Day 2 :
Keynote Forum
Chih-Hung Ku
Kainan University, Taiwan
Keynote: Role of a biostatistician in detecting risk factors for surgical-site infection
Time : 10:00-10:45
Biography:
Chih-Hung Ku has completed his study from Harvard School of Public Health (HSPH) with a master degree in Environmental Epidemiology, and a doctoral degree:
major in occupational epidemiology, and minors in biostatistics and bioaerosols in 1999, and a Visiting Scholar at the HSPH in 2004. He is a Faculty of the Kainan
University, Taoyuan City, Taiwan and an Adjunct Faculty of the School of Public Health, National Defense Medical Center, and Taipei City, Taiwan. He has published
more than 47 papers in reputed journals and has been serving as an Editorial Board Member of the Disease Markers.
Abstract:
Cardiac surgery site infection (SSI) is a nosocomial infection. We conducted a prospective study to assess the risk factors for
SSI at the Taipei Veterans General Hospital (TVGH), Taipei city, Taiwan, from July 1999 to August 2000. This study was
approved by the Institutional Review Board. Patients who had undergone cardiac surgery were invited to enroll in the study.
42 potential risk factors for SSI were classified into three stages: 22 in preoperative, 20 in intraoperative, and 2 in postoperative.
42 factors were reduced to 34 after the collinearity diagnostic analysis. Multiple logistic regression analysis using a generalized
logit model was used to assess associations of interest. A total of 471 cardiac surgery patients were enrolled in the study. SSI
incidence rates were 2.5 episodes per 1,000 person-days for the sternum and 3.6 episodes per 1,000 person-days for the leg.
After adjustment for covariates, we found that age, gender, New York Heart Association (NYHA), creatinin, and duration of
surgery were significantly associated with sternal SSI; whereas age, peripheral arterial occlusive disease (PAOD), and length of
stay in the recovery room were significantly associated with leg SSI. We concluded that in addition to patients’ characteristics
(age, gender) and health situations (heart and kidney function, PAOD), the significant findings for duration of surgery and
length of stay in the recovery room confirmed our concern that time is an important parameter in studying risk factors for SSI.
Further study might focus on the relation between infectious agents cultured from wounds and air sampling.
Keynote Forum
Mahboob Quershi
Toruo University, USA
Keynote: Control and prevention of nosocomial RSV pneumonia in neonates and immunocompromised adult population
Time : 11:00-11:45
Biography:
Mahboob Quershi is presently the Associate Dean for Research and Professor of Microbiology and Immunology Toruo University Nevada and also associated with
Unviersity of the Ryukyus, Japan.
Abstract:
RSV bronchiolitis and pneumonia is a common cause of pediatric hospitalization in the USA and all over the world. Severity
of RSV pneumonia is exacerbated in the premature neonates and those with congenital cardiopulmonary pathologies.
Additionally, adults with hematopoietic malignancies and particularly those receiving stem cell transplants often become
predisposed to RSV pneumonia. Breakouts of RSV-pneumonia in community often pre-herald those at the nosocomial
settings. Attempts to minimize the incidence frequencies and severity of these nosocomial events require multifactorial
approach including screening of staff and visitors, screening on admission, visitor restriction, compliance monitoring and
finally use of personal protective equipment which yet generates variable results. Prophylactic use of monoclonal antibody
palivizumab has been reported with variable responses. RSV and other respiratory viral infections among stem cell transplant
recipients are commonly encountered after allogenic transplant, which often poses a significant challenge for patient recovery
and transplant survival. Prospective studies confirming the efficacy of Ribavarin use in these patients preventing progression
to life threatening pneumonia are yet to be properly done. Thus, it leaves the scope for prospective studies utilizing alternate
therapeutic approaches. Osteopontin (OPN) is an immunomodulatory molecule originally reported to be involved with
osteogenesis and only later have been implicated in modulating immune response polarizing the response towards a Th1 type.
Recently, several research groups in the USA and other countries have reported immune-modulatory effects of OPN in RSV
infections. RSV-infected infants develop a hyperactive airway (Th2 bias) response which has been shown to be prevented in
experimental animal models by prophylactic administration of OPN. It is yet to be established whether prophylactic use of
OPN in nosocomial setting has a similar effect in preventing progression to severe pneumonia and minimize mortality. Use of
OPN in combination with the existing multifactorial approaches may prove wise and worthwhile to prevent the untimely death
of the RSV-infected neonates, as well as those immunosuppressed hematopoietic stem cell recipients.
