Day :
- Infection Treatment and Prevention Control | Pediatric Infections Prevention and Control | Resistance and Emerging Infectious Organisms | Infection Novel Therapies | Control of Zika/Malaria/Dengue Viral Infections | Hepatitis C | Surgical Infections Control | Control of HIV/AIDS from STDs & STIs | Antimicrobial Resistance| Microbial Pathogenesis
Chair
Paul Kadetz
Drew University, USA
Co-Chair
Saungi McCalla
White Plains Hospital, USA
Session Introduction
Saungi McCalla
White Plains Hospital, USA
Title: Automated hand hygiene compliance system associated with improved monitoring of hand hygiene
Time : 14:10-14:35
Biography:
Saungi McCalla is Registered Nurse for over 24 years and has been working in Infection Prevention and Control for 16 years. She is board certified in Infection Control. She is currently the Director of Infection Prevention and Control at Community Hospital in Westchester County, New York. She is passionate about her role in infection prevention and the impact it has on staff, patients and visitors, and work hard to be an advocate and to lead by example. She considers herself a change agent and will collaborate with all key players to implement evidenced-based in initiatives that will yield positive outcomes. She has also authored articles including a white paper on topics related to infection prevention and patient safety. In addition, she has been accepted as a Fellow of the Association for Professionals in Infection Control and Epidemiology (APIC). She was the proud recipient of the 2014 APIC Chapter Leadership Award presented at APIC National.
Abstract:
Statement of the problem: Healthcare-associated infections (HAIs) are a substantial concern in US hospitals. Approximately one in 25 patients in the US has at least one HAI during a hospital stay and an estimated 80,000 people die annually in the US from an HAI. Consistent hand hygiene is key to reducing healthcare-associated infections (HAIs) and assessing compliance with hand hygiene protocols is vital for hospital infection control staff. The conventional approach is to employ a team of observers who can record hand hygiene opportunities (HHOs) and the number of times caregivers comply with protocol. However, relying on human observation has limitations. The purpose of this study is to determine if implementation of the automated HHCS is associated with improved hand hygiene compliance and a significant reduction in MDROs, CLABSIs, and CAUTIs in the hospital’s ICU and ICU stepdown unit compared to the use of human observers.
Methodology: Using a retrospective cohort design, researchers investigated whether implementation of the HHCS resulted in improved hand hygiene compliance and a reduction in common HAI rates. Pearson Chi-square tests were used to assess changes in compliance, and incidence rate ratios were used to test for significant differences in infection rates.
Results: During the study period, the HHCS collected many more hand hygiene events compared to human observers (632,404 vs 480) and ensured that the hospital met its compliance goals (95%+). While decreases in MDRO, CLABSI, and CAUTI infection rates were observed, they represented non-significant differences. Discussion & Conclusions: Human hand hygiene observers may not report accurate measures of compliance. The HHCS is a
promising new tool for fine-grained assessment of hand hygiene compliance. Further study is needed to examine the association
between the HHCS and HAI rate reduction.
Yaa Boateng-Marfo
National University of Singapore, Singapore
Title: Zein-loaded artemether nanoparticles for treatment of severe malaria
Time : 14:35-15:00
Biography:
Yaa Boateng is a PhD candidate at National University of Singapore, Singapore. Her research interest is in formulation design via nanotechnology. She has been working of developing nanoformulations for severe malaria treatment for her PhD thesis. Prior to her PhD candidature, she worked as a community pharmacist and a production
pharmacist.
Abstract:
Half of the world’s population is at risk of malaria infection. Severe malaria is life threatening and causes one death per minute each day. WHO recommends parenteral administration of artesunate, artemether and quinine till patients can tolerate oral dosage forms. Intravenous artemether formulations have shown potentially better therapeutic efficacy but it’s use is limited by poor watersolubility and short plasma half-life. Nanoparticles are becoming indispensable in many industries including the pharmaceutical industry for the advantages they offer including extended release and targeted delivery. Synthetic polymers and surfactants usually used as carriers and stabilizers, respectively. However, these agents can elicit immune reactions and produce toxic metabolites, resulting in increased toxicity to the host. Proteins such as zein on the other hand have low toxicity, low immunogenicity, and biodegradable. Considering that: zein is water insoluble and suitable for extended release formulations, longer contact is required between malaria parasite and drug to minimize development of resistance and the intravenous nanoparticles has been successfully applied for clinical use, zein-loaded artemether nanoparticles are been developed and characterized in this work. Artemether and zein were dissolved in ethanol-water mixture, aqueous sodium caseinate solution was added at once. Ethanol was then removed and the nanosuspension was frozen and freeze dried. Particles with size 120-200 nm were obtained with 80% ethanol content been optimum for smaller particles. Higher sodium caseinate –zein ratio, lower zein artemether ratio and evaporation time of 3 h favored the formation of smaller particles. Encapsulation efficiency of 52% was obtained.
Mohamed A Abouelkhair
University of Tennessee, USA
Title: Staphylococcus pseudintermedius adenosine synthase inhibits the innate immune response and promotes bacterial survival in canine blood
Time : 15:00-15:25
Biography:
Mohamed A Abouelkhair has completed his Master’s degree from University of Sadat City, Egypt. He is an Assistant Lecturer in Bacteriology, Mycology and Immunology department, University of Sadat city, Egypt. Currently, he is a Graduate PhD student in Comparative and Experimental Medicine Graduate program, college of veterinary medicine, University of Tennessee, USA.
