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NEWSLETTER Special Edition | 07.2019
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Medical Microbiology & Infection Prevention
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ECCMID 2019
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Management of chronic bone and joint infections
Marjan Wouthuyzen-Bakker, MD PhD Internist-infectiologistDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
View this presentation via Link
Surgical management is not always feasible in patients with a chronic prosthetic joint infection due to comorbidity, an expected poor functional outcome or because of the wish of the patient. In these cases, suppressive antibiotic treatment (SAT) might be a good alternative treatment approach, although clear evidence about its efficacy is lacking. The choice of SAT should be mainly based on the bioavailability of the prescribed antibiotics, its penetration into bone and how well it is tolerated by the patient. A feared side effect of minocycline is irreversible hyperpigmentation of the skin which occurs in around 50% of patients who are on long-term treatment. For this reason, doxycycline might be a better option as a tetra-cycline. SAT should be administered as life-long antibiotic suppressive therapy, not with the intention to cure the infection (which is not possible with the presence of persister cells), but to prevent relapse of infection. The development of guide-lines are warranted to describe which patients will benefit most from SAT and how these patients should be monitored.
Suppressive antibiotic treatment for implant-associated infections: pros and cons (speaker)
This year’s ECCMID in Amsterdam was a special event. 13.773 participants coming from 130 countries with 5.453 abstracts submitted. Interestingly , the top 5 represented countries were USA (1407), UK (1246), Netherlands (1157), France (950) and Germany (935). Based on the number of inhabitants, this shows that research in Clinical Microbiology and Infectious Disease in the Netherlands continues being on the world top level. And the scientists of the UMCG research program “Microbes in Health&Disease” (MHD) had an important and active role here. We were present with more than 30 talks, poster- presentations and open-forum discussions and you will read about many of them in this special newsletter edition. In 5 out of the 27 ESCMID study groups, MHD-scientists have a leading role in the executive committee taking responsibility in proposing to the ECCMID scientific program, organizing educational workshops and contributing to evidence-based guidelines.
As MHD, we offer different educational and scientific workshops such as the ESCMID work-shop on Metagenomics in clinical Microbiology and the EUCIC training courses. In EUCIC, we do not only organize the obligatory basic course for the European training certificate, but several colleagues from the UMCG are also following this unique pan-European training course in infec-tion control. At this year’s ECCMID, our EU/Interreg-project health-i-care was present as a pipeline-corner for diagnostic and prevention and we were even
present with an own booth in collaboration with the DNHK (Duits-Nederlandse Handelskamer) to show the practical outcomes of the crossborder consortia. Finally, Iza Rodenhuis-Zybert of the research group of Jolanda Smit on experimental virology received a prestigious ESCMID Research Grant 2019! Congratulations to the research grant winner and congratulations as well as thanks to everybody who contributed to the impressive scientific vitality that we were able to bring to ECCMID 2019. See you next year in Paris!
Alex Friedrich, Chair and Head of the Department of Medical Microbiology and Infection Prevention
Editor's NoteIn this Special Edition Newsletter we have published a selection of abstracts of MHD presenters. In the table at the end of this Newsletter you’ll find the links to webcasts, slidesets and ePoster presentations of all MHD presenters. Special thanks to Bhanu Sinha, John Rossen, Erik Bathoorn and last but not least Corinna Glasner who have shared their high-lights of ECCMID 2019 with us.We hope that you enjoy reading this Special Edition Newsletter.
ECCMID Live – Catch up on what you missed in Amsterdam!Couldn’t catch every session at ECCMID 2019? Webcasts, slidesets and ePoster presentations are available online at www.eccmidlive.org. Browse by session type, author or keywords!
Figure 1: Alex Friedrich, Chair and head of department Medical Microbiology and InfectionPrevention
ECCMID 2019 in Amsterdam: A great success for MHD
Day 1 – April 13, 2019
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Infections in migrants and travellers
Adriana Tami Postdoctoral researcherDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
View poster via link
Resurgence of vaccine-preventable diseases in Venezuela in the midst of a worsening humanitarian crisis (poster)
Mirjam Kooistra-Smid, PhDMedical Molecular Microbiologist at Certe Medical Microbiology and Senior Researcher at the Department of Medical Micro-biology and Infection Prevention, UMCGEmail: [email protected]
View poster via link
Project group(s): Personalized Microbiology, Genomics for Infection PreventionCollaborators on these projects: Ing. Evert van Zanten1, Ing. Guido Wisselink1, Dr. Alewijn Ott1, Dr. Robin Benus1, Drs. Glen Mithoe1, Dr. Richard de Boer1, Prof. dr. Alex W. Friedrich2, Prof. dr. John W.A. Rossen2
1 Certe, Department of Medical Microbiology, Groningen, The Netherlands; 2University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
Accurate and rapid identification of pathogens in clinical samples facilitates optimal treatment of the individual patient. Microbiological diagnostic laboratories largely depend on conventional culture or 16S rDNA Sanger sequencing methods which may be hampered by the use of antibiotics, slow-growing or fastidious microorganisms, or infections that are polymicrobial or with a low load of microorganisms. The last years our research has been focused on the development and validation of an easy-to-use, culture-free diagnostic method based on 16S-23S rDNA next generation sequencing to improve (1) the resolution of bacterial species identification and (2) the detection and identification of bacterial species in complex clinical samples. This approach will aid in the effective treatment of infections and will prevent unnecessary use of antibiotics thus consequently preventing the induction of antimicrobial resistance.