Break: 10:45-11:00
- Infection Prevention and Control |Diagnostic Microbiology | Multi Pathogens Infections| Urinary Tract Infections
Chair
Hua-Wei Chen
Naval Medical Research Center, USA
Co-Chair
Shabanov A.K
N.V. Sklifosovsky Institute of Emergency Medicine, Russia
Session Introduction
Alberti Amador E,
International Center for Neurological Restoration
Title: Epidemiologic, clinical and microbiological characteristics of nosocomial urinary infection the spinal cord lesioned patient
Biography:
Alberti Amador E is a Researcher at Cuba International Center for Neurological Restoration, Cuba.
Abstract:
Urinary infections constitute one of the main causes of intrahospitalary infections. At the clinic for the attention of spinal cord
injured (SCI) patients, we observed that these can be the causes of high incidence rates as a consequence of multiple risk factors
associated with the neurogenic bladder as: vesicle urethral reflux, vesicle lithiasis, diverticula and pseudo diverticula, urethral stenosis
and permanent or intermittent catheterization objective lesioned patients with neurogenic bladder as well as their microbiological
behavior.
Patients & Method: We performed a descriptive, retrospective-type study on 68 patients in order to schedule a neuro restorative
treatment for the affectation of the SCI for six months. They all received clinical, imaging test and bacteriologic assessment, that is,
urocultures, uretheral and vaginal exudates to determine risk factors, forms of presentation of the infection, as well as associated
complications and microbiological behavior.
Results: The most frequent forms of presentation of infections are: recurrent symptomatic bacteriuria, asymptomatic bacteriuria,
bacterial urethritis, bacterial vaginosis and acute pyelonephrites. Most acute germs are: Ecerichia coli (for a 46% of isolation), followed
by Klepsiella pneumoniae (l6%), Proteus mirabilis 8.1% and other Enterobacteria 10%. Sensitiveness to aminoglycosides was kept high,
where we observed a growing resistance to sulphas (100%) and fluoroquinolones (>60%), cefalosporine (Cefepime 34%) amikacine
7% and very sensitivenes a carbapenemics 100%.
Conclusions: Clinical peculiarities of urinary infections in the patient with neurogenic bladder, allow performing more adequate
strategies for treatment as to the clinical, microbiological and epidemiologic criteria.
Biography:
Dhruv Kamlesh Mamtora has completed his MBBS in 2010, from Lokmanya Tilak Municipal Medical College, Mumbai. He also did MD in Medical Microbiology from
Government Medical College, Miraj, Maharashtra in year 2013. He is Head of Microbiology and Infection control at S L Raheja Hospital, a 150 bedded multispecialty
hospital and center of excellence for diabetes and oncology. He has published papers in journals and has been serving as Editor for pubmed indexed journal. He
is also media subject expert on infection control, microbiology, antimicrobials and outbreaks.
Abstract:
Antimicrobial stewardship program implementation is a challenge for private healthcare settings especially it is a multispeciality
hospital catering exclusively to diabetic and oncology patients and in city like Mumbai where antibiotics are sold as over the
counter medicines. Looking at the antimicrobial resistance pattern of institution, we have implemented extensive and elaborated
antimicrobial stewardship program starting from critical care settings and operation theatres with respect to surgical prophylaxis
extending to wards. The challenges faced are multifaced and solution to each and every step needs team work and integration of
multiple specialities. First and foremost was to form SOP as per international guidelines, next step was to prepare antibiograms
and antibiotic policy which was reviewed by clinicians. The team was formed with AMS workgroup and roles were assigned to each
of the key members. Then program was rolled out with CME program highlighting issue of antimicrobial resistance in India and
importance of antimicrobial stewardship progrm and launching program of antibiotic policy. The daily follow up is continuous
and ongoing process. Justification of each restricted antibiotics needs to be implemented by every clinicians prescribing restricted
antibiotic and relevant cultures are sent before empiric antibiotic therapy is started. Compliance is fluctuating but process has >90%
compliance in critical care area where maximum consumption of restricted antibiotics is done. Being a diabetic hospital, no direct
restrictions were done for issuing restricted antibiotics however every issue needs to be justified by issuing consultants supported by
culure evidence. The help from IT department was taken on streamlining process at multiple level and hence the program could be
successful program.
