LAUSR

This year’s ECCMID in Madrid convened roughly 13,000 professionals to hear and discuss about 3500 contributions in more than 200 sessions, most of them in parallel. The field was covered extensively in all aspects from infections control over clinical microbiology, clinical infection management through vaccination and other preventive measures. One contribution of the European Centre for Disease and Prevention Control (ECDC) by Dr. Robesyn summarized clinical characteristics of all 37,365 cases of measles reported to the ECDC from 2013 to 2017, 81% occurring in persons without vaccination. Countries which are represented with at least 5% of the reported cases are Italy, Romania, Germany, the Netherlands and the United Kingdom. The fact that 33% were hospitalized and 11% had pneumonia as well as the fact one in thousand patients died results once more in a call for higher vaccination rates. Odds ratio for mortality was seven times higher in children < 12 months of age as compared to older children and adults (O 0060). It has been discussed that this might especially be important in refugees to Europe [1]. Duration of antibiotic treatment in patients with cellulitis is mainly based on expert opinion and many say 10–14 days [2]. A Dutch study addressed the question whether 6 days of flucloxacillin treatment would be noninferior to treatment duration of 12 days. On a short term, 6 days of treatment appeared to be equivalent in efficacy to 12 days. However, those with a short treatment course did have significantly more and quicker relapses by day 90. Noteworthy in this trial: only 151 of 248 included participants (61%) had sufficiently improved by day 6. This was the inclusion criterion for randomisation. We could also take home this message: For 39% of patients in the Netherlands (probably equalling patients in developed countries) flucloxacillin is not sufficient to result in sufficient clinical improvement by day 6. Moreover, in both groups only roughly 50% reached clinical cure opening the question, whether flucloxacillin can remain the suggested first line option for cellulitis (O 1122 [3]). A putative “DEAD box RNA helicase” gene “help”s Pseudomonas to be a killer: By sequencing and establishing a phylogenetic analysis of the core and accessory genome of pseudomonas strains from blood stream infections a microbiology group from Tübingen in Germany (Oral presentation 0322 Willmann) found a novel and obviously clinically relevant virulence marker which they called “helP” (abbreviation for helicase of Pseudomonas). This is of importance because it seems to be suitable for clinical use and for its presumed high ability to predict negative outcome in Pseudomonas blood stream infection. The hazard ratio for poor clinical outcome was 1.96. In the same session, there were two very promising talks on rapid diagnosis of organisms in sepsis using next generation sequencing (NGS [4]) and magnetic resonance technology (MRT): Silke Grumaz (O 0324) reported on the high performance of NGS diagnostics compared to culture-based microbiological diagnostics in patients suffering from septic shock. The talk made very clear that this is now a feasible tool that may come to clinical use. The same holds for MRT diagnostics, a test with very rapid and easy detection of the seven most likely organisms in sepsis [5], while in 112 samples in 95 patients only 15 were positive in blood culture the MR test had high sensitivity and detected organisms in 45 samples (O 0326 presented by Peter-Michael Rath). It was not known whether Piperacillin–Tazobactam is an adequate carbapenem-sparing therapy for infections by Escherichia coli or Klebsiella pneumoniae which express extended-spectrum β-lactamases [ESBLs] mediating resistance to third-generation cephalosporins (3GCs). Using the concept of a multinational, randomised multi-continental trial in 32 trial sites in nine countries Harris and colleagues report that the use of * Johannes R. Bogner [email protected]