Abstract:
Staphylococcus pseudintermedius is an important opportunistic bacterial pathogen that is the most common cause of canine pyoderma. It is frequently associated with urinary tract, wound and surgical site infections and occasionally causes zoonotic infections in human beings. The development of a staphylococcal vaccine is challenging and prior infection with S.pseudintermedius is not associated with protective immunity. Identification of a novel virulence factor inhibiting phagocytosis and evasion of innate immunity could play an important role in the prevention or treatment of S. pseudintermedius infection. Here, through bioinformaticsbased analysis of S. pseudintermedius genome sequences, we identified a putative adenosine synthase gene (SpdsA) encoding a 5′-nucleotidase. S.pseudintermedius SpdsA protein shares approximately 73.46 % similarity with that of Staphylococcus aureus and 46.44% similarity with that of S. suis type2. Like the orthologous protein in S. aureus it catalyzes the dephosphorylation of adenosine mono- and triphosphates and consequently produces the immune signaling molecule adenosine. Attenuation of this enzyme with selected amino acid substations result in diminished hydrolytic activity on adenosine mono-and triphosphates and low adenosine production. Adenosine perturbation enable escape of S. pseudintermedius from phagocytic clearance in dog blood. In contrast, the addition of SpdsA inhibitor or A2A receptor antagonist to phagocytic cells result in diminished ability of S. pseudintermedius to escape from phagocytic killing. Taken together, these results indicate that SpdsA may play an important role in promoting S.pseudintermedius survival and in inhibiting neutrophil activity by adenosine synthesis.
Ruhul H Kuddus
Utah Valley University, Bangladesh
Title: Rapid changes in antibiotic sensitivity and resistance among pathogenic bacteria isolated from clinical samples in two hospitals in Dhaka City, Bangladesh
Time : 15:25-15:50
Biography:
Ruhul H Kuddus is a professor of Biology at Utah Valley University. He teaches Clinical Microbiology, Molecular Biology and Immunology. He has a diverse research interest. Data presented here was collected at Dhaka Bangladesh in 2011-12, when he served there as a Fulbright Scholar and a Visiting Professor at University of Dhaka, Dhaka, Bangladesh.
Abstract:
Background: It is established that improper use of antibiotics leads to rapid development of bacterial antibiotic resistance. How the conditions affect the change of antibiotic sensitivity over time is less investigated. We investigated changes in antibiotic sensitivity of pathogenic bacteria in a megacity where improper antibiotic use is common.
Materials & Methods: Data on the percent of clinical isolates sensitive or resistant to 28 commonly used antibiotics was obtained from two large hospitals. Changes in drug sensitivity of the isolates at time point A and at about three years later (i.e. time point B) were compared using a one-sided test for equality of proportions. For large samples, tests using Z-score and normal distribution were conducted; for small samples, Fisher’s exact test was performed.
Results: The antibiotic sensitivity of 194 different pairs of isolate-clusters were compared. Of them 66.5% of the cluster-pairs showed no change. The time point B isolate-clusters showed a significantly lower sensitivity in 21.1% of the cases, and a significantly higher sensitivity in 12.4% of the cases, when compared to the corresponding time point A clusters. The decreased sensitivity was observed in 20.0% of the Gram-negative and 24.1% of the Gram-positive bacterial isolate clusters; and the increased sensitivity was observed in 10.0% of Gram-negative and 18.5% of Gram-positive bacterial clusters.
Conclusions: Bacterial antibiotic resistance and sensitivity may change significantly over a period of three years. Continuous vigilancemon bacterial antibiotic sensitivity may keep effective and affordable antibiotics clinically relevant.
Hafid Soualhine
National Public Health Institute of Quebec, Canada
Title: Spread of M. chimaera in cardiac surgery operating room in quebec: WGS and RTPCR for outbreak investigation and management
Time : 16:55-17:20
Biography:
Dr Soualhine has extensive experience in reference diagnosis of TB and mycobacteria, He did post-doctoral fellowss in France on genome sequencing, in Quebec on genomic and proteomic of drug resistance and at UBC on development of new recombinant BCG vaccine. His research career has been devoted to antimicrobial resistance in M. tuberculosis. He is interested in mycobacterial pathogenicity, molecular methods for rapid characterization and genotyping with special interest in Crohn’s disease and cystic fibrosis.
Abstract:
Mycobacterium chimaera outbreaks affecting patients subjected to open-chest heart surgery have been reported worldwide and associated with a high case fatality rate, reinforcing the need for strongly coordinated surveillance and outbreak control. The ECDC, Health Canada, the U.S. Centers for Disease Control and Prevention (CDC) and others issued warnings regarding the
potential risk of infection with M. chimaera for patients underwent open-heart surgery since 2012. The public health reference laboratory in Quebec undertook a laboratory active surveillance screening of all sterile site samples collected from patients presenting with M. chimaera -positive results between 2010 and 2016. The surveillance of environmental and clinical cases was extended to
the nine busiest cardiac surgery centers in Quebec. In this study, we attempted to determine the source of M. chimaera infection by establishing a molecular link between patients (n=7) and environmental strains (n=32). We developed a genome-wide strain genotyping approach and investigated the relatedness of M. chimaera isolates from patients and heat-cooler units (HCUs) from different geographical locations in Quebec. Four clinical isolates were associated to the European outbreak. We also implemented a new rapid molecular test based on quantitative real-time PCR targeting the ITS regions. This allowed us to detect rapidly the presence of M. chimaera in water samples and compare results with culture, follow up the bacterial burden in 26 contaminated HCUs. In conclusion, four patients infected with M. chimaera during cardiac surgery were related to one site in Montreal and were associated to the worldwide outbreak. Moreover RT-PCR allowed us to monitor and follow up the contamination in HCU in operating rooms.
