Escmid News 3 3008 Final.Pdf

3 /2008 ESCMID SOCIETY ESCMID Web Relaunch in NEWS November 2008 page 4 PROFESSIONAL AFFAIRS Report and Photo Gallery: The ESCMID Professional Affairs Workshop page 15

Survey of Clinical Microbiology and Infectious Diseases in Europe – ESCMID Opens Country- specific Websites page 20

Tasks and Possible Beneﬁ ts of a Closer Liaison. Between CMs and IDs Specialists: Sharing Responsibilities. Starting ID Day Prompt Diagnosis Resistance Protection from from the CM Lab! (CM) Surveillance (CM) Antimicrobial Resistance (CM+ID)

Reduction of Antibiotic Policies Appropriateness of Application of Antimicrobial (ID+CM) Antimicrobial PK/PD (ID) Resistance therapy (ID) (CM+ID)

Surgical Hospital Hospital Infection Written guidelines Prophylaxis (ID) Epidemiology Control (CM+ID) for diagnosis and (CM+ID) therapy of Infections Diseases (ID+CM) In this Issue Table of Contents

Society Science and Education 3 Editorial 26 Reports on Training in a Foreign Institution: 4 Vote Now and Elect Your Representatives! – Role of Lipooligosaccharide Locus Classes 4 ESCMID Web Relaunch in November 2008 in Diversity and Invasion Potential of 5 From the Executive Campylobacter Jejuni 6 Messages from the CMI Editors – A Quest for Antibiotic Treatment 8 Joint ESCMID and FEMS Research Alternatives for Cholera in an Era of Fellowships Challenging Antimicrobial Resistance 9 ESCMID Scholarships 2008 – Rotavirus Surveillance in Bulgaria – Present State and Future Directions Professional Affairs 32 Course Review: 7th ESCMID Summer 15 Report and Photo Gallery: The ESCMID School 2008 Professional Affairs Workshop Erratum 20 Survey of Clinical Microbiology and Infectious Diseases in Europe – ESCMID Calendar Opens Country-speciﬁ c Websites 34 Forthcoming Events 24 ESCMID Observerships and Collaborative Centres 25 UEMS: The First Meeting of the Section of Medical Microbiology

ESCMID News Copyright for articles accepted in the next month‘s issue. Printer Ex offi cio member Newsletter of the European for publication is shared Hofmann Druck P Cologna, Managing Director, Society of Clinical Microbiology between ESCMID and the Distribution and Emmendingen, DE Basel, CH and Infectious Diseases author(s). circulation number ESCMID News is sent via post ESCMID Ad hoc members Editors and editorial offi ce Editorial statement to all ESCMID members and Executive Committee F Baquero, 18th ECCMID Giuseppe Cornaglia, Despite careful editing and is distributed at international G Cornaglia, President, Verona, IT President, Madrid, ES ESCMID President, responsible setting, ESCMID, the editors conferences for information SR Norrby, Past President, P Huovinen, 19th ECCMID for content; and Hofmann Druck cannot about ESCMID‘s activities. Stockholm, SE President, Turku, FI Peter Cologna, ESCMID be liable for any errors or Circulation number: 5’000 M Akova, Education Offi cer, G Schmid, Editor CMI Managing Director; inaccuracies in this publication. Ankara, TR Supplements, Geneva, CH Dianne White, Publications; Opinions expressed are those Change of address J Garau, President-elect and D Raoult, CMI Editor-in-Chief, Editorial Offi ce: of the contributing authors. Notice of change of address Secretary General, Barcelona, ES Marseille, FR ESCMID Executive Offi ce, can be given via the ESCMID G Kahlmeter, Professional Affairs PO Box, 4002 Basel, Number of website or can be sent to Offi cer, Clinical Microbiology, Copyright © European Society Switzerland, [email protected] issues and editorial deadlines Birgit Menzemer, ESCMID Vaxjo, SE of Clinical Microbiology and ESCMID News appears Membership Offi ce, E Nagy, Treasurer, Szeged, HU Infectious Diseases 2008. All Manuscripts and copyright three times per year in April, PO Box 1131, 82018 R Read, Professional Affairs rights reserved. Non- The editorial team welcomes September and December. Taufkirchen, Germany, Offi cer, Infectious Diseases, commercial reproduction your manuscripts, Manuscripts must arrive at the [email protected]. Sheffi eld, UK authorized, subject to graphics and photographs Editorial Offi ce (preferably J Vila, Scientifi c Affairs Offi cer, acknowledgment of source. for publication, especially by email) by the 15th of the Design Barcelona, ES from ESCMID Study Groups, previous month if they are Flux Design Studios, A Voss, ECCMID Programme collaborators and third parties. to be considered for publication Basel, CH Director, Nijmegen, NL Professional Affairs Editorial

