Anti infective

Highlights from the 26th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), April 2016

The 26th ECCMID, the annual congress of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), was held in Amsterdam between 9–12 April 2016.

Research highlights from this congress included:

• Discussion of the development of novel, innovative antimicrobial agents 1
  
• A meta-analysis investigating the duration of use of surgical antibiotic prophylaxis (SAP) for surgical site infections (SSI). 2

Novel antibiotics to overcome antibacterial resistance

In the dedicated Pipeline Corner session, several small biotech companies presented some of their innovative approaches and novel antimicrobial therapies in development.

Led by Dr Ursula Theuretzbacher, founder of the Centre for Anti-Infective Agents, Vienna, the innovations highlighted in this session included:

• Targeted therapies, based on standard antibiotics and antibodies to target a specific pathogen 1
  
• Adjunctive therapies, including those that combine antibiotics with drugs that modulate the immune system or microbiome 1
  
• Potentiators, i.e. adjuvant drugs that enhance the efficacy of antibiotics by inhibiting resistance mechanisms e.g. β-lactamase inhibitors or efflux pump inhibitors. 1

In addition, the session provided insights into approaches to drug discovery to identify novel agents to address multidrug-resistant bacteria. 1

Several promising antibacterial agents of a new class or with novel modes of action are in preclinical research. 1

Systematic review and meta-analysis investigating the optimal duration of antibiotic prophylaxis

Use of SAP before unsterile and implant surgery to reduce the risk of SSI is well documented. 2 guidelines recommend treatment for 24 hours post-surgery, and recent surveys suggest that many surgeons prolong treatment durations for several days post-surgery. 2However, evidence suggests that a single pre-operative dose of SAP may be non-inferior to a SAP duration of 24 hours post-surgery.

Stijn W de Jonge from the Academic Medical Centre in Amsterdam presented results of a systematic review and meta-analysis investigating the effect of different durations of pre-operative SAP on the risk of developing SSI in studies published from 1990 to October 2015. 2

43 randomised controlled trials consisting of 17,733 patients were included in the meta-analysis. 2

No benefit to continued SAP treatment post-surgery was found (odds ratio [OR] for preventing SSI compared with a single dose prior to surgery = 1.11; 95% confidence interval [CI] 0.96–1.28; p=0.16). 2

Stratified analysis taking the specific procedure into account largely matched results for the complete analysis except for 2 procedures. 2

For these procedures, evidence of some beneficial effect of prolonging SAP post-surgery was found:

• Vascular surgery (OR 2.30; 95% CI 1.32–4.01; p=0.003)
  
• Cardiac surgery (OR 2.00; 95% CI 1.02–3.92; p=0.04). 2

However, no benefit was shown if SAP was extended beyond 24 hours post-cardiac surgery (OR 1.35; 95% CI 0.58–3.17; p=0.49).

Prolonging SAP post-surgery had no benefit over a single pre-operative dose in reducing the odds of developing SSI for the majority of surgeries. 2

With the increasing worldwide problem of antimicrobial resistance, correct use of SAP is required. 2

Reference list

1. ESCMID press release. Antimicrobial drug pipelines presented at ECCMID. [Online] 12 April 2016.
   
2. De Jonge SW, Zayed B, Solomkin J, Dellinger P, Allegranzi B, Boermeester M. Optimal duration for antibiotic prophylaxis. A systematic review and meta-analysis. ECCMID abstract 6194. [Online] 2016.