Ibrahim Zeid
Hammoud Hospital University, Lebanon
Title: Using lean six sigma approach to reduce central line associated bloodstream infections in Hammoud hospital university medical center
Time : 17:20-17:45
Biography:
Responsible for planning, administration, and monitoring of consistent readiness of all quality management, regulatory requirements, and quality-improvement processes. As a member of the senior management team, initiates and oversees the development of a comprehensive quality/performance improvement program. In collaboration with hospital leadership, staff, medical staff leadership, and the Board of Trustees, directs and coordinates quality/performance improvement and hospital initiatives.
Abstract:
Statement of the Problem: CLABSIs are considered important problem among ICU patients as they are significantly associated with increased mortality and morbidity, increased hospitalization, and higher cost. During the calendar 2014, the CLABSI rates for medical surgical ICU patients were 3.25 per 1000 catheter days. Our goal was ZERO CLABSIs. The purpose of this study is to use the Lean Six Sigma process to reduce CLABSIs in adult ICU. Methodology & Theoretical Orientation: A multidisciplinary team of nurses, infection control officer, quality manager, residents and nurse educator utilized the Lean Six Sigma process improvement plan model to study the root causes and solutions to prevent CLABSIs, plan process improvements and to develop a plan for maintaining improvement over time. A retrospective chart review of all 2014 CLABSIs was conducted to identify infecting organisms, type of catheter, insertion site location and number days between insertion and infection. Registered nurses were interviewed to assess their understanding level of CLABSI prevention policy and asked for ideas about the causes of CLABSIS and what they could do to prevent these infections. Observations were made to evaluate compliance with central line insertion and maintenance Bundle. Findings: Lack of compliance with CL insertion policy by Hospital Residents was identified. Prior to the project, the CLABSI rate for adult medical ICU was 3.25 per 1000 catheter days. After launching the project, we achieved 0 rates. Compliance rate with central line insertion bundle was increased from 71% to 89%. Compliance rate with central line maintenance bundle was increased from insertion from 79% to 97%.
Lesson learned:
1. Lean Six sigma allowed in depth examination of potential causes and solution to prevent CLABSIs.
2. To improve patient safety by eliminating life-threatening errors.
Shirley Gutkowski
Primal Air LLC, USA
Title: Improving breathing with a novel use of xylitol
Time : 17:45-18:10
Biography:
Shirley Gutkowski has practiced Clinical Dental Hygienist from 1986 to 2003, when she focused her energy on product research, writing and speaking. She is the 2008 Alumna of the Year Marquette University School of Health Science in Dental Hygiene, a recipient of the Leadership Award from the World Congress of Minimally Invasive Dentistry, and 2006 – 2007 president of the Wisconsin Dental Hygienists’ Association. Her podcast Cross Link Presentations highlights notables such as Patrick McGowan (author of The Oxygen Advantage and premier Buteyko instructor), Dr. Kevin Boyd (Darwinian Dentist), Gill Rapley (author of Baby Led Weaning), Dr. Allison Hazelbaker,
Dr. Mike Nelson (metabolic flexibility) and others. As the science continues to point to correlations between oral and systemic health, the function of the nasal airway is also under scrutiny. She has published extensively on these topics. She is a featured speaker on the upcoming The Functional Oral Health Summit.
Abstract:
Epigenetic changes in the shape of the face have modified the airway leading to changes in breathing, like mouth breathing. Mouth breathing in children has consequences leading to decreased nasal volume and dental malocclusions. Allergy profiles have also increased over the last century topping 15 million Americans, today improving the odds for mouth breathing and its consequences. Allergy symptoms often include a sinus component that may be relieved, reduced, or eliminated using a saline nasal spray complimented by xylitol. The mechanism of action, recommended usage, and safety profile of this novel functional ingredient are discussed.
Abbas Ali Husseini
Ankara University, Turkey
Title: Seroepidemiology of HIV-1 and HTLV I\II in Afghanistan
Time : 18:10-18:35
Biography:
Abbas Ali Husseını has completed his PhD at Ankara University. His research interests lie in the area of infectious disease. He has researched on epidemiology
and molecular profile of HIV, HTLV, HBV, HCV and HDV. He has experience of designing different NA isolation kits and HBV, HCV, HIV and CMV quantitative real time PCR Kits.
Abstract:
Background: Infections caused by HBV, HCV and HDV are global public health problem. Few studies on these diseases have been done among risk groups and less attention has been made to assess the general population. For a better evaluation of HBV, HCV and HDV epidemiologic situation we assessed the Anti-HBc, Anti-HBs, HBsAg, Anti-HCV and Anti-HDV in adults. The results of our study reflect the susceptible population, acquired immunity rate via natural infection and exposure and infection rate among population.