vey of the profi le of professional activity, accredi- tation and training in ID and CM in European na- tions is now completed. Many thanks go to the Professional Affairs Subcommittee for their help in its design and testing. The survey will greatly aid professional mobility and exchange throughout Europe and help ESCMID lobby our political mas- ters on behalf of all the membership. More detailed information about this initiative can be found on page 20. Clinical practice guidelines are an important contribution of any large clinical society such as ours, and over the past 2 years we have accelerated our involvement in this area with investment in several major initiatives (see Table). Again, the Professional Affairs Subcommittee has provided valuable advice to us, resulting directly in the re- Robert Read, Professional Affairs Offi cer cent commissioning of European guidelines on for Infectious Diseases (ID) and sore throat. Gunnar Kahlmeter, Professional Affairs Offi cer Finally, ESCMID hosted an important Profes- for Clinical Microbiology (CM) sional Affairs Workshop in Rome from 9–10 Octo- ber. A large number of presentations on the theme This issue of ESCMID News is strongly devoted to “Working together over borders” (national borders, Professional Affairs. The past year has seen borders between specialties, professions, organiza- ESCMID dramatically increase its involvement in tions, etc.) were given and discussed by the 140 this area of activity. The two of us have greatly en- delegates from all over Europe, including many joyed this partnership spurred on by the more than trainees in both disciplines. Discussion was lively gentle prodding of the President, Giuseppe Corna- and wide ranging (see details by Winfried Kern on glia. page 15). Proceedings of this meeting will be pub- One year ago we were pleased to co-chair the lished in Clinical Microbiology and Infection in fi rst meeting of the ESCMID Professional Affairs 2009, and we certainly are looking forward to the Subcommittee (for members see page 16), a multi- next PA Workshop. national group of infectious disease physicians and clinical microbiologists which also includes the Medical guideline developments chairmen of the UEMS Section for Infectious Dis- – International Guidelines for Management of eases (Mike McKendrick, UK) and the recently ap- Severe Sepsis and septic Shock (in coopera- proved UEMS Section for Medical Microbiology tion with the Surving Sepsis Campaign, pub- (John Degener, NL). From the fi rst meeting of this lished in Crit. Care Med. 2008; 36:296–327) group sprang the ideas that developed into the – Guidelines on the diagnosis and management ESCMID Collaborative Centres and the ESCMID of Clostridium diffi cile-associated disease Observerships (described in detail on page 24). It (ESCMID guidelines, ongoing, led by Ed is our hope that many infectious disease units and Kuijpers, Leiden, NL) clinical microbiology laboratories as well as cen- – Lower Respiratory Tract Infection (ongoing, tres of research will put themselves forward as in cooperation with ERS) ESCMID Collaborating Centres. In this way the – Endocarditis (ongoing, in cooperation with Observerships should get off to a fl ying start in the ECS) New Year. – Catheter-related Urinary Tract Infection (on- The creation and updating of an accurate alma- going, in cooperation with IDSA) nac of the profi le of Infectious Diseases and Clini- – Urinary Tract Infection (ongoing, in cooper- cal Microbiology is an important goal for ation with IDSA) ESCMID. We are pleased to announce that the sur- – Sore throat, led by Pentti Huovinen

ESCMID NEWS 02/2008 SOCIETY 3 Vote Now and Elect Your Representatives!

