Action on Infection - FIS 2013
On the 11th November, I attended the Action on Infection: FIS 2013 conference in Birmingham and thoroughly enjoyed some fantastic talks on the latest in antimicrobial resistance.
In one day, I listened to talks from 13 speakers, so obviously a lot was covered! Here’s a highlight of what’s going on in the field right now:
- David Livermore started the day with a very enthusiastic introduction on the latest in resistance trends. There’s some good news for MDR-Enterobacter bacteraemia infections which have declined with the decreasing use of cephalosporins. There’s also a decreasing trend in the cefixime resistant N. gonorrhoea infections. However, Livermore stressed that this falling resistance is only one small victory, as there is now concerning ezithromycin and ceftriaxone resistance in N. gonorrhoea (currently used to treat infection). Unsurprisingly, we are seeing a continued rise in carpbapenemase Enterobacteriaceae cases (20 in 2008, now 20 per week) and Streptococcus pneumoniae is becoming more resistant.
- MERS-CoV. This new virus was discussed by Alison Bermingham, Principle Clinical Scientist at PHE. The genome of this novel coronavirus has been sequenced but where it came from and how it transmitted to humans is still unknown. What we do know is that it shares close similarities with a coronavirus in the Egyptian tomb bat and dromedary camel, making these likely culprits. Palm dates (eaten by many MERS-CoV patients) are also a possible source of infection (Contagion comes to mind!).
- The Meningitis B vaccine developed by Novartis was discussed. This vaccine was licensed for use in January but is not recommended by the JCVI for routine use as it’s not cost effective. Pfizer is also developing a meningitis B vaccine so this subject is likely to be big news in 2014.
- The use and formulary positioning of new antibiotics and antifungals was discussed:
- Daptomycin use in bone infections, which is enhanced in combination with rifampicin. This antibiotic kills MRSA more rapidly when used with beta-lactams which prevent emergence of resistance.
- Echinocandins – class of antifungals which have a novel mode of action. Three have been licenced; micafungin, caspofungin and anidulafungin. They have proved better than amphotericin B at killing fungi in biofilms and are useful for treating azole-resistant yeast infections.
- Ceftaroline – This was David Livermore’s second talk of the day, who discussed how this new beta-lactam – able to bind to PBP-2 and inhibit MRSA – could be used clinically without enhancing C. difficile risk. This antibiotic is able to bind to penicillin resistant PBP’s and does so better than other available drugs. It was recommended to be used with mixed infections that may contain MRSA, as it has broad spectrum activity, and has shown promise against pneumococcal infections.
- Fidaxomicin. First licensed antibiotic for C. difficile infection in more than 20 years. It’s better than vancomycin and metronidazole at preventing recurrences with less side effects. The problem? Cost. With hope, this will be reduced and will make treating C. difficilemuch easier as some difficult-to-treat infections are being treated with high vancomycin levels, causing more harm than good.
- Bioterrorism – With the recent chemical warfare in Syria, this was a topical subject. Syndromes of bioterrorism attacks were discussed along with some incredibly gory photos - not ideal after lunch! Also discussed was the way forward for improving teaching of medical students at undergraduate level about bioterrorism.
The day ended with ‘I’m a Scientist: Live! Drugs, Bugs and Infections’ hosted by Simon Watt. This was a fantastic outreach event attended by school children from surrounding areas, who got the chance to ask a panel of 5 scientists questions on antimicrobial resistance. Each scientist began with a ‘Fact or Fiction’ question, some of which were surprisingly difficult! Using electronic voting pads, the audience voted for their favourite scientist who was awarded a trophy (and MRSA bug!) by Laura Piddock.
All in all, a great conference! Presentations should be available online soon and for Tweets sent during the event, click here.