Methodology: Totally 492 samples selected randomly from Nangarhar, Herat, Mazar-e Sharif, Kandahar and Kabul with age group of 25-70 years old. Among the participants 269 [54.67%] were female and 223 [45.32%] were male. Anti-HBc, Anti-HBs, HBsAg, Anti-HCV and Anti-HDV were detected by chemiluminescent microparticle immunoassay (CMIA). HBV and HCV
viral load was determined also.
Results: The HBV exposure rate and infection rate were 149 [30.28%] and 31 [6.3%] respectively. We have not found Anti-HDV positive in our HBsAg positive samples. Among the studied individuals 136 [27.64%] samples presented titers of Anti-HBs≥10.0 mIU/mL and 59,95% of population was susceptible against HBV. Only 8 [1.62%] persons were positive for Anti-
HCV, four [50%] of them had a history of exposure to hepatitis B as well. Kandahar shows the lowest rate of prevalence in all markers. Exposure rate in nangarhar and acquired immunity rate in Mazar-e-sharif were the highest compare to other regions. Herat includes the most infected population among all other regions. The acquired immunity due to natural infection rate
shows a significant increase with age (P=0.001053) but susceptible rate shows a negative correlation with age (P=0.012701). The viral load of HBV DNA, ranged from 6.1×101 to 1.2× 109 IU/mL and high level viral load rate was 25.8%. There was also a positive correlation between HBsAg and HBV DNA level (P-value=0.00167). In the cases of Anti-HCV positive, viral load was
detected in the range from 9.5×100 to 6.7×104 IU/mL and all of them were considered as a low viral load.
Conclusion: Most of the population, especially the younger generation, is sensitive and the risk of exposure is high in the population. Public awareness and increased health education are recommended to prevent hepatitis.
- Special Session
Session Introduction
Stef Stienstra
Armed forces of the Netherlands, Netherlands
Title: Zoonotic diseases threat needs sharing of information and new diagnostic systems in less developed countries
Biography:
Stef Stienstra works internationally for several Medical and Biotech companies as Scientific Advisory Board Member and is also an Active Reserve-Officer of the Royal Dutch Navy in his rank as Commander (OF4). For the Dutch Armed Forces. He is CBRNe specialist with focus on Microbiological and Chemical threats and Medical- and Environmental functional specialist within the 1st CMI (Civil Military Interaction) Battalion of the Dutch Armed Forces. For Expertise France he is now managing an EU CBRN CoE public health project in west Africa. In his civilian position, he is at this moment developing with MT-Derm in Berlin (Germany), a novel interdermal vaccination technology as well as a new therapy for cutaneous leishmaniasis for which he has won a Canadian ‘Grand Challenge’ grant. With Hemanua in Dublin (Ireland), he has developed an innovative blood separation unit, which is also suitable to produce convalescent plasma for Ebola virus disese therapy. He has finished both his studies in Medicine and in Biochemistry in The Netherlands with a Doctorate and has extensive practical experience in cell biology, immunohaematology, infectous diseaases, biodefense and transfusion medicine. His natural business acumen and negotiation competence helps to initiate new successful businesses, often generated from unexpected combinations of technologies.
Abstract:
Sharing public health threat information is a necessity for governments to prevent outbreaks of infectious diseases. Zoonotic diseases are the most dangerous for outbreaks running out of control, as the population does not have natural nor artificial (from vaccination) immune response to new emerging diseases. The recent Ebola virus disease outbreak in west Africa was such an example. New diagnostic methods, which can be performed in developing countries lacking critical infrastructure should be developed to have an early response on (potential) outbreaks. It must be high tech with high reliability, which can be used in rural areas without proper infrastructure. The mitigation of highly infectious and deadly disease pandemics should be recognized at the source. Sophisticated diagnostic equipment and good calibration, maintenance and interpretation of the results is essential. To identify pathogens at molecular level, new technologies are under development. In developing countries military and civilian actors cooperate fruitfully in fighting potential biological threats. In this civil-military cooperation it is not only the biosafety, which should be considered, but also the biosecurity, as misuse of extremely dangerous strains of microorganisms cannot be excluded. Several zoonotic infectious diseases, like anthrax, small pox and the haemorrhagic fevers like Ebola virus disease are listed as potential bioweapons. With this extra threat in mind, both biosafety and biosecurity should be implemented in all mobile or fixed clinical laboratories. An information/computer network with a cloud in which essential information can be traced, helps in early detection of outbreaks of ‘new’, mostly zoonotic, infectious diseases. The same technology helps in the forensic aspects in case of a bioterror attack.
- Microbial Infections | Infection Control and Hospital Epidemiology | Medical Microbiology | Immunity and Vaccination | Antimicrobial Resistance | Pediatric Infections Prevention and Control
Chair
Lia Monica Junie
Iuliu Hatieganu University of Medicine and Pharmacy, Romania
Session Introduction
Narveen Jandu
Gannon University, USA
Title: Application of online tools & resources on foodborne outbreaks for microbiology instruction
Time : 11:45-12:10
Biography:
Dr. Narveen Jandu is currently working as an assistant professor in the Gannon University, Pennsylvania, USA.
Abstract:
In recent years, there have been several newsworthy outbreaks of infectious disease agents, such as Zika, Ebola and the 2015 Escherichia coli O26 outbreak associated with Chipotle restaurants in the United States. During these outbreaks, numerous resources can provide the public, faculty and students with timely, accurate, and credible information. The outbreaks associated
with these microbiological infectious disease agents can and should be incorporated into ongoing microbiology courses. One way to do this is to utilize the excellent resources available from the Centers for Disease Control and Prevention (CDC). The CDC website provides a wealth of resources and information on numerous current, ongoing and past outbreaks. Understandably, the CDC website can be overwhelming for new users, such as students. Students, however, can be gradually introduced to some of these resources
through planned assessments that will allow students to learn both microbiology content and how to utilize online resources. Two specific online resources were selected for students to develop their understanding of foodborne outbreaks. These resources include the FOOD (Foodborne Outbreak Online Database) Tool and the Multistate Foodborne Outbreaks webpage, which are both available through the CDC website. Both resources allow users to retrieve up-to-date information on ongoing outbreaks, which allows the
content in a microbiology course to be relatable to current news events. As well, students can utilize these resources to learn how to access public data, use spreadsheets, generate charts, and perform quantitative data analysis and interpretation. For teaching purposes, these resources are valuable for professors to generate figures and graphics for lectures. The utilization of real-time online data on ongoing outbreaks on infectious disease agents provides a more relatable and application based approach to understanding
how infectious disease agents cause foodborne and other outbreaks.
Pavithra Saikumar
University of Pacific, USA
Title: Prevalence of parasitic infection among school going children in south India
Time : 12:10-12:35
Biography:
Pavithra Saikumar is a Visiting Scholar in Genetics and Stem Cell Laboratory at University of Pacific, San Francisco, where she is currently researching the effect of folic acid in ameliorating hypoxia induced stem cell changes, and its correlation to non-syndromic craniofacial cleft lip and palate. She has obtained her Medical degree from India, at the culmination of which she was awarded the “Best Outgoing Student” for her academic excellence and research interests. She has worked in Department of Internal Medicine, where she treated patients and organized medical camps in rural and underserved areas. She plans to continue her research and provide healthcare as a physician in the US.
Abstract:
Intestinal parasitic infection is one of the major health problems in many developing countries, including India. Intestinal protozoans and helminths are widely prevalent and cause significant medical and public health problems. The study described in this poster was conducted to determine the prevalence of intestinal parasitic infections in the age group of 8-12 years and correlate their growth parameters to parasitic infections. 500 students participated in the study, detailed history and physical examination was done and stool samples were collected. In our study, out of 500 samples, 280 were positive for intestinal helminths. Among 280 positive samples, 180 (64.3%) were boys and 100 (35.2%) were girls. Furthermore, out of 280 positive samples, 110 (39.2%) were positive for Ascaris lumbricoides, 80 (28.5%) for Ancylostoma duodenal, 40 (14.2%) for Strongyloides stercoralis, 27 (9.6%) for Hymenolepis nana and 23 (8.2%) for Enterobius vermicularis. In our study, 40.3% of infested children were underweight and 29.6% of infested children were short stature. The results from our study indicate that parasitic infections are more common in male children and these infections had a drastic effect on growth of these children. Appropriate diagnosis, effective health education, prompt treatment, regular deworming and better sanitary measures will reduce the parasitic infections and improve the health status of children.
Abbas Ali Husseini
Ankara University, Turkey
Title: Molecular Epidemiology of HBV, HCV and HDV in general population of Afghanistan
Time : 12:35-13:00
Biography:
Abbas Ali HUSSEINI completed his Ph.D at Ankara University. His research interests lie in the area of infectious disease. He has researched on epidemiology and molecular profile of HIV, HTLV, HBV, HCV and HDV. Abbas has experience of designing different NA isolation kits and HBV, HCV, HIV and CMV quantitative real time PCR Kits.
Abstract:
Background: Infections caused by HBV, HCV and HDV are global public health problem particularly in low-income countries such as Afghanistan (1). Although limited studies on these diseases provide important information about seroepidemiology of viral hepatitis in this country but molecular epidemiology of these viruses has also remain completely vague in Afghanistan. This study
give a clue about HBV, HCV and HDV genotypes, sub genotypes and subtypes circulating among general population of Afghanistan
and also HBV vaccine scape and Anti-viral resistance mutation prevalence as well.
Methodology: Totally 234 HBsAg, 44 anti-HCV and 5 Anti-Delta positive Samples sera belong to age group 25-70 years old of permanent residues of five region of Afghanistan were included in this study.After quantify viral load by real time PCR, HBV, HCV and HDV genotyping were performed by amplifying and direct sequencing of a segment of the HBV Pre S1, HCV NS5B, and HDV Delta antigen regions, from 61 HBV, 29 HCV and 1 HDV samples containing sufficient amounts of genetic material. In addition, to
HBV serotyping, HBV vaccine escape and anti-viral resistance mutations analysis a segment of related S gene (coding for aa100-167) and HBV polymerase region (coding for aa 160–257) of 20 patient were amplified and sequenced respectively.
Results: All HBV isolate were dispersed throughout the genotype D branch, 60 samples subgenotype D1 and one sample in subgenotype D4 and ayw2 was the only subtype found in Afghan patients with HBsAg positive. throughout the vaccine escape and antiviral resistance mutation analysis, one mutation in P120S and Q215P positions in the respective S gene and in the HBV
polymerase region, respectively, were detected. The Anti-HDV prevalence among HBsAg positive patient in our study was 2.5% and the single sample of HDV we were able to amplified and sequenced partially was stayed in Branch genotype I in phylogenetic analysis. Nucleotide sequence analysis of HCV isolates has shown subtype HCV-1b in 22 (75.86%), HCV-3a in 6 (20.69%) and HCV-3b in 1 (3.44%) patients.
Conclusion: Finally, it can be said that there is little genotypic variation in Afghan patients. HBV genotype D1, subtype ayw 2, HDV RNA type 1, and HCV RNA genotype 1b are likely to be dominant in Afghan patients. We recommend further study in this subject.
Dhruv K. Mamtora
S. L. Raheja Hospital, India
Title: Lower limb deep tissue infections in type 2 diabetes patients at superspeciality tertiary care reference center in Mumbai
Time : 13:00-13:25
Biography:
Dhruv Mamtora has completed his MBBS in 2010 from Lokmanya Tilak Municipal Medical College, Mumbai, India. He also did his MD in Medical Microbiology from Government Medical College, Miraj, Maharashtra, India in the year 2013. He is the Head of Microbiology and Infection Control Department 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 reviewer for Pubmed indexed journal. He is also Media Subject Expert on infection control, microbiology, antimicrobials and outbreaks.
Abstract:
Diabetes is a slowly progressing disease of modern India. India has the highest number of diabetes patients amongst WHO member countries. Around 15% of patients with diabetes develop lower limb ulcers. Diabetes is the commonest cause of non-traumatic amputations due to chronic polymicrobial infections of foot and lower limb. Hence a study was conducted to further elucidate the
details about lower limb infections. Around 1294 isolates were studied from 758 patients in year 2016. Four hundred and sixty seven cultures showed no growth. Four hundred and twenty cultures showed single isolate, 247 cultures grew two isolates, 91 cultures grew three or more organisms. Colonization pattern was as follows: Candida species were 30, coagulase negative Staphylococcus (CoNS) were 28, Aspergillus species seven and two Mycobacterium which were seen only on smear examination. Most common were bacterial infections, followed by fungal infections. The bacteria most commonly isolated were Staphylocccus species (267), Pseudomonas
aeruginosa (212), Klebsiella species (196), E. coli (160), proteus/providential/morganella group (151) followed by Streptococcus species
(138) comprising of 88 enterococci and 38 streptocci. Multidrug resistant organisms were MRSA (62), carbapenem resistance in Pseudomonas aeruginosa (33.5%), Klebsiella pneumoniae (34.5%), E. coli (15.29), proteus group (6.76%) and Vancomycin resistant Staphylococcus aureus (VRSA) 1 isolate. One Enterococcus raffinosus was isolated which was resistant to vancomycin. Certain relatively rare organisms viz. Burkholderia species (3), Alkaligenes group (1), Sphingomonas spp. (4) and Cryptococcus laurentii (3)
and Raoultella ornitholytica (2). In context of emergence of carbapenem resistant gram negative isolates, delayed wound healing, immunocompromised status of Type II diabetes patients; the only option left for the diabetic foot surgeons will be amputation, if the emergence of antimicrobial resistance is not addressed appropriately. Timely treatment is of utmost importance as time is tissue.
Barley Chironda
Toronto East General hospital, Canada
Title: Implementation science a missing ingredient in healthcare surface disinfection
Time : 14:25-14:50
Biography:
Barley Chironda is working as a Nurse and is the Social Media Manager of IPAC Canada. He is also the past President of IPAC-GTA. He is also the National Healthcare Sales Director and Infection Control Specialist with Clorox Canada. He is certified in Infection Prevention and Control (CIC™) and has worked extensively in Infection Control. He has been an integral force behind the successful decline in Clostridium difficile infections by implementing innovative technology and quality improvement behavioural change. He has also volunteered as the Infection Control Specialist with the Cdiff Foundation.
Abstract:
Despite numerous interventions in surface disinfection, healthcare facilities continue to have surfaces that are not adequately cleaned/disinfected. The author, in this presentation will go through the latest literature, adressing some of the reasons as to why this is the case. The talk will also provide insights into how, after considering all the key criteria of selcting surface disinfenctants the
missing link seems to be the implementation science. Key comparisons will be drawn from other areas of infection control such as hand hygiene, surgical checklists, etc. where the failure of having proper implementation has led to poor clinical outcomes. The talk will focus on implementation science and product rollout in key areas such as electronic health records and learning management system. Therefore it will be showcasing the efficacy of implementation science in the realm of surface disinfenctants. This presentation
will put some light on the microbiological adavancements in surface disinfection and how these still yield to proper implementation.