Barrantes K
University of Costa Rica, Costa Rica
Title: Detection of integrases clases 1 and 2 (inti-1 and inti-2) in multidrug resistant enterobacterias isolated from clinical samples
Biography:
Barrantes K is a Microbiologist and Researcher at the Health Research Institute (INISA) from University of Costa Rica (UCR). She has completed her Master
degree on Microbiology and a specialist degree on immunology from UCR. She has published more than 10 papers in the field of infectious diseases transmited
by food and water and antibiotic resistant pathogens.
Abstract:
The disease burden of bacterial infections is found to coexist with the rapid spread of resistance to commonly used antibiotics. The
molecular basis of antibiotic resistance lies within genetic elements such as plasmids, transposons, integrons, genomic islands,
etc., which are found in the bacterial genome. Integrons are known to acquire,exchange, and express genes within gene cassettes and
it is hypothesized that they play asignificant role in the transmission of multidrug resistance genes in several Gram-negative bacteria
including enterobacterias. Here we are reporting the presence of class 1 and class 2 integrases (intI-1 and intI-2) and antibiotic
resistance genetic cassettes (blaOXA, blaTEM, sul1 and sul2) among multidrug resistant enterobacteria isolates in Costa Rica. The
antibiotic resistance pattern and presence of antibiotic resistance genes were analyzed in 58 bacterial isolates, including Shigella,
Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, among others. All isolates were resistant to at least, one antibiotic.
Multidrug resistance was observed in 54 out of 58 isolates (93%), and 100% of isolates carried integrase class 1 (intI-1). Integrase class
2 (intI-2), blaOXA, blaTEM, sul1 and sul2 were observed in Shigella isolates. In 19 out of 24 Shigella isolates, transfer of intI-1 blaOXA
and blaTEM, cassettes were detected by conjugative plasmids to a competent and antibiotic-sensitive strain of E. coli. These results
confirm that information about epidemiology and molecular mechanisms of multidrug resistance determinants in enterobacterias
is important to develop intervention strategies. Regional and local antimicrobial resistance pattern in bacterial pathogens should be
considered as a part of control strategies.
Shabanov A.K
N.V. Sklifosovsky Institute of Emergency Medicine, Russia
Title: Early immunosubstitution therapy for severe multiple injury
Biography:
Aslan Shabanov, MD, with the higher qualification. Senior researcher in the intensive care unit. General seniority in this field is 22 years. He has been working: as
a reanimatologist since 1997. Also he have been into emergency medical helicopter group since 2002.
Achievements: Development of diagnostic methods and treatment of patients with severe polytrauma, which provides proper improvement of the treatment.
Abstract:
Introduction: Severe multiple traumas are the main non-specific factor that causes early immune imbalance, which in turn
acutely increases the risks of development of infectious complications in the affected areas. In a comparative individual analysis
of deviations in the values of immunogram parameters, more than a third of victims with severe multiple trauma, an imbalance in
hypoergic or hyperergic type is observed already on the first day. Currently there are nearly no data justifying the conduction of early
immunosuppressive therapy at early stage of multiple trauma and to assess its impact on the development of nosocomial infection
and the parameters of immune system.
Aim of the Study: Evaluation of the effectiveness of early immunosubstitution therapy (IST) in patients with severe multiple trauma
(SMT).
Materials & Methods: 225 patients with severe co-occurring trauma (ISS>30 points) were examined. The mean age was 35.5±14.1
years. Depending on the use of early IST therapy with donor IgG (daily for the first three days) patients were split into two groups:
the first- 126 patients with standard intensive treatment supplemented with IST; the second-99 victims, who did not receive IST.
Immunological examination was performed on days 1, 3, 6 and 9 after trauma. The relative and absolute number of lymphocytes
of the main populations were determined: (CD3+)-T lymphocytes and (CD19+)-B lymphocytes; T cell subpopulations: (CD4+)
T helper and (CD8+) T cytotoxic lymphocytes, concentration of immunoglobulins class A, G, M (IgA, IgG, IgM); absorbing and
bactericidal activity of neutrophils; serum content of circulating immune complexes: large, medium and small, as well as concentration
of C-reactive protein (CRP) and procalcitonin (PCT). In both groups the severity of the condition was assessed according to the
APACE-II scale (in dynamics), duration of mechanical ventilation, incidence of nosocomial pneumonia, CPIS score (in dynamics)
and outcome.
