Conference Reports
The 18th European Congress of Clinical Microbiology and Infectious Diseases, Barcelona, Spain
19th-22nd April 2008
Against a backdrop of Barcelona in the springtime, 9000 delegates and exhibitors assembled at the International Convention Centre for the 18th European Congress of Clinical Microbiology and Infectious Diseases. With a record number of attendees and a plethora of sponsors, a wide range of workshops, symposia, oral sessions and poster presentations were provided to suit everyone.
Despite a lack of new agents in development there was no shortfall of data, with gram-positive infections, especially MRSA being one of the largest topics and the majority of in vitro data relating to multi-drug resistant Gram-negative infections. Resistance and epidemiology studies showed high MRSA/E levels increasing in N America and Europe including multi-drug resistant phenotypes. Elevated daptomycin MICs have now been seen in a few isolates, with reduced vancomycin susceptibility reported in the Netherlands. While several therapeutic options for MRSA are in development, few are reliably active against VRE; rates have climbed together with co-resistance and linezolid-resistance continuing to be reported.
Pfizer showed 16-fold potency of dalbavancin over vancomycin, as well as a similar incidence and severity of adverse events among patients regardless of the degree of hepatic impairment. Concentrations and exposure of dalbavancin did not increase with increasing degrees of hepatic impairment, although there was decreased dalbavancin exposure and an increase in clearance in subjects with moderate to severe hepatic impairment. An intravenous infusion resulted in similar concentrations and pharmacokinetic parameters in patients with normal renal function and mild renal impairment, with a slightly higher plasma concentration in patients with moderate renal impairment.
Pneumonia, and especially community-acquired pneumonia (CAP), renewed focus at this meeting with oral and meet-the-expert sessions, as well as congress and satellite symposia from Bayer-Schering, J&J and Novartis. The emphasis was on more severe CAP. The importance of risk stratification scores was stressed in several sessions, but the high mortality rates remain in hospital-acquired (HAP), healthcare-associated (HCAP) and CAP as well as ventilator-associated pneumonia (VAP). S. pneumoniae remains the most common pathogen in CAP and HCAP and the US FDA has now accepted the benefits of treatment, rendering placebo trials unnecessary; however, protocols will need to be agreed with the FDA for mild-moderate disease.
In Canada, S. pneumoniae resistance to macrolides and tetracyclines despite stable or declining usage remains high, while fluoroquinolone resistance remains low. This could suggest that moxifloxacin exerts minimal selective pressure for resistance. Multi-drug-resistant S. pneumoniae (MDRSP) is an emerging issue, seen in serotypes that 7-valent pneumococcal conjugate vaccine does not adequately protect against.
C difficile-associated diarrhoea [now termed C. difficile infection, CDI] was still a hot topic, attracting a pre-congress workshop, a satellite symposium from Optimer, an official congress symposium, and oral and poster sessions. The incidence and severity of this type of infection is increasing, with new serotypes emerging and a binary toxin. But while the role of antibiotics vs. transmission is still debated, retrospective studies continue to identify various antibiotics as risk factors. Recurrent disease is still the main problem.
Replidyne’smethionyl tRNA synthetase inhibitor is a non-absorbed narrow spectrum antibiotic in development which was also reported at this conference as was the increasing resistance of Bacteroides fragili , especially fluoroquinolone-resistance; with the most active products for this still being piperacillin/tazobactam and carbapenems.
The rate of resistance in Gram-negative bacterium is a continuing worry, with the lack of new agents in development. Although extended spectrum β-lactamases (ESBLs) and amphotericin C rates in enterobacteriaceae have remained steady in intra-abdominal infection, ertapenem is the carbapenem most often affected by resistance. It is increasingly used in community-acquired infections and in CTX-M outbreaks. Escalating resistance in non-fermenters was reported by SENTRY, with metallo-β-lactamases emerging in India. Multi-drug resistance in cystic fibrosis P aeruginosa isolates, especially the hypermutable strains, and person-to-person transmission are concerns making the development of inhaled agents a timely pursuit.
With an inspiring opening ceremony on the 1st night that included a ballet performance, daily tours and the option to attend a classical music concert; delegates were spoilt for choice both socially and intellectually. Many hope that the 2009 conference will be as informative and culturally stimulating as this year’s was.
The 19th ECCMID will be held in Helsinki, Finland, 16th - 19th May 2009
