EH 6_2015

www.healthcare-in-europe.com 7INFECTION CONTROL German infection experts unite in a joint congress Defining internationally common standards to assess bacterial resistance Efficiency is vital to combat epidemics Antimicrobial breakpoints Report: Anja Behringer Efficient refers to faster diagnosis, more effective treatment and more information for medical staff as well as patients. The increasing resist- ance to antibiotics worldwide has led to the development of new infectious diseases and turned those that have been known for years into epidemics, such as Ebola or SARS. In November, the German Society of Infectious Diseases (DGI) and the German Centre for Infection Research (DZIF) held, for the first time, a joint congress in Munich. ‘The speedy development of vac- cines against Ebola and other new infectious diseases is an important focus at the DZIF,’ emphasised the organisation’s chairman, Professor Martin Krönke. DZIF researchers are not only involved in combating new virus- es but also work against diseases such as AIDS, hepatitis, malaria, tuberculosis (TB) and gastro-intes- tinal diseases. A further focus is on beating hospital acquired infec- tions. The increasing spread of antibiotic-resistant pathogens calls for new anti-infectives and an An antimicrobial breakpoint is an agreed concentration to identify at what point the growth of bacterium is inhibited – the minimum inhibi- tory concentration (MIC) – which essentially defines at what dose each bacteria is considered susceptible, or resistant, to antimicrobial therapy. Breakpoints of new agents are totally vital in standardising a global defini- tion of resistance and the point at which increased dosages are needed. Ninety percent of Europe’s countries now follow the European Committee on Antimicrobial Susceptibility Testing (EUCAST) categorisation of bacterial susceptibility and resist- ance to new and existing antimicro- bial agents – indeed, this uptake has snowballed with countries such as Australia, New Zealand and South Africa either already adhering to the EUCAST system or seriously contem- plating adoption. This is considered a huge breakthrough in the committee’s efforts to unify scientists and labora- tories worldwide in their assessment of the bacterial resistance situation. However, EUCAST is little known by the general public. Founded in 1997, it is fully known of as the European Committee on Antimicrobial Susceptibility Testing, a standing com- mittee jointly organised and funded by the European Society of Clinical Microbiology and Infectious Disease (ESCMID), and the European Centre for Disease Prevention and Control (ECDC), as well as European nation- al breakpoint committees. EUCAST aims to establish a common sys- tem to determine the defining and measuring of resistance. The new breakpoints currently worked on will enable increased conservation of new antimicrobial agents and ensure sci- entists are comparing like for like resistance. effective containment of resistant bacteria. DGI President Professor Gerd Fätkenheuer, who heads the Department for Infectious Diseases at the Clinic I for Internal Medicine, at Cologne University Hospital Cologne, is calling for the training of more specialists for complex infec- tious diseases, who could, in turn, also ensure appropriate training for other groups of doctors. The WHO warns Europe The World Health Organisation is warning of an HIV epidemic in Europe. This year there were 142,000 new infections, 6,000 more than in 2014. Eastern Europe was particularly affected, but because of the streams of refugees heading west the infections are unlikely to remain contained to that part of Europe. TB has long been associated with poverty. At least eight million peo- ple a year develop the disease, with 5% of those being diagnosed with open TB – doubling the number of cases. Every year, 1.4 million people die as a result of this infec- tion, meaning it remains one of the biggest health risks despite the enormous efforts involved in com- bating it. Co-infections with HIV and the spread of largely resistant and multi—drug-resistant (MDR) trains of bacteria and extensively drug-resistant (XDR) within the so- called Mycobacterium tuberculosis complex (Mtb-complex) further increase the problem. These MDR strains are increasingly spreading in Eastern Europe, Sub-Saharan Africa and Asia. TB as a worldwide challenge On a global level TB containment faces various challenges. There is currently no effective vaccine against pulmonary tuberculosis; effective medication against TB is scarce and the pharmaceutical industry has only few active ingredients under development. There is also a lack of biomarkers that can help to predict treatment success, or help to define the course of treatment more pre- cisely. Less affluent countries also lack the resources for a fast diag- nosis of TB cases. The diagnosis of the disease is particularly difficult amongst refugees because it takes several local examinations to con- firm a diagnosis of open TB, but the individuals tend to be highly mobile upon arrival in Europe. The laboratory at the Clinical Tuberculosis Centre (ClinTB) in the Medical Clinic Borstel, Schleswig- Holstein, is evaluating procedures for the individual characterisation of the endpoint of M/XDR tuber- culosis treatment. The organisation and scheduling of seminars to help educate doctors and public health workers forms an important part of this work. The development of a new ‘online consultation service’, through which specialists can discuss and agree on individual and efficient TB treat- ment, is also important, and so is the development and issuance of universal guidelines on the manage- ment of M/XDR-TB. The infection can only be tackled with an interdisciplinary approach. The focal points of research are the examination of the genetic resist- ance of the pathogens to drugs and the identification of biomarkers that are to improve our ability to predict the treatment length needed for individual patients. However, there are many calls for the speedy devel- opment of vaccines; experts are not yet agreed as to exactly which of the pathogens should be tackled because they change in different outbreaks of the disease, and drugs will have different effects. One sin- gle vaccine per pathogen would therefore not be enough, and this is before there has even been a discus- sion about how to finance all of this developmental work. Interdisciplinary use of anti- biotic stewardship Professor Fätkenheuer believes that the careful and intelligent use of antibiotics is essential to achieving relief, fast. To this end, the DGI has founded the Antibiotic Stewardship (ABS) research initiative, which is utilised to train colleagues from clinical and diagnostic fields, as well as pharma- cists, in responsible use of antibiot- ics. Strategies for this are accessible in the German-Austrian guidelines. All of this could save lives. ESCMID past-president Professor Gunnar Kahlmeter MD , Sweden The 4th generation of New Spirolab®, worldwide bestseller! Cyberbloc FP Flat Panel Surgical C-arm Fast and intuitive for modern professionals. 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