Dear ESCMID member, The election platform is now open to all members in good standing (1 full year of paid membership). For some of our colleagues in the Executive Com- Please use this opportunity to cast your vote for mittee, their terms will expire in May 2009. Rag- your colleagues, so we can ensure that your spe- nar Norrby will retire from his function as Past cialty is well represented for the next term of 4 President, while Gunnar Kahlmeter’s and Robert years. Read’s 1st terms as Professional Affairs Ofﬁ cers Please go to www.escmid.org/election, log on end, but they are running for re-election. with your member ID and password and cast your For the term starting next May, we have three vote by 22 December. openings in the Committee: one in Clinical Micro- Best regards, biology and two in Infectious Diseases. We are pleased to report that seven excellent candidates have been nominated in the respective ﬁ elds:

Clinical Microbiology Infectious Diseases – Barry Cookson – Pierre Dellamonica – Gunnar Kahlmeter – Matthew Falagas – Johan Mouton – Winfried Kern Javier Garau, – Robert Read President-elect and Secretary General

ESCMID Web Relaunch in November 2008

One and a half years ago we gave the ESCMID Searching is improved, especially in the Dates & website a new “look” to match the new ESCMID Events section. Here you can generate lists of corporate design and logo. This was announced as events with speciﬁ c search criteria. a transitional stage that now leads to a relaunch with major aesthetic and functional improvements. Society The new website has a better structure, is easier to For administering the Society there are “behind the navigate through and has additional features. Be- scenes” features that will enable us to better serve low are a few explanations of how it will better members and users, especially in the areas of Mem- meet your needs. bership and Grants & Fellowships, Awards.

Information Additional services We want you to fi nd what you are looking for more New on the web are features called Collaborative quickly. The new website features shorter more Centres and CM & ID Survey, more information concise texts, which are more conducive to screen about this can be found in the articles on pages 20 reading. Images and icons help you rapidly identi- to 24. Our Training & Career Centre has also been fy types of information, such as whether you can improved to give more user fl exibility. Over the download a fi le or are transferred to another page. coming months we will be adding more features to In addition, from a specifi c page other documents the website. of possible interest are displayed in the right col- umn for you to quickly access.

Navigation Navigation is now easier. Quick links to frequently Giuseppe Cornaglia, visited pages are available from every page. ESCMID President

4 ESCMID NEWS 03/2008 SOCIETY From the Executive

Dear ESCMID Members, crease, and we will keep you updated on new membership benefi ts. Some of you may have read in the ESCMID News Website: Our newly designed website is now up or Online News that I am ESCMID’s new Manag- and running. A more attractive and user- ing Director. Peter Schoch, who has been instru- friendly “look & feel” will take you where you mental in leading the Executive Offi ce and our op- want to go. erations for 9 years, has handed me the helm. He will be starting other business pursuits. I thank him Professional Affairs for his valuable contributions to the Society and For an overview of activities in Professional Af- for the smooth transition. We all wish him the best fairs, please see the editorial to this issue. for his new endeavours. It is a great honour for me to serve this prestig- Scientifi c Affairs ious organization. Having been employed in the In October, a joint conference between ESCMID medical fi eld in both private and non-profi t sectors and FEMS was held in Villars-sur-Ollon on for the last 13 years is very advantageous to my Clostridia. Numerous participants enjoyed excel- rapid integration. Yet, the fi elds of Microbiology lent presentations and the “Villars series” again and Infectious Diseases are certainly also unique. I proved to be successful. am highly motivated and curious to learn more about your specialties and to discover as many fac- Education ets as possible. Once most of Europe returned from summer holi- We are pleased to present the various pro- days, our educational offerings encompassed grammes and activities that have been organized a number of highly interesting events: The 7th since our last communication to the membership. ESCMID Summer School was organized in Re- gensburg, Germany, in the United Kingdom the General and Managerial Issues 3rd GRACE Workshop took place in Cambridge, Executive Committee: By the time you receive this and we were able to set up the 5th GRACE Post- issue, the electronic election platform will have graduate Course in Berlin. Interactive events al- been opened. We kindly ask you to take a close lowed for good discussion between faculty and look at the nominated candidates and to cast your participants, who were able to benefi t from numer- vote to appropriately represent your specialty in ous take home messages that can be implemented the Executive Committee. Do not forget the candi- in clinic and laboratory daily practice. dates from other specialties. Please use this oppor- As you may have noticed, ESCMID offers a tunity to take advantage of your membership wide array of programmes, most of them to the rights. non-member specialist, but many exclusively to Programme 2009: The planning for 2009 has the benefi t of our members. Our committee mem- been initiated a while ago, more details have been bers and staff at the Executive Offi ce are eager to worked out recently in the budgeting process. On a provide you with the best programmes and servic- more operational level, we are working with the es, leading to an improvement of patient care, lab- local organizers of the respective Postgraduate Ed- oratory procedures and prevention. We are an or- ucation Courses and Workshops. Preparations ganization for our members that also needs its for the 19th ECCMID in Helsinki in May 2009 are members to contribute as organizers, speakers, on schedule. You will appreciate an exceptional moderators or participants in all our offerings. To- programme! gether we can advance our Society. My team and I Membership: While our membership base has are looking forward to our collaboration in the grown over the years, we are still working on at- spirit of advancing ESCMID and all its affi liated tracting new colleagues and most importantly, re- specialists. taining them over the years. Our offerings will in- Yours truly,

