 67% in favour to 76% against; and 2007 guidelines from the UK Department of Health say that the wearing of neckties is poor practice. A poster presentation (P1531) gave some biological backing for this sartorial sea change. Researchers at St Vincent's University Hospital (Dublin, Ireland) cultured bacterial flora from the ties of 95 male doctors (52 medical, 30 surgical, 13 other). One in five ties were colonised with potential pathogens including Staphylococcus aureus and Gram-negative bacilli; one in ten ties carried meticillin resistant S aureus. Perhaps the most concerning finding of all was that, when asked, 52 of the surveyed doctors said they never washed their ties.