Results: The study showed that in the group of victims who received IST the need for prolonged mechanical ventilation was 1.7 times less
infectious complications developed 1.4 times less, the signs of nosocomial pneumonia decreased on the CPIS scale and the mortality
decreased by 1.6 times. The favorable course of the posttraumatic period was expressed in the improvement of the APACE-II scale
and the reduction of the ICU stay for more than 7.5 days.
Conclusion: The use of early immunosuppressive therapy in the treatment of patients with severe multiple trauma reduced the
duration of mechanical ventilation and the incidence of nosocomial pneumonia, which in turn reduced mortality in the investigation
group.
Ivana Haluskova
French society of immunology, France
Title: Tackling resistance in infectious diseases
Biography:
Ivanka Haluskova Balter is a Medical and cosmopolitan professional specialised in infectious diseases, internal medicine covering various therapeutic axes,
certified in Immunology and Pediatric, MBA vaccinology and years of clinical practise contributing to bring innovative science and diplomacy for global health.
Abstract:
Antibiotic resistance is regarded as a major threat to global public health, to the extent that medicine could be on its way “back to
the future” of a pre-antibiotic era. The issue is receiving high-level political attention, with resolutions passed at events such as the
G7 Health Ministries summit and the European Parliament, the endorsement by the WHO of the AMR Global Action Plan, and
culminating at the United Nations High-Level Meeting on AMR and the adoption of its declaration by the UN General Assembly.
The list was drawn up in a bid to guide and promote research and development (R&D) of new antibiotics, as part of WHO’s efforts
to address growing global resistance to antimicrobial medicines. The list highlights in particular the threat of gram-negative bacteria
that are resistant to multiple antibiotics. These bacteria have built-in abilities to find new ways to resist treatment and can pass along
genetic material that allows other bacteria to become drug-resistant as well.(27th February 2017, WHO) meantime Tuberculosis
(omitted from the list ) and resistant tuberculosis in particular (MDR/XDR) merits interest for rapid, affordable, easy diagnostic,
innovative immunology approach for vaccine research. HIV/AIDS has known link with tuberculosis but other risk factors have also
emerged in recent years as important determinants of the TB epidemic, one of which is diabetes mellitus. Bacille Calmette – Guérin
(BCG )vaccine successfully helped to interrupt transmission cycle and along with antibiotic discovery to decrease mortality. BCG
has been used for more than 90 years with astonishing safety records. However, its efficacy remains controversial. No universal
BCG vaccination policy exists, with some countries merely recommending its use and others that have implemented immunization
programs. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable
tuberculosis (totally drug-resistant tuberculosis). Of note that HIV/AIDS has known link with tuberculosis but other risk factors
have also emerged in recent years as important determinants of the TB epidemic, one of which is diabetes mellitus.This poses several
challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and
the need for alternative methods to prevent disease transmission. Another issue is reappearing of “old diseases” like pertussis, measles
but meantime existence of viral or parasitic diseases resistant to current treatment (HIV, Malaria, Hepatitis C) underline important
role of adapted immunization as one of strong tool with large impact along with role of effective diagnostic and surveillance and
better understanding of genetic and immunologic background of host specific response and pathogen evolution. Additionally, risk
or new emerging and re-emerging pathogens originated from animals after having crossed the species barrier underline importance
to implement preventive and intervention strategies including boosted vaccine research and development. Immunology and deep
understanding (along with genetics) and lesson learned from oncology research helps to orientate vaccine research for improved
delivery (use of sIgA as mucosal vaccine vehicle for example applicable for live attenuated vaccines), vectors (live attenuated,
recombinant virus vectored vaccines and to look at host improved innate and adaptive immune response (APC – DC, CD4/CD8) to
combined major pathogens and development of “universal vaccines”. Know limitations for use of anti-infectives and antivirals antiparasitic
treatments such us comorbidities, potential drug toxicity, disease related organ dysfunctions, drug–drug interactions and
overlapping toxicities, pill burden, particularities of children population and immune reconstitution inflammatory syndrome support
role of vaccines as highly potent tool to tackle resistance and valuable alternative from long term perspective and clearly recognized
being major tool for public health.