Peter A. Cologna ESCMID Managing Director

ESCMID NEWS 03/20002/2008 SOCIETY 5 Messages from the CMI Editors

Editor-in-Chief Supplements Editor

Stepping into the role of fourth Editor-in-chief of Every new editor must try different things. Read- CMI, I look forward to the challenge of assuming ers are familiar with sponsored Supplements, usu- responsibility for the journal at this point where it ally representing the proceedings of symposia, and has an established place among specialty journals with Supplements featuring recent guidelines and in the fi eld. Challenge greatly interests me, and my recommendations from ESCMID Study Groups objective is to help the journal continue in the di- and the ECDC. These will continue. rection established by the three preceeding editors- New plans for Supplements will emphasize top- in-chief. ics of epidemiologic and clinical relevance in the My own idea of a good journal is one that I fi elds of microbiology and infectious diseases, ei- would be pleased to publish in. Beyond that, I be- ther as Supplements themselves or as articles em- lieve creating a good journal consists of recruiting bedded within Supplements. Focusing on practi- the best papers from our fi eld, including reviews cality and skills, we would like to make each one from eminent specialists. These reviews will be the relevant in some way to every reader. basis of thematic monthly issues, each of which And we would like to hear from you, to know will be coordinated by a guest editor. what you are interested in reading about and what Authors may look forward to online publication you may wish to sponsor. Please contact the edito- upon acceptance and colour fi gures online without rial offi ce with your suggestion of a topic or your charge, as well as fast-track publication of prelimi- proposal of sponsorship [[email protected]]. nary results or results that warrant immediate dif- We look forward to hearing from you. fusion. We look forward to receiving your submissions.

Didier Raoult, George Schmid, Marseille, France Geneva, Switzerland

6 ESCMID NEWS 03/2008 SOCIETY Announcements Concerning CMI Judith Crane, CMI Managing Editor

Length restrictions for submissions January In order to publish more original research papers, The medical importance of chalmydiae the word limit for articles has been signifi cantly re- Guest Editor: Gilbert Greub duced to: – 2’500 words for original articles February – 1’000 words for research notes. Concensus concerning MRSA Guest Editor: Javier Garau Colour fi gures online As of January 2009, all fi gures that have been sub- March mitted in colour will be published in black/white in Emerging borrelioses hard copy but online in colour, without charge to Guest Editor: Sally Jane Cutler the author, and will be available for download without charge to subscribers. April Authors: please include high resolution colour Infections due to MDR Gram-positives fi gures, as appropriate, at the time of submission. Guest Editor: Giuseppe Cornaglia Subscribers: please be aware that all fi gures published in CMI are available for downloading, May without charge, for use in academic lectures or Treatment for sepsis other than antibiotics presentations. Guest Editor: Mical Paul

