#ECCMID2017, post-ECCMID syndrome and One (Infection) Stewardship?

The trip back from a pivotal medical conference such as ECCMID is always a great opportunity to make balance of the huge amount of information received. In my case it has consisted of +35 hours of live sessions, posters and networking and extracting the take-home messages for clinical practice as well as ideas for future projects and research is a must. This is usually pursued with a feverish activity, in the setting of a multi-stormed mens and an exhausted corpore. It’s the post-ECCMID syndrome. 
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And as I’m just hands on, I can say that this has been one of the best (if not the best) ECCMIDs that I have had the chance to attend. The program has been pretty balanced and the selection of topics and the quality of the presentations have been real good, thanks to all of those involved in the program and to all the people from the ESCMID Office that have been working hard on this for a long time.
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If I was asked for negative experiences as attendee, the one that comes most rapidly to my mind is the fact that there were many good sessions that I did not manage to attend due to the great number of high-interest sessions running at the same time (exquisite session buffet). Although probably this could be considered a good overall “performance indicator” for ECCMID, this does not make it painless for the attendee. Even though all material has been recorded and is freely available at ECCMIDlive (another great advantage of ECCMID) I must admit that it is very unlikely that I have the opportunity to go back on the missed sessions. I’m pretty sure that recycling recording contents into track-based e-learning modules could significantly improve the post-ECCMID experience. As ESCMID is working on the adoption of an e-learning platform this could be a good chance for it.
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And regarding antimicrobial stewardship (AS), the main reason why OVLC (this blog) exists, AS has truly been well represented in this ECCMID. Céline Pulcini, current ESGAP secretary, has received one of the Young Scientist awards (congratulations, Céline!!!), there have been Special Lectures/Key Notes on antimicrobial Stewardship (i.e. Dilip Nathwani, former ESGAP chair) as well as some other other sessions that we will cover from OVLC soon. But, of all this fabulous content I would like to remark 2 brilliant sessions, one at the very beginning (say, alfa session) and the other at the very end (Omega session) of the ECCMID:
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Alfa session (EW005) Implementing infection control and antimicrobial stewardship interventions in your hospital (2h session)
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Omega session (SY195) – How medical overuse drives healthcare costs and antimicrobial resistance
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As said, both sessions, that were brilliant, pointed in the same direction: One Stewardship, as a denomination for the needed, synergistic cooperation between infection control (IC) and antimicrobial stewardship (AS). Even further, stewardship was presented by Daniel Morgan as the key strategy to improve the implementation of the “choosing wisely” initiatives.
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To a significant extent, both activities have a lot of behavioral science under their hood and, thus, many believe that IC and AS, need to work jointly and share tools and experiences. Nevertheless, it should not be forgotten that the type of ‘technical’ expertise needed in both activities is quite different. The ‘quality of care / patient safety’ context of these two activities is important but always in the setting of a technical expertise, that in the case of AS needs a strong clinical background.
  • How do you think that IC and AS should cooperate in hospitals?
Categories: Debates, Events

1 Comment

  • Bojana Beović says:

    Great summary of the impressions that are shared, I am sure, by many of us just back from ECCMID! Thank you, Jose!

    Let me add some more thoughts…
    Antimicrobial stewardship is becoming a rising star at ESCMID and ECCMID. It reflects higher interest of researchers in the field and higher numbers of publications, but above all the increase of the awareness of the problem of antimicrobial resistance, and, unfortunately, the frightening increase of antimicrobial resistance itself. The excellent ECCMID 2017 presentations by Dilip Nathwani, Céline Pulcini, José Ramón Paño Pardo, Guillaume Béraud, and some others summarized nicely the results of recent research and efforts in antimicrobial stewardship. Antimicrobial stewardship has become an established evidence-based activity aimed to improve the quality of antimicrobial treatment and patients’ safety, and a pillar in the combat against antimicrobial resistance. We are more and more aware that antimicrobial stewardship is not an add-on workload, but a professional medical activity requiring specific knowledge and skills. The awareness is slowly spreading not only among the professional community but spills over to the health-care administrators. So far, so good!
    But…
    Attending several ECCMID sessions on antimicrobial stewardship and some others I am not really sure if we are all aware of the main goal of antimicrobial stewardship, that is, to my understanding, best described as “sustainable use” of antimicrobials, especially (at the moment) antibacterials. It is great that we discuss the evidence behind the interventions and the behaviour and team based strategies. But above all, as antibiotic prescribers, we need the knowledge on how to use the antibiotics, which is their spectrum and how to balance the safety risks with the resistance selection pressure. We need to use antibiotics very precisely, every dose, every prescription counts. Instead of the precisions, several ECCMID presentations brought about confusing information for the prescribers attending the sessions. Cefazolin was mentioned as the most appropriate drug for the staphylococcal infections, there was no mentioning of aminoglycosides for the treatment of urinary tract infections, streptococcal bacteremia was reported to be treated with third generation cephalosporin for the full course, a patient with intra-abdominal infection received tigecycline, meropenem, metronidazole, and vancomycin for several at the same time for the definitive treatment with no information on the isolates or any resistance risk…
    If we are not precise and responsible with every antibiotic dose within IC/CM community such as ESCMID and ECCMID, how can we expect better prescribing in the majority of prescribers, general practitioners, surgeons, cardiologist..? Do we really care?

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