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28 May 2019

Dear colleagues,

Please find below the latest edition of ESCMID Weekly News.

With kind regards,

ESCMID Executive Office.


PK-PD Expert sought for the EUCAST Steering Committee

Due to the increasing number of proposals of new antimicrobials requesting marketing authorisation and the increasing pace of reviewing existing breakpoints, the EUCAST Steering Committee is seeking to expand its expertise in pharmacokinetics-pharmacodynamics as it relates to susceptibility testing and clinical breakpoint setting.

You can find out more about the position and its requirements at the EUCAST website.

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Apply now for an ESCMID funded Observership at the ECDC – Applications close tomorrow!

Applications are still being accepted for the ESCMID funded observerships at the ECDC. Submit your documents until until 29. May 2019, 12:00 (CET) for one of the 15 precious observerships at the European Centre for Disease Prevention and Control (ECDC). The visit at ECDC will take place from 2. – 6. Septmeber 2019 and the first preview of the programme is online. Use the link below to get directed to the website and submit your application to ESCMID today.

In case of questions, please contact: observership@escmid.org

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CMI Highlight: Intensive Care management of influenza-associated pulmonary aspergillosis

P. Koehler et al, aimed to provide a comprehensive review of management of influenza-associated pulmonary aspergillosis in patients with acute respiratory distress syndrome (ARDS).

Severe pulmonary infections are among the most common reasons for admission to ICU. Within the last decade increasing reports of severe influenza pneumonia resulting in ARDS complicated by Aspergillus infection were published.

Review of the literature pertaining to severe influenza-associated pulmonary aspergillosis. PubMed database was searched for publications since database inception until January 2019.

In patients with lower respiratory symptoms, development of respiratory insufficiency should trigger rapid and thorough clinical evaluation, in particular in case of suspected ARDS, including electrocardiography and echocardiography to exclude cardiac dysfunction, arrhythmias and ischemia. Bronchoalveolar lavage should obtain lower respiratory tract samples for galactomannan assay, direct microscopy, culture, and bacterial, fungal and viral PCR. In case of positive Aspergillus testing, chest CT is the imaging modality of choice. If influenza pneumonia is diagnosed, neuraminidase inhibitors are the preferred approved drugs. When invasive aspergillosis is confirmed, first-line therapy consists of isavuconazole or voriconazole. Isavuconazole is an alternative in case of intolerance to voriconazole, drug-drug interactions, renal impairment, or if spectrum of activity including the majority of Mucorales is desired. Primary anti-mould prophylaxis with posaconazole is recommended in haematology patients at high-risk. It may be considered in newly diagnosed influenza and ARDS, but ideally in clinical trials.

The authors highlight that rising reports of influenza-associated pulmonary aspergillosis in patients with ARDS, who are otherwise not considered at risk for fungal pneumonia demands heightened clinical awareness. Tracheobronchitis and Aspergillus in respiratory tract samples should prompt suspicion of invasive fungal infection and further work-up. The management algorithm should comprise bronchoalveolar lavage, CT imaging, sophisticated ventilator-management, rescue extracorporeal membrane oxygenation, antifungal and antiviral therapy. In order to decrease the burden of influenza-related illness, vaccination is of utmost importance, specifically in patients with comorbidities.

A Case vignette illustrate this statement: A 46-year old woman without underlying disease was admitted with respiratory insufficiency due to influenza B pneumonia (Figure 1). Respiratory worsening despite appropriate supportive treatment required extracorporeal membrane oxygenation (ECMO).ite.

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New surveillance network of ECDC – Call for submissions.

The European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net) is a new surveillance network of the European Centre for Disease Prevention and Control (ECDC) with the objective to establish genomic-based surveillance of multidrug-resistant bacteria of public health importance.

The first step in this direction is a European-wide survey of carbapenem- and/or colistin-resistant Enterobacteriaceae (CCRE survey) that is being conducted in 2019. The CCRE survey will complement the phenotypic antimicrobial resistance data available from the European Antimicrobial Resistance Surveillance Network (EARS-Net) with genomic information to identify high-risk clones and gain a more detailed understanding of transmission pathways. The CCRE survey results are intended to inform national and European level risk assessment and decision-making for better targeting of control measures.

The strain collection is primarily intended for up to 6000 isolates collected during the CCRE survey and an additional strain collection of up to 3000 isolates of Acinetobacter baumannii from a similar survey in the future.

The deadline for submission of tenders is 13 June 2019 16:00 CEST.

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Guideline Highlight: “EHRA international consensus document on how to prevent, diagnose and treat Cardiac Implantable Electronic Device infections” has now enter the Public Consultation Phase.

The guideline is a result of the concerted efforts of experts across Europe from the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)

The ESCMID members wishing to comment on the manuscript may write to the ESCMID Publications and Medical Guidelines Manager to request the (confidential) draft of the manuscript along with the comments form for listing feedback. We are happy to receive your feedbacks and comments on the manuscript until 25th June 2019.

To be noted:

By requesting this document you commit to provide comments at the end of the Public consultation phase

Please be aware that your comments and the authors’ responses to the comments will be made available online once the guideline is published.    

Email: guidancedocuments@escmid.org for a copy of the draft guideline!

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EUCAST proposes to revise aminoglycoside breakpoints

The role of aminoglycosides as monotherapy for infections outside the urinary tract has diminished over time. A meta-analysis carried out several years ago agreed with this conclusion. Recent PK-PD target attainment analyses also support the need for a review of aminoglycoside breakpoints. Even at maximum exposure dosing regimens, breakpoints based on conventional PK-PD endpoints split relevant MIC wild type distributions. The proposed changes therefore revolve around the use of ECOFFs as breakpoints, but only for mono-therapy of infections related to the urinary tract. For other infection types, a NOTE instead of a breakpoint would be added. The NOTE suggests that aminoglycosides can be used only as part of combination therapy and only if the phenotypic test indicates that the organism belongs to the wild type for the aminoglycoside.

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