Monthly theme sections June The January 2009 issue of CMI will be the ﬁ rst to Is Europe prepared for highly infectious include a section devoted to a particular theme. diseases? The remaining content of the issue will comprise Guest Editor: Philippe Brouqui original research as submitted, not necessarily related to the theme. July Diagnosis and monitoring of fungal infections Guest Editor: Maiken Cavling Arundrup

August Emerging virus diseases and climate change Guest Editor: Ernest Gould

September Frontiers in Helicobacter pylori research Guest Editor: Francis Megraud

October Infectious causes of cancer Guest Editor: Georgios Pappas

November Emerging non-tuberculous mycobacteria Guest Editor: Michel Drancourt

December Hard to swallow emerging and re-emerging issues in food-borne infection Guest Editor: Panayotis Tassios

ESCMID NEWS 03/2008 SOCIETY 7 Joint ESCMID and FEMS Research Fellowships

ESCMID and FEMS offer a joint award to foster outstanding research in microbiology by young European scientists. Every year each organization selects one individual among their recipients of research fellowships to receive an additional amount of EUR 1’000 from the other organization. We are delighted to announce that the ﬁ fth combined FEMS / ESCMID fellow is Filip Ruzicka, Brno, Czech Republic and the ESCMID / FEMS fellow is Frank Breinig, Saarbrücken, Germany.

FEMS / ESCMID Research ESCMID / FEMS Research Fellow 2008 Fellow 2008

Filip Ruzicka, Department of Microbiology, Frank Breinig, Department of Applied Molecular Faculty of Medicine, Masaryk University, Brno, Biology, Saarland University, Saarbrücken, Czech Republic Germany Research project: Inﬂ uence of culture Research project: Recombinant yeast as novel conditions on bioﬁ lm formation of bloodstream mucosal live vaccine Candida isolates

8 ESCMID NEWS 03/2008 SOCIETY ESCMID Scholarships 2008

The individuals listed below were awarded an ESCMID attendance grant in 2008 for one of the below events