Al dubisi Fatimah
University of Toronto, Canada
Title: Invasive streptococcal Pyogenes infection
Time : 14:50-15:15
Biography:
Al dubisi Fatimah has completed her Pediatric Infectious Board Certificate in Saudi Arabia 2014, She used to work as a Staff in the Division of Infectious Diseases and later as a Director of Infection Control Division in the Minsitry of Health, Saudi Arabia 2014-15. Currently she is doing an extensive work on infectious diseases at the Hospital of Sick Childen, University of Toronto since 2016 with extra focus on tuberculosis. She has couple of case reports and a published study about Clostridium difficile. She is currently working on some reasearch projects in the tuberculosis and antibiotic stewardship
Abstract:
Whenever Streptococcus pyogenes infection comes into attention, most people would simply think of strept pharyngitis, what they used to call for a long time a “strep throat”. In few other occasions, this might indicate a localized skin infection that has been traditionally treated with a few-day course of antibiotics. Unfortunately, this is not always the case. Invasive streptococcal infection
has been increasingly reported in the recent years. The spectrum of the disease ranges from soft tissue infection to severe sepsis, toxic shock syndrome and even death. Not uncommon, post streptococcal sequelae have been irreversible and led to permanent disabilities even when the best antibiotics have been used. The strain characteristics and the genetic profiles of the isolates, the so called "super antigens" are responsible for the different clinical presentations and most importantly the seriousness of the disease. We here present a case of an 11 year old healthy girl who developed severe streptococcal sepsis that was complicated with toxic shock syndrome, multi-organ dysfunction and purpura fulminans. Over the course of her illness, she developed cardiac asystole and sever vascular compromise that have unfortunately led to the amputation of two limbs. And yet she had to undergo a long-term rehabilitation program that could last for years.
- Workshop
Session Introduction
Guy Hagues Fontaine
HDR Hôpital de la Salpêtrière, France
Title: Superimposed myocarditis can lead ARVD patients to acute progression to CHF
Biography:
G H Fontaine has made 15 original contributions at the inception of cardiac pacemakers in the mid-60s. He has identified ARVD as a side work during the beginning of antiarrhythmic surgery in the late 70s. He has published more than 860 scientific papers including 197 book chapters. He was the Reviewer of 17 journals both in clinical and basic Science. He has also served for 5 years as a Member of the Editorial Board of Circulation. He has been invited to give 11 Master’s lectures of 90 minutes each during three weeks in the top universities of China (2014).
Abstract:
ARVD is one of the cause of sudden death in the young and the athlete leading to the crucial problem of indication of ICD implantation. However, the occurrence of an acute phenomenon of superimposed myocarditis may be in some cases a major problem leading to acute devastating CHF. Here, we report such a case in whom the clinical course was illustrated by release of troponin and progressive decrease in LVEF and finally heart transplant confirming the diagnosis of ARVD but also showing a typical involvement of both ventricles by histological signs of myocarditis. A male teenager with negative family
history presented one episode of palpitation after a game of soccer. Four months later, he had a documented episode of VT with LBBB. Echo showed major dilatation of right atrium associated with RV dilatation, LV size and function were normal. SAECG was positive and contrast angiographies were typical of ARVD. VT was not inducible at EPS but a TdP-like pattern followed by LBBB VT was observed after Isoproterenol injection. CMR confirmed RV dilatation and thinness of the free wall, also diffuse RV hypersignal. Some days later the patient had chest pain, increase in troponin level and T waves changes in inferior leads. Viral test was positive for para-Influenzas III. Two months later Frequent PVCs. Three months later non-sustained episodes of VT. Same positive viral testing. FEVG was 57%. Abrupt change in disease progression was observed three months later. Severe VT occurred during exercise necessitating DC Shock. Major Increase in Troponin level reached 120 ng/ml. ICD was implanted. After nine months multiple episodes of VT: LBBB + superior axis was associated with sign of RV failure. Major dilatation of RV and decrease in LVEF 45% occurred as well as signs of hepatic dysfunction. Few months later, CHF was associated with LVEF 25%. Clots in the LV were observed with probable coronary emboli. Successful heart transplantation was performed. Pathology showed in RV evidence of typical ARVD with clusters of lymphocytes. The same pattern was observed in the LV with multiple foci of lymphocytes, associated with areas of myocardial necrosis. This case illustrates the recent work of Lopez-Ayala (HR 2016) confirming the suggested association of ARVD with myocarditis which can be based on the same
genetic factor not available in our old case (Dr F Roland, Medical Thesis, University of Toulouse 2002).
- Video Presentation
Session Introduction
Zbigniew Pawlowski
Poznan University of Medical Sciences, Poland
Title: Taeniasis/neurocysticercosis control: Medical aspects
Time : 15:15-15:40
Biography:
Zbigniew Pawlowski is a Professor Emeritus of the Medical University in Poznan, Poland. He was a Chief of the Clinic of Parasitic and Tropical Medicine in Poznan (1970-1979 and 1987-1996) and an Organizer of the Intestinal Parasitic Infection Unit at World Health Organization in Geneva (1979-1986). He was active in several international parasitic and tropical medicine institutions (long term WHO expert, honorary member of several professional societies incl. American Society of Tropical Medicine and Hygiene). He has a DTMH diploma of the Liverpool School of Tropical Medicine (1964) and was for years involved in the Association of the Directors of the European Schools of Tropical Medicine. For almost three decades, he collaborated scientifically with the Centre for Disease Control in Atlanta, US. In 1999, he was awarded Doctor Honoris Causa by Warsaw Medical University.
Abstract:
Neurocysticercosis due to a larval stage of Taenia solium is a serious public health problem across low and middle-income countries of Latin America, Sub-Saharan Africa and Asia. It is a considerable problem in Europe and the United States, caused by immigration of T. solium carriers from endemic countries. Neurocysticercosis has a various clinical presentation, which ranges from asymptomatic infections to fatal cases. The most common symptoms are a late-onset epilepsy or partial seizures. The control of neurocysticercosis considers two aspects of T. solium transmission; it may be an indirect meat-born zoonotic control measure preventing human taeniosis by limitation of cysticercosis in pigs and a direct control measure by eradication of human tapeworm carriers, being the sole faecal-borne source of cysticercosis for humans and pigs. The control measures can be realized by the organized local or regional eradication programs as well as the routine daily medical and veterinary services. There is much progress in the veterinary control measures in endemic areas. However, the medical control of neurocysticercosis is still inadequately realized in spite of the improvements in diagnosis (fecal antigen tests), new taenicides (niclosamide, praziquantel) and better understood epidemiology (focality of transmission) of human T. solium taeniosis/cysticercosis. Several rules are proposed to be accepted in the medical control measures: Leaving untreated any detected case of T. solium taeniosis, spreading neurocysticercosis, is a medical error, due to difficulties in T. ,solium diagnosis the specific anthelminthic treatment has to be considered also in a suspected case of taeniosis (eg., there is a potential carrier of a T. solium tapeworm in every fourth case of neurocysticercosis), any Taenia tapeworm infection (T. solium, T. saginata, T. asiatica) deserves a specific treatment in order that T. solium is not missed, modern or traditional taenicides has to be easily available where needed, possibly free of charge, instruction has to be elaborated how to avoid the neurologic adverse reactions to praziquantel and preserve the stability and efficacy of niclosamide, a professional training in the control of taeniosis/neurocysticercosis has to be intensified in endemic areas, especially among mental health, public health and primary health care services as well as among veterinarians preventive screening of the T. solium tapeworm infected immigrants or visitors to endemic countries as well as local street meat vendors and specific treatment of those with a positive fecal antigen test, have to be considered.
Abdelhakam Hassan Ibrahim Ali
Neelain University, Sudan
Title: Carbapenemase production in hospital isolates of multidrug-resistant Klebsiella pneumoniae in Sudan
Time : 15:40-16:05
Biography:
Abdelhakam Hassan is a Technologist and is working as a Lecturer of Medical Microbiology (bacteriology, mycology, virology and molecular biology) who rapidly learnt all the aspects related to his study. He has more than four years' experiences in the field of drug resistance. He has done his MSc complementary research in the extended spectrum β-lactamase in K.pneumoniae (ESBL).
Abstract:
Background: Antibiotic non susceptible Bacteria have been increased and disseminated all over the world. So this resistant strain with treatment difficulty may threat the Patients lives. However the last line of treatment for such infection is antibiotic from Carbapenem family (1). One of the most virulence bacteria with pandrug resistant is Klebsiella pneumoniae which associated with high associated with morbidity and mortality (2). In this study, the phenotypic and genotypic features of carbapenem-resistant K.pneumoniae strains isolated in some Sudanese hospitals were studded.
Methodology: Strains of K. pneumoniae resistant to at least one carbapenem (imipenem or meropenem) were collected from May, 2015 to January, 2017. Isolates were obtained from clinical samples of patients treated inside the hospitals. Carbapenem resistance was confirmed using modified Hodge test (MHT) as phenotypic test and real-time PCR for genotypic detection.
Findings: A total 96 strains of K. pneumoniae of different non duplicated isolates were obtained from following samples; urine (47), wound swab (22), sputum (16), stool (3), CSF (1), HVS (4), seminal fluid (1), peritoneal (1) and blood.
All these isolates were found to be resistant to carbapenem by disc sensitivity test and modified Hodge test (MHT) revealed 63 (65.6%) isolates were carbapenemase producers. Seventy-two percent (70/96) isolates were positive for carbapenemase genes; 59.4% (57/96) were positive for blaKPC genes, 57.3% (55/96) were positive for blaNDM genes, 37.5% (36/96) were positive for blaVIM genes and 35.4% (34/96) were positive for blaOXA-48 genes. Nineteen isolates possessed four genes (blaKPC, blaNDM, blaVIM and blaOXA-48) , fourteen isolates possessed three genes{(blaNDM, blaVIM and blaOXA-48=6), (blaKPC, blaNDM, and blaOXA-48=3), (blaKPC, blaNDM and blaVIM =3), (blaKPC, blaVIM and blaOXA-48=2)}, 27 isolates possessed two genes{(blaKPC and blaNDM =21), (blaKPC, blaOXA-48=2), (blaNDM and blaVIM=3), (blaNDM and blaOXA-48=1)}, 10 isolates possessed only one gene (blaKPC=8, blaOXA-48=1 and blaVIM =1) and the remaining 26 isolates were free from these genes.
Conclusion & Recommendation: In Sudan, the most common type of carbapenemase gene multidrug-resistant K. pneumoniae is KPC. Co-production of KPC, VIM, NDM and OXA-48 genes are found in K. pneumoniae. To our knowledge, this study was done for the first time in Sudan. Therefore, it is necessary to determine carbapenem resistance in K.pneumoniae isolates and take essential infection control precautions to avoid spread of this resistance.