Key sentences/conclusions:1. 16S-23S NGS increased the yield of bacteria detected in clinical infections. It enabled detection of non-cultured bacteria and was able to identify different bacteria in polymicrobial complex samples.2. 16S-23S rDNA NGS is of added clinical value. Furthermore, it has the potential to be integrated into the routine diagnostic workflow.3. This approach needs further clinical evaluation in collaboration with treating physicians (multidisciplinary teams).
Session (day 2): Performance and utility of broad-range molecular diagnostics.Next generation sequencing of the 16S-23S rRNA region compared to culture and 16S rDNA Sanger sequencing for the identification of bacterial species in clinical samples (mini oral-ePoster).
View ePoster via link
Assessment of the added clinical value of next-generation sequencing of the 16S-23S rRNA region in a clinical setting (poster)
Session Omics, omics and even more omics
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Dengue: old disease, new challenges
Natacha Couto ResearcherDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
Project group: Genomics for Infection Prevention and Personalized MicrobiologyPresentation unfortunately not available online.
The advances in next-generation and single molecule sequencing allow a broader audience to access relevant techniques and software for data analysis. However, an in-depth understanding of the underlying techniques, minimum data quality criteria and the right choice of sequence data analysis approaches and pipelines, is essential to underpin reliable and trustworthy diagnostics and typing. Using practical examples, this session discussed common obstacles that need conside-ration and ways to overcome such obstacles when performing whole genome sequence data analysis.
Making sense of genome shreds: tools and strategies for straightforward genome data analysis (speaker and session chair)
Erley Lizarazo PhD StudentDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
Presentation unfortunately not available online.
Project group: Genomics for Infection Prevention, EPITROPSupervisors: John W.A. Rossen, Adriana Tami, Alex W. FriedrichCollaborators: Natacha Couto, Maria Vincenti-Gonzalez from the Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen.Daria Camacho, Sarah Bethencourt and Prof. Guillermo Comach from the University of Carabobo, Venezuela.Prof. Thomas Jaenisch, University of Heidelberg.Diogo Silva, Prof. Mario Ramirez and João Carriço from the Institute of Molecular Medicine, University of Lisbon.
The introduction of different dengue virus (DENV) serotypes throughout time and the increase on the frequency of outbreaks has shown an interesting dynamic that has shaped the genetic diversity among DENV populations in Venezuela. In summary our study has shown i) a tendency of the DENV relative genetic diversity (Net) to decay in all serotypes except in DENV-2 in which it remained constant and ii) purifying selection was the dominant force that drove the genetic evolution of the virus by elimination of the DENV population mutations that carried deleterious amino acid substitutions.
Understanding dengue genetic dynamics in the context of consecutive outbreaks in Venezuela (oral presentation)
There were many new and interesting topics. A selection of interesting sessions and inspiring presentations:
SY118 Information technology and innovation
Big Data, Artificial Intelligence and Machine Learning are buzzwords and are becoming increasingly important in healthcare. The four presentations in this session have highlighted a wide range from microbiome-host interaction through "multi-omics" (Sofia Forslund ) to application of machine learning/artificial intelligence for infections (Mehmet Gönen ) and improvement of empiric antibiotic therapy (Carolina Garcia Vidal ) to the application for microbiological diagnostics (Adrian Egli). I found the presentation of Adrian Egli, which is available
online, particularly interesting and inspiring because he showed what is already possible in daily practice in the field of Medical Microbiology, and what will be possible in the close future.
SY144 Burden and cost of healthcare-associated infections and antimicrobial resistance
The two speakers (Carolyn Tarrant and Rasmus Leistner) showed what would be necessary to measure success of interventions and how available processing of routine EMR data can help to better analyse costs. In addition, Carolyn Tarrant has also substantiated from a social sciences perspective why personal contact (face-to-face/bedside) provides added value over remote contact.
SY139 Hot topics in antimicrobial stewardship
The two speakers (Alison H. Holmes and Marlies Hulscher) discussed the ins and outs for successful implementation of Antimicrobial Stewardship. Alison H. Holmes in particular explained the role of organisation and management in order to succeed .
Bhanu Sinha, Professor of Medical Microbiology, Microbial Pathogenesis and Therapy, department of Medical microbiology and Infection Preventi-on, UMCG
Highlights of my visit to the ECCMID 2019 in Amsterdam - Bhanu Sinha
Day 2 – April 14, 2019
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Enterobacterales: virulence and pathogenesis
Session OXA-48 and other OXA enzymes are struggling!
Christina Brühwasser, MSc PhD PostDoc Technical Infection PreventionDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
Current supervisor: Prof. Dr. Alex W. FriedrichProject group: Genomics for Infection PreventionCollaborators on this project: Mariëtte Lokate, John W Rossen, Natacha Couto, Monika Chlebowicz, Corinna Glasner, Alex-ander W. Friedrich, Erik Bathoorn
View poster via Link
Field/theme: Citrobacter freundii clones in nosocomial outbreaks: genotypic characteristics and the role of the rnaI / relBE element in extended survival of C. freundii on inanimate surfaces.Key sentences/conclusion: C. freundii can transform into a transmittable drug-resistant hospital pathogen, and is an excellent survivor under nutrient-free conditions. The prolonged survival was observed in all isolates irrespective of the presence of the rnaI / relBE element.
Persistence on inanimate surfaces of OXA-427 and GES-7-producing Citrobacter freundii clones on a haematology ward (poster)
Ana Carolina da Cruz Campos PhD StudentMedical Microbiology and Infection Prevention, UMCG Email: [email protected]
Current supervisors: John W. A. Rossen, Monika ChlebowiczView poster via Link
The presence of the colicin-containing plasmid identified in highly virulent and resistant ST131 isolates may contribute to the successful dissemination of this lineage. Such isolates can outcompete other pathogenic and non-pathogenic E. coli and/or other commensal bacteria in human host most likely leading to infection. Therefore, routine screening for the presence of bacteriocins in pathogenic E.coli isolates to produce bacteriocins is advised in order to take measures to prevent further spread.
Characterisation of beta-lactamase CMY-2 gene and bacteriocin-encoding plasmids of ST131 ExPEC using MinION and Illumina sequencing and evaluation of its potential role in the virulence (poster)
Silvia García Cobos Senior ScientistDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
Current supervisors: Alex W. Friedrich, John W.A. RossenResearch group: Genomics for Infection Prevention and Personalized MicrobiologyCollaborators: L. Schouls, T. Bosch, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Nether-lands; M. Pérez-Vazquez, J. Oteo, Pedro J Sola-Campoy, B. Aracil, J. Campos, National Center of Microbiology, Institute of Health Carlos III (ISCIII), Madrid, Spain.
View poster via Link
K. pneumoniae (Kp) is a well-known nosocomial pathogen causing a wide range of infections. We investigated the presence of virulence factors in OXA-48-producing Kp (OXA-48-Kp), one of the most prevalent carbapenemases in Europe using whole -genome sequencing. OXA-48-Kp clinical isolates, from different hospitals from Spain (ES) (n=57, six different serotypes (STs)) and the Netherlands (NL) (n=69, thirty-one STs) were included. OXA-48-Kp clinical isolates showed a conserved virulence core – enterobactin, LPS synthesis, urea metabolism and non-fimbrial adhesin genes – and an accessory virulence content of fimbriae, yersiniabactin, aerobactin, salmochelin, and colibactin that differs between isolates, STs and sample source. Association between STs and specific K and O serotypes was observed, with a higher K-serotype diversity.
Virulence profiling of OXA-48-producing Klebsiella pneumoniae from Spain and the Netherlands using whole-genome sequencing (poster)
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Polymyxin resistance around the globe
Giuseppe Fleres PhD studentDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
Current supervisors: Alex W. Friedrich, Silvia García-CobosProject group: Pronkjewail, Genomics for Infection PreventionCollaborators: Natacha Couto, Monika Chlebowicz, John W. A. Rossen
Presentation unfortunately not available online.
Colistin is considered a last-resort antibiotic for treating serious infections caused by multidrug resistance Gram-negative bacteria. The efficacy of this antibiotic is challenged by the emergence and global spread of mobile colistin resistance (mcr) determinants, which threaten human, animal and environmental health. The first mobile colistin resistant gene (mcr-1) was reported in 2015, and since then up to eight different variants have been described. We reported for the first time the detection of an mcr-5 gene in (hospital) water environments using short-read metagenomics sequencing (SRMseq) and subsequent characterization using long-read metagenomics sequencing (LRMseq) to reveal its genetic environment.Colistin resistance determinants (mcr) have been rarely reported in water environments. This is the first-time description of an mcr-5 gene in an indoor and healthcare water environment. The comparative analysis confirmed a Tn6452 trans-poson carrying the mcr-5 gene, which could be inserted in a different location according to the novel observed genetic environment. Taxonomic analysis suggested the order of Pseudomonales as the most probable host of the mcr-5 gene in the water sample. Although the bacterial host carrying the mcr-5 gene has not been fully identified, the fact that mcr-5 is located in a Tn6452 suggests its potential mobility and transfer to other bacteria. Further studies are needed to determine the frequency of this gene in hospital-water and other water environments and to evaluate the potential risks for patients and healthcare-workers.
Detection of a mobile colistin resistance (mcr-5) gene in hospital tap water using short- and long-read shotgun metagenomics sequencing (oral presentation)
ECCMID for me is like running a marathon. Long days with many meetings from the early morning until deep in the night. Unfortunately, and as usual, I only had the opportunity to join few scientific presentations. As said, most of the day I had meetings.
ECCMID is an excellent event to catch up with re-presentatives of companies to discuss possible collaborations to improve diagnostics for infectious diseases, obviously for the benefit of patients! In addition, I had meetings on ESCMID-related businesses, among which several ESCMID study group business meetings.
During the ECCMID in Amsterdam elections took place for several study groups in order to stick to already existing ESCMID rules on the composition of the board. Having been the secretary for the ESCMID study group for Genomic and Molecular Diagnostics (ESGMD) for the last two years, I was now elected as the chair of ESGMD for the next two years.
Besides this the UMCG (MHD/MMBI) is very active in ESCMID, with Alex Friedrich being the treasurer of ESCMID, Natacha Couto being elected as the secretary of ESGEM, Marjan Wouthuyzen-Bakker being elected as the chair of ESGIAI and Ymkje Stienstra and Linda Veloo as chairs of ESGITM and ESGAI, respectively. ECCMID is also the place to be for meeting your network partners to discuss ongoing and new projects. However, although being very busy, one of the highlights of this, and every ECCMID for me is being
reunited with old friends as Kai Zhou, Holger Karas, Debby Bogaert and Jacob Moran-Gilad.
John Rossen, Professor of Medical Microbiology, Personalised Microbiology, department of Medical microbiology and Infection Prevention, UMCG
Figure 2: John Rossen with old friends
Highlights of my visit to the ECCMID 2019 in Amsterdam - John Rossen
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Meet the expert
Marjan Wouthuyzen-Bakker, MD PhD Internist-infectiologistDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
View this session via link
In this meet the expert session a case of hematogenous prosthetic joint infection (PJI) caused by Staphylococcus aureus was discussed. Several key messages were highlighted: i) risk factors for failure of debridement, antibiotics and implant retention (DAIR), ii) the importance of exchanging the mobile components during DAIR and not delaying surgery when there is a clinical suspicion of an acute PJI, iii) treatment duration of acute PJIs, in particular whether a 6-weeks treatment course may suffice, iv) when rifampin should be added during the treatment course and v) what to do with an asymptomatic prosthetic joint during S. aureus bacteremia.
How to manage orthopaedic implant infections? Real-life clinical case discussion
Figure 3: The meet-the-expert session with internist- infectiologist Marjan Wouthuyzen-Bakker
Figure 4: The health-i-care stand in the exhibition hall
Day 3 – April 15, 2019
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Corinna Glasner (chair and moderator) Scientific Project Manager INTERREG project health-i-care and EurHealth-1HealthDepartment of Medical Microbiology and Infection Prevention, UMCG Email: [email protected]
Project group: Genomics for Infection PreventionCollaborators on this project: DNHK and other project partners of health-i-care
Health-i-care focuses on the development of innovative products and technologies that protect the public from infections and help combat antibiotic resistance. Thirty innovation consortia have been established for the health-i-care project. Each consortium consists of one small and medium-sized business (SME) and supporting partners from knowledge institutions (e.g. universities) and the healthcare sector (e.g. hospitals). These consortia develop demand-oriented innovations that are innovative and novel tools or resources within the professional fields of medical information provision & training/eHealth, diagnostics & prevention, infection prevention - OneHealth, medical (e)-technology. Health-i-care uses cross-country and cross-sector network development to strengthen the innovative capacity of the border region and, consequently , the development of a unified region with sound health economics. Next to the pipeline corner we also had a stand with health-i-care in the exhibition hall.
Conclusion: Innovations for safer healthcare in diagnostics &infection prevention from the Dutch-German border region, the health-i-care example.
Pipeline corner health-i-care
Session Pipeline corner health-i-care
Caring for migrant patients
During the last decade, huge numbers of refugees have fled to Europe to seek asylum since it is unsafe to stay in their country of origin. The main countries of origin are Syria, Afghanistan, and Eritrea. In the Netherlands, over 180,000 refugees have been granted asylum in the past five years. Many refugees have been in need of medical care after arrival to the Netherlands, and have been admitted to the hospitals in our region.
Refugees may be suffering from chronic infectious diseases, caused by pathogens by which they have been infected in their country of origin. In addition, human to human spread of infectious diseases, and bacteria resistant to antibiotics may occur during their travel due to poor hygiene circumstances on migrant ships and in refugee camps. It is important to recognize these specific infectious diseases in the care for migrant patients. The ESCMID Study Group for Infections in Travellers and Migrants, ESGITM, has the objective to share knowledge and expertise in this field.
On the first morning of the ECCMID, a session has been organized with the topic “Caring for migrant and travelling patients”. During this session, study results about surveillance of infectious diseases and carriage of antimicrobial resistant bacteria were presented. Among the most frequently diagnosed infections are tuberculosis, schistosomiasis, and mild/persistent forms of malaria.
Many migrants suffering from malaria have been admitted to hospitals, also in our region. A study from the UK showed that migrants suffering from mild malaria may be treated in ambulatory care. The study aimed at identifying risk factors for hospitalization and showed that if the parasitaemia is <0.5% or temperature>38.5, it is more likely that treatment in a hospital is required.
A study from Germany showed that schistosomiasis is frequent in refugees from Sub-Sahara Africa. schistosomiasis is a disease caused by parasitic flatworms. These worms may move through the walls of the colon, and through the urinary bladder. This may cause bloody diarrhea, or blood in the urine. The diagnosis is often missed by microscopy. To make a diagnosis, it is use-ful to detect antigens against the worms or eggs by serology, or to use novel point-of care tests detecting specific Schistosoma antigens in urine (circulating cathodic antigen).Not only may refugees be suffering from infections acquired in their country of origin, but they are also at risk to acquire new infections after arrival in the country that welcomes them. In the Nether-lands, native Dutch inhabitants are protected against many viral disease such as measles and polio by a national vaccination program. Refugees need to catch-up this protection by vaccination. A comparison of vaccination programs for recently-arrived refugees among European countries to prevent immigrants against the infections that are common in the Europe was presented.Refugees may also present with infections by bacteria common to the human flora such as Staphylococcus aureus (mainly soft skin infections) and Escherichia coli (mainly urinary tract infection) . For the treatment of bacterial infections, it is important to be aware of the antimicrobial susceptibility patterns of these pathogens. Antimicrobial resistance is common in bacteria carried by refugees. The prevalence of methicillin- resistant Staphylococcus aureus (MRSA) and extended-spectum beta-lactamase producing E. coli (ESBL) is high among refugees. Christina Louka, clinical microbiologist from Greece doing her PhD within the Pronkjewail-project in the UMCG, presented data on E. coli resistance isolated from refugees that have been hospitalized in our region. She compared the isolates from refugees with isolates from the Dutch community before the refugee crisis. Surprisingly, the ESBLs
of the refugees belong mainly to the same type of strains that were already predominantly pre-sent in our community before the refugee crisis. This shows that the most successful ESBL lineages were already globally present. An infection with ESBL E. coli sometimes need to be treated with last line antibiotics such as carbapenems and colistin. Fortunately, no acquired resistance genes against such antibiotics have been detected in the ESBL E. coli.To conclude, the session underlined the importance of awareness of migration-related infection problems, and the need for a multidisciplinary approach to tackle these problems, and thereby achieving better care for migrant patients.
Erik Bathoorn, clinical microbiologist, depart-ment of Medical microbiology and Infection Pre-vention, UMCG
Figure 5: Clinical microbiologist Christina Louka during her presentation about her PhD-research within the Pronkjewail project
Highlights of my visit to the ECCMID 2019 in Amsterdam - Erik Bathoorn
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Corinna Glasner (chair and moderator) Scientific Project Manager INTERREG project health-i-care and EurHealth-1HealthProject group: Genomics for Infection Prevention Email: [email protected]
Poster unfortunately not available online.
This prevalence study is part of the INTERREG V EurHealth-1Health project and was performed in 23 hospitals in the Dutch-German border region. During eight weeks, between September 2017 and June 2018, patients admitted to intensive care units (ICUs) were screened for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and rectal carriage of vancomycin-resistant Enterococcus faecium/E. faecalis (VRE), extended-spectrum beta-lactamase (ESBL) positive and carbapenem-resistant Enterobacteriaceae (CRE). To our knowledge this is the first prospective multi-center screening study in a European border region focusing on ICU admission prevalence of the most common antibiotic-resistant bacteria within the healthcare system in one single study. Although the overall screening compliance was higher in the Netherlands than in Germany, the prevalence of all measured pathogens was, as expected, higher in German than in Dutch hospitals, but also lower than in national studies of both countries, highlighting the importance of an euregional approach.
Zoom into reality: a close-up of the prevalence of antibiotic-resistant bacteria in a European border region (poster)
Session Surveillance of healthcare-associated infections
Figure 6: Corinna Glasner presenting her poster
Day 4 – April 16, 2019
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Session Predicting sepsis and bloodstream infection severity and outcomes
Lisanne BraamsMaster student MedicineDepartment of Medical Microbiology and Infection Prevention, UMCGEmail: [email protected]
Current supervisors: Prof. dr. J.M. van Dijl, dr. M. van OostenProject group: Molecular bacteriologyCollaborators on this project: J.W.A. Sijbesma, dr. H.H. Boersma, Prof. dr. P.H. Elsinga, dr. A.W.J.M. Glaudemans, Prof dr. R.H.J.A. SlartPoster unfortunately not available online.
Imaging of inflammation and infection is a fast and non-invasive diagnostic method, mostly done with the positron emission tomography (PET) tracer fluorine-18-fluorodeoxyglucose (18F-FDG). However, current imaging modalities cannot reliably distinguish bacterial infection from a tumour or sterile inflammation, as the used tracers are not bacteria-targeted. Sorbitol is a sugar analogue solely metabolized by bacteria of the Enterobacteriaceae family and not by mammalian cells, which makes it an ideal candidate for targeted bacterial PET imaging. In this study, the application potential a sorbitol based PET tracer 2-[18F]-fluorodeoxysorbitol (18F-FDS) was assessed using a broad panel of bacterial isolates and patient materials.
Key sentences/conclusions:• 18F-FDS was successful in detecting Enterobacteriaceae in infected patient materials, making it a promising bacteria-
targeted PET tracer for clinical translation.• Clinical isolates from the family Enterobacteriaceae accumulated 18F-FDS substantially as well as Pseudomonas aeruginosa
and Corynebacterium jeikeium• The highest uptake of 18F-FDS was seen in Klebsiella pneumonia, both in clinical strains as well as in infected blood
samples
Nuclear imaging of infection: in vitro assessment of 2-[18F]-fluorodeoxysorbitol tracer for the detection of bacterial infection (poster)
Session Focus on malaria
Adriana Tami Senior researcherDepartment of Medical Microbiology and Infection Prevention, UMCGEmail: [email protected]
Collaborators on this project: Working group on vector-borne diseases in VenezuelaPresentation unfortunately not available online.
Background: Over the last two decades, Venezuela has transitioned into a deep socioeconomic and political crisis. Once recognised as a regional leader for public health and vector control policies and programming, Venezuela’s healthcare has fallen into a state of collapse, creating a severe and ongoing humanitarian crisis. Economic and political mismanagement have precipitated hyperinflation rates above 45,000%, people impoverishment and long-term shortages of essential medicines and medical supplies. In this context, well controlled diseases, such as malaria, are turning into epidemics of unprecedented magnitude. We assess the impact of Venezuela’s healthcare crisis on malaria and other vector-borne diseases and the spillover to neighbouring countries.
Materials/methods: Active search of published and unpublished data was performed. Venezuela and Latin America data were sourced from PAHO Malaria Surveillance and Observatorio Venezolano de la Salud. Brazilian data was accessed via its Ministry of Health.
Results: Between 2000-2015 Venezuela witnessed a 365% increase in malaria cases representing in 2017, 53% (519,209/975,700) of the total cases in the Americas. Recent figures have surpassed 600,000 malaria cases with a prediction to reach 1 million by the end of 2018. Venezuela accounted for 34.4% of the total reported cases in the Latin American region in 2016. Plasmodium vivax accounts for 71% of reported cases followed by P. falciparum (20%) and other Plasmodium infections (˜ 9% of mixed and P. malariae cases). High malaria incidence in Venezuela is positively correlated with an increase in illegal mining activities and forest exploitation which are in turn strongly linked to the ongoing socio-economic crisis. In response to Venezuela’s rapidly decaying situation, a massive population exodus (>3,000,000 people) is ongoing towards neighbouring countries causing a spillover of diseases. Brazil has reported an escalating trend of imported cases from Venezuela from 1,538 (2014) to 3,129 (2017) with some areas reporting up to 80% of imported cases from Venezuela.
Conclusions: The continued upsurge of malaria in Venezuela is becoming uncontrollable jeopardizing the hard-won gains of the malaria con-trol programme in Latin America. National, regional and global authorities must take action to address this worsening epidemic and prevent its further expansion beyond Venezuelan borders.
Unprecedented malaria epidemic in Venezuela in times of complex humanitarian health crisis: A regional menace (oral presentation)
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
“And here we go again”, that’s what I thought Friday the 12th of April 2019, when I was standing in Amsterdam in front of the RAI with the well-known “I AM AMSTERDAM” sign and all the ECCMID flags. This was my 7th ECCMID and another four full days of talks, posters, listening, talking, thinking and walking were laying ahead of me. If you want, you can start as early as 7.30am with Meet-the- Experts sessions and end around 6pm with any other session, the early one I never made, the later one I sure did.
My personal highlight at this year’s ECCMID was our own health-i-care stand in the large exhibition hall. Our project partner the “Duits-Nederlandse Handelskamer” (DNHK) had organized it all and during the four days, five of our small- and me-dium-sized businesess consortium partners were presenting their innovations to the ECCMID parti-cipants. Checkbuster, Biovisible, Virtask, Ophardt and Hycult interactively engaged with partici-pants, presented their innovations and happily promoted the health-i-care project. On Monday, we even had a little get-together with some healthy fruit and juices before we went to our health-i-care pipeline corner.
From 12.15-13.15 in the Arena 3, right next to all the posters, we presented another four of our innovations to enthusiastic listeners.
As every year, it is always difficult to decide to which session to go to. Sunday morning, there were 4 parallel sessions that all sounded very interesting based on the speakers and titles , but of course, I can only be present at one session at a time (Luckily ). In the end, I chose “Emerging infectious diseases” for the first part before quickly walking to the session “Decision making under certainty”. Especially the talk from Frank Aerestrup about “Urban sewage as a surveillance tool: the global urban sewage project” was really interesting to listen to, and he is also a very enthusiastic speaker. In the other session, our own department head Prof. Friedrich very happily showed the diversity of work performed by all of “us”. In the afternoon, I went to the open forum “Gaming Infectious Diseases” and shortly to “Travelling microorganisms in a world of travel ”. In the open forum 2 people presented games they developed to teach kids or medical students about the exciting field of infectious diseases. In the other session our EurHealth-1Health project
partner from Münster presented a study about travelers and their carriage of resistant-bacteria when they return to our border region. Right afterwards I joined the session “Climate change and infectious diseases” and ending the day with, in my opinion one of the best sessions of the congress “Information technology and innovation”.
Looking back at those four days, they were as always super busy and super exhausting. You meet a lot of current and old colleagues and collaborators, which I always find one of the nicest things at the ECCMID. But some people you also don’t see at all, since a total of 13.773 people from all over the world were present during those four days.
So all in all, it was AWESOME
Corinna Glasner, Scientific Project Manager INTERREG project health-i-care and EurHealth-1Health, department of Medical microbiology and Infection Prevention, UMCG
Highlights of my visit to the ECCMID 2019 in Amsterdam - Corinna Glasner
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Name Contribution Title Sessionname Link
April13,2019
MarjanWouthuyzen--Bakker Speaker Suppressiveantibiotictreatmentforimplantassociatedinfections
Managementofchronicboneandjointinfections
Link
AdrianaTami Poster Resurgenceofvaccine-preventablediseasesinVenezuelainthemidstofaworseninghumanitariancrisis
Infectionsinmigrantsandtravellers Link
MirjamKooistra-Smid Paperposterpresentation Assessmentoftheaddedclinicalvalueofnext-generationsequencingofthe16S-23SrRNAregioninaclinicalsetting
Omics,OmicsandevenmoreOmics Link
April14,2019
NatachaCouto InvitedSpeaker/Chair Makingsenseofgenomeshreds:toolsandstrategiesforstraightforwardgenomedataanalysis
Presentation/sessionunfortunatelynotavailableonline
BhanuSinha Chair Advancingpatientmanagementthroughdiagnosticstewardship
Sessionunfortunatelynotavailableonline
MarjanWouthuyzen-Bakker Chair Newinsightsinboneinfections Sessionunfortunatelynotavailableonline
ErleyLizarazo OralPresentation UnderstandingdenguegeneticdynamicsinthecontextofconsecutiveoutbreaksinVenezuela
Dengue:olddisease,newchallenges Presentationunfortunatelynotavailableonline
AlexFriedrich Speaker Overcominguncertaintyindiagnostics Decisionmakingunderuncertainty Link
MarjoleinHeuker Oralpresentation Real-timearthroscopicimagingofbacterialbiofilmsinahumanpost-mortemmodelusingfluorescentlylabelledvancomycin
Mechanismsatplayinbiofilm-associatedinfections
Presentationunfortunatelynotavailableonline
AnaCarolinadaCruzCampos Paperposter Characterisationofbeta-lactamaseCMY-2geneandbacteriocin-encodingplasmidsofST131ExPECusingMinIONandIlluminasequencingandevaluationofitspotentialroleinthevirulencemechanisms
Enterobacterales:virulenceandpathogenesis Link
NilayPeker PaperPoster Next-generationsequencingtechnologiesfortheidentificationofMycobacteriumtuberculosisresistancepatterns
Diagnosticassaysintuberculosis Posterunfortunatelynotavailableonline
MaaikevandenBeld Paperposter ComparisonofrisksanddiseaseoutcomesofShigellaspp.andentero-invasiveEscherichiacoli:resultsofatwo-yearcross-sectionalstudy
Salmonella,ShigellaandCampylobacterontherun
Posterunfortunatelynotavailableonline
MaaikevandenBeld Paperposter PhenotypicandgenomiccharacterizationofShigellaspp.andentero-invasiveEscherichiacoliisolatesfromatwo-yearcross-sectionalstudyintheNetherlands
Salmonella,ShigellaandCampylobacterontherun
Posterunfortunatelynotavailableonline
LindaVeloo Paperposter PrevalenceofantimicrobialresistancegenesinBacteroidesspp.andPrevotellaspp.strainsinDutchclinicalspecimens
Newinsightsintheanaerobeworld Posterunfortunatelynotavailableonline
BhanuSinha Paperposter Next-generationsequencingtechnologiesfortheidentificationofMycobacteriumtuberculosisresistancepatterns
Diagnosticassaysintuberculosis Posterunfortunatelynotavailableonline
SilviaGarcíaCobos PaperPoster VirulenceprofilingofOXA-48-producingKlebsiellapneumoniaefromSpainandTheNetherlandsusingwhole-genomesequencing
OXA-48andotherOXAenzymesarestruggling! Link
ChristinaBrühwasser PaperPoster PersistenceoninanimatesurfacesofOXA-427andGES-7-producingCitrobacterfreundiiclonesonahaematologyward
OXA-48andotherOXAenzymesarestruggling! Link
GiuseppeFleres Oralpresentation Detectionofamobilecolistinresistance(mcr-5)geneinhospitaltapwaterusingshort-andlong-readshotgunmetagenomicssequencing
Polymyxinresistancearoundtheglobe Presentationunfortunatelynotavailableonline
MirjamKooistra-Smid Mini-oralePosterSession Next-generationsequencingofthe16S-23SrRNAregioncomparedtocultureand16SrDNASangersequencingfortheidentificationofbacterialspeciesinclinicalsamples
Performanceandutilityofbroad-rangemoleculardiagnostics
Link
MMBI at ECCMID 2019 overview
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention © MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Name Contribution Title Session name Link
April 15, 2019
Marjan Wouthuyzen-Bakker Speaker How to manage orthopaedic implant infection? Real-life clinical case discussion
Meet the expert Link
John Rossen Chair Clinical metagenomics: practical applications
Session unfortunately not available online
Corinna Glasner Pipeline corner: Diagnostics & Infection Prevention
Pipeline corner: Diagnostics & Infection Prevention Pipeline corner: Diagnostics & Infection Prevention
Presentation unfortunately not available online
Adriana Tami Speaker Shortage of antimalarial drugs in Venezuela Open Forum “Dealing with drug and vaccine shortages on site”
Presentation unfortunately not available online
Linda Veloo Paper poster The presence of conjugative transposons in Prevotella bivia strains isolated from human clinical specimens, determined by whole genome sequencing
Promiscuous plasmids on the attack: mobile genetic elements and their impact on antibiotic resistance
Poster unfortunately not available online
Bhanu Sinha Paper poster - last author
Effect of a day-2 intervention by an antimicrobial stewardship team on antimicrobial use and length of stay on an urology ward in a Dutch regional hospital, compared to an academic hospital
Results and impact of antimicrobial stewardship interventions
Link
Alex Friedrich Chair Fast and furious in infection control: how to be successful in seven steps!
Link
John Rossen Chair Optimised diagnosis of bacterial infection Session unfortunately not (yet) available online
April 16, 2019
Catarina Mendes Oral presentation DEN-IM: dengue virus identification from metagenomic sequencing data
Emerging viral infections: what's around the corner?
Presentation unfortunately not available online
Corinna Glasner Poster Presentation Zoom into reality: a close-up of the prevalence of antibiotic-resistant bacteria in a European border region
Surveillance of healthcare-associated infections
Poster unfortunately not available online
Matthijs Berends 2nd author on poster Zoom into reality - a close-up of the prevalence of antibiotic-resistant bacteria in a European border region
Surveillance of healthcare-associated infections
Poster unfortunately not available online
Anna Boef Paper poster Phenotypic differentiation between Klebsiella pneumoniae SHV-1 hyperproducers and ESBL-positive K. pneumoniae
Detection of antibacterial resistance mechanisms
Poster unfortunately not available online
Lisanne Braams Poster presentation Nuclear imaging of infection: in vitro assessment of 2-[18F]-fluorodeoxysorbitol tracer for the detection of bacterial infection
Predicting sepsis and bloodstream infection severity and outcomes
Poster unfortunately not available online
Artur Sabat Paper Poster RNA-seq analysis of the effects of mprF and vraS non-synonymous point mutations associated with daptomycin-resistance on Staphylococcus aureus transcriptome
Resistance mechanisms in Gram-positive cocci
Poster unfortunately not available online
Viktoria Akkerboom Contributing author - Paper poster
RNA-seq analysis of the effects of mprF and vraS non-synonymous point mutations associated with daptomycin-resistance on Staphylococcus aureus transcriptome
Resistance mechanisms in Gram-positive cocci
Poster unfortunately not available online
Adriana Tami Oral presentation Unprecedented malaria epidemic in Venezuela in times of complex humanitarian health crisis: a regional menace
Focus on malaria Presentation unfortunately not available online
© MMB Newsletter Special Edition 07.2019 • Medical Microbiology and Infection Prevention
Alex W. FriedrichChair of Medical Microbiology and Infection Prevention
Head of DepartmentUniversity Medical Center Groningen
Tel: +31.(0)50.361 3480
This newsletter is published by the Department of Medical Microbiology and Infection Prevention of the University Medical Center Groningen.The editorial staff consists of: Alex W. Friedrich, Christien Rondaan and Edwina Doting.
[email protected]@[email protected]
The editors especially thank Corinna Glasner for the nice pictures that illustrate this newsletter.
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