18th ECCMID (travel grants and/or free registration) Karageorgopoulos, Drosos (Athens, Greece) Agarwal, Vishnu (Roorkee, Uttarakhand, India) Karahan, Z. Ceren (Ankara, Turkey) Aguiar, Sandra (Lisbon, Portugal) Khanna, Priya (London, UK) Al Hamad, Arif (Manchester, UK) Kim, Dong-Min (Gwang-Ju, Korea) Al Naiem, Nashwan Krizova, Lenka (Prague, Czech Republic) (Amsterdam, The Netherlands) Kronenberg, Andreas (Berne, Switzerland) Al-Akeel, Raid (Manchester, UK) Lang, Kevin (St. Paul, MN, USA) Alexiou, Evangelos G. (Athens, Greece) Laverde, Jenny A. (Werningerode, Germany) Almeida, Filipe (Oeiras, Portugal) López Martínez, María (Logrono, Spain) Antikainen, Jenni (Helsinki, Finland) Lozhkina, Olga (St. Petersburg, Russia) Antunes, Patricia (Porto, Portugal) Machado, Elisabete (Porto, Portugal) Arends, Joop E. (Utrecht, The Netherlands) Martinez Serrano, Maria (Valencia, Spain) Borisov, Vitaly (Moscow, Russia) Martins, Elisabete (Lisbon, Portugal) Bruns, Anke (Utrecht, The Netherlands) Martins, Margarida (Braga, Portugal) Carriço, João André (Lisbon, Portugal) Martins, Marta Sofi a (Lisbon, Portugal) Cateau, Estelle (Poitiers, France) Matrat, Stéphanie (Paris, France) Chang, Li-Yen (Selangor, Malaysia) Matthaiou, Dimitrios K. (Athens, Greece) Chatzimoschou, Athanasios Melin, Sara (Jönköping, Sweden) (Thessaloniki, Greece) Mendonca, Nuno (Lisbon, Portugal) Cirkovic, Ivana (Belgrade, Serbia) Metan, Gokhan (Kayseri, Turkey) Costa, Silvia (Porto, Portugal) Mitt, Piret (Tartu, Estonia) Cullen, Mairi (Manchester, UK) Mohajerani, Nazanin (Tehran, Iran) Dahl Christensen, Louise (Lyngby, Denmark) Morelli, Patrizia (Genova, Italy) Damborg, Peter Panduro (Copenhagen, Denmark) Morozova, Oxana (Nizhniy Novgorod, Russia) D‘Andrea, Marco Maria (Siena, Italy) Motakefi , Alma (Växjo, Sweden) de Regt, Marieke (Utrecht, The Netherlands) Neghina, Raul (Timisoara, Romania) Deurenberg, Ruud H. Noguera, Antoni (Barcelona, Spain) (Maastricht, The Netherlands) Nosareva, Olesya (Koltsovo, Russia) Doi, Yohei (Pittsburgh, PA, USA) Novais, Angela (Madrid, Spain) Dukers, Nicole (Geleen, The Netherlands) O‘Sullivan, Matthew (Wentworthville, Australia) Evans, Ben (Edinburgh, UK) Petrov, Maxim (Novosibirsk, Russia) Evans, Joanna (Cape Town, South Africa) Pires, Renato (Lisbon, Portugal) Faria, Nuno (Oeiras, Portugal) Plamondon, Mireille (Sherbrooke, Canada) Felix, David (Lisbon, Portugal) Quinteira, Sandra (Porto, Portugal) Figueiredo, Samy (Le Kremlin Bicêtre, France) Rak, Svetlana V. (Koltsovo, Russia) Freitas, Ana (Porto, Portugal) Reuter, Gábor (Pécs, Hungary) Friaes, Ana (Lisbon, Portugal) Rezaei, Nima (Tehran, Iran) Gabrielli, Simona (Rome, Italy) Ribes, Sandra (Göttingen, Germany) Garcia, Cabrera, Emilio (Seville, Spain) Ripoll Gonzalez, Aida (Madrid, Spain) Genesca, Txell (Davis, CA, USA) Rivera Olivero, Ismar A. (Caracas, Venezuela) Gobin, Ivana (Rijeka, Croatia) Rodrigues Pinto, Francisco (Lisbon, Portugal) Gonzalo, Ximena (Buenos Aires, Argentina) Rodríguez Dominguez, Mario José Gupta, Nishith (Berlin, Germany) (Madrid, Spain) Haghighi, Mohammad Ali (Tehran, Iran) Rodriguez-Morales, Alfonso J. Hancock, Viktoria (Lyngby, Denmark) (Caracas, Venezuela) Heikens, Esther (Utrecht, The Netherlands) Sáenz Domínguez, María Yolanda Howard, Julia (London, UK) (Logrono, Spain) Hui, Charles (Ottawa, ON, Canada) Saleem, Mehvish (Bangalore, India) Ivanov, Ivan N. (Sofi a, Bulgaria) Schaible, Bettina (Dublin, Ireland) Jones, Gwennan (Telford, UK) Shaikh, Farha (Leicester, UK)

ESCMID NEWS 03/2008 SOCIETY 9 Sleator, Roy (Cork, Ireland) Blanco, Juan Pablo (Distrito Federal, Mexico) Smeesters, Pierre (Gosselies, Belgium) Blaser, Cornelia (Berne, Switzerland) Soeltan-Kaersenhout, Debby Bottai, Daria (Pisa, Italy) (Amsterdam, The Netherlands) Braoudaki, Maria (Athens, Greece) Spreer, Annette (Göttingen, Germany) Brugnaro, Pierluigi (Mestre, Italy) Steininger, Christoph (Vienna, Austria) Bubonja, Marina (Rijeka, Croatia) Stoeva, Temenuga (Varna, Bulgaria) Cabello, Angela (Chile) Tam, Vincent H. (Houston, TX, USA) Calbo, Esther (Terrassa, Spain) Tato Diez, Marta (Madrid, Spain) Campo Esquisabel, Ana Belen (Santander, Spain) ter Waarbeek, Henriëtte Canny, Geraldine (Lausanne, Switzerland) (Geleen, The Netherlands) Cano, Maria (Santander, Spain) Theocharidou, Dionysia (Thessaloniki, Greece) Carnalla, Ma. Noemi (Cuernavaca, Mexico) Türetgen, Irfan (Istanbul, Turkey) Carriço, Joao (Lisbon, Portugal) Valverde de Francisco, Aranzazu (Madrid, Spain) Carter, Melissa (Leicester, UK) van Gennip, Maria (Lyngby, Denmark) Castellanos, Ma. Del Carmen van Mansfeld, Rosa (Utrecht, The Netherlands) (Distrito Federal, Mexico) Vryonis, Evangelos (Athens, Greece) Castro, Natividad (Chilpancingo, Mexico) Wagner, Karen (London, UK) Chai, Louis (Singapore, Singapore) Wassenberg, Marjan (Utrecht, The Netherlands) Chmielarczyk, Agnieszka (Krakow, Poland) Wellinghausen, Nele (Ulm, Germany) Cirkovic, Ivana (Belgrade, Serbia) Wittwer, Matthias (Berne, Switzerland) Conceição, Teresa (Oeiras, Portugal) Yang, Jennifer (London, UK) Cordova, Ma. Guadalupe Yilmaz, Mesut (Istanbul, Turkey) (Distrito Federal, Mexico) Zinyowera, Sekesai (Harare, Zimbabwe) Cortéz, Dzoara Aracne (Distrito Federal, Mexico) Zong, Zhiyong (Westmead, Australia) Cortoos, Pieter-Jan (Leuven, Belgium) Cruz, Edgar (Distrito Federal, Mexico) Postgraduate Education Courses, ESCMID Summer Cuny, Christiane (Wernigerode, Germany) School and conferences organized or co-organized Daurel, Claire (Caen, France) by ESCMID De Aquino, Areli (Puebla, Mexico) Abadía, Lorena (Sucre, Venezuela) de la Cabada, Javier (Guadalajara, Mexico) Adame, César (Aguascalientes, Mexico) Dias Alves, Anna Sofi a (Evora, Portugal) Aguilar, Ernesto Mario (Puebla, Mexico) Diliz, Verónica (San Luis Potosí, Mexico) Aires de Sousa, Marta (Lisbon, Portugal) Dobay, Orsolya (Budapest, Hungary) Al-Haroni, Mohammed (Bergen, Norway) Echenique Rivera, Hebert (Argentina) Alonso, Karla Raquel (San Luis Potosi, Mexico) Eklund, Asa (Uppsala, Sweden) Altunsoy, Adalet (Ankara, Turkey) Engelmann, Ilka (Hannover, Germany) Alvizouri, Ana María (Morelia, Mexico) Escalona, Gerardo (Tecamac, Mexico) Ampe, Els (Leuven, Belgium) Espinoza, Ma. Del Rosario Araujo, Javier (Distrito Federal, Mexico) (Distrito Federal, Mexico) Arias, Susana Leticia (Distrito Federal, Mexico) Fadare, Joseph Olusesan (Kano, Nigeria) Arroyo, Sara (Distrito Federal, Mexico) Fadee-Shohada, Mina (Leicester, UK) Arzate, Elvia (Distrito Federal, Mexico) Farfán, René (Distrito Federal, Mexico) Arzate, Patricia (Distrito Federal, Mexico) Fazio, Cecilia (Rome, Italy) Astobiza Perez, Janire (Biskaia, Spain) Fernandes, Isabelle (Nice, France) Avila, José Juan (Distrito Federal, Mexico) Fernandes, Victor (Leicester, UK) Avolio, Manuela (Pordenone, Italy) Fernández, Mónica (Distrito Federal, Mexico) Babayeva, Zemfi ra (Ludwigshafen, Germany) Flores, Angélica (Distrito Federal, Mexico) Bachvarova, Assya (Sofi a, Bulgaria) Flores-Ramires, Gabriela (Bratislava, Slovakia) Bahar, Gul (Ankara, Turkey) Garza, Ulises (Cuernavaca, Mexico) Barreto, Helena (Utrecht, The Netherlands) Genova, Petia (Sofi a, Bulgaria) Bavestrello, Luis (Santiago, Chile) Giono, Silvia (Distrito Federal, Mexico) Begdullayev, Almas (Almaty, Kazakhstan) Glenn, Sarah (Leicester, UK) Benhafi a, Houda (Tunis-Belvédère, Tunesia) Golkocheva-Markova, Elica (Sofi a, Bulgaria) Bermejo, Karina (Distrito Federal, Mexico) Gomes Faria, Nuno Alexandre (Oeiras, Portugal)

10 ESCMID NEWS 03/2008 SOCIETY Gómez, Georgina (San Luis Potosí, Mexico) Medic, Deana (Novi Sad, Serbia) Gonzalez, Rosa (Distrito Federal, Mexico) Medina, Rosa Elvia (San Luis Potosí, Mexico) González, Julia Lorena (Guadalajara, Mexico) Melin, Sara (Jönköping, Sweden) González, Ma. Inés (Distrito Federal, Mexico) Méndez, Socorro (Distrito Federal, Mexico) González, Ruth Ana María (Puebla, Mexico) Mendoza, Sandra (Distrito Federal, Mexico) Gordillo, Ma. Guadalupe Mesic, Anita (Sarajevo, Bosnia and Herzegovina) (Distrito Federal, Mexico) Michos, Athanasios (Athens, Greece) Gorza, Margherita (Verona, Italy) Mimica-Matanovic, Suzana (Osijek, Croatia) Gosiewski, Tomasz (Krakow, Poland) Miragaia, Maria (Oeiras, Portugal) Gozalo Margüello, Mónica (Santander, Spain) Moeck, Greg (St. Laurent, QC, Canada) Gracner, Maja (Ljubljana, Slovenia) Mohsin, Jalila (Oman, Sultanate of Oman) Gurol, Yesim (Yeditepe, Turkey) Molzen, Tanja E. (Copenhagen, Denmark) Guzvinec, Marija (Zagreb, Croatia) Moncada, David (Distrito Federal, Mexico) Hadi, Usman (Surabaya, Indonesia) Montefusco Pereira, Carlos (Manaus, Brazil) Hadzic, Amir (Sarajevo, Bosnia and Herzegovina) Monter, Bertha Victoria (San Luis Potosí, Mexico) Hernández, Ana María (Distrito Federal, Mexico) Montesinos Hernandez, Isabel (La Laguna, Spain) Hernández, Irma (Distrito Federal, Mexico) Moreno, Ma. Asunción (Distrito Federal, Mexico) Hoffman Abruquah, Harry (Nottingham, UK) Natera, Eva (Distrito Federal, Mexico) Hosni, Taha (Perugia, Italy) Neghina, Raul (Timisoara, Romania) Husada, Dominicus (Surabaya, Indonesia) Neou, Evangelia (Larissa, Greece) Ikonomidis, Alexandros (Larissa, Greece) Ntokou, Eleni (Larissa, Greece) Ikryannikova, Larissa (Moscow, Russia) Nunes, Alexandra Isabel (Lisbon, Portugal) Iosiﬁ des, Elias (Thessaloniki, Greece) Ochoa, Luz Edith (Perote, Mexico) Jensen, Ulrich Stab (Copenhagen, Denmark) Ochoa, Sara Ariadna (Distrito Federal, Mexico) Jilich, David (Prague, Czech Republic) Olivares, Alma Lidia (Distrito Federal, Mexico) Jiménez, Guillermo (Distrito Federal, Mexico) O‘Sullivan, Matthew (Sydney, Australia) Juda, Marek (Lublin, Poland) Palkovicova, Katarina (Bratislava, Slovakia) Juricic, Danica (Zagreb, Croatia ) Pappné Abrok, Marianna (Szeged, Hungary) Kabanov, Dmitry (Pushchino, Russia) Pedromingo Kus, Miguel Sebastian Kalinic Grgorinic, Hana (Pula, Croatia ) (Madrid, Spain) Kalkanci, Ayse (Ankara, Turkey) Petkovsek, Ziva (Ljubljana, Slovenia) Karapavlidou, Paraskevi (Kastoria, Greece) Pimenta Rodrigues, Marcus Vinicius Katsibardi, Katerina (Athens, Greece) (Botucatu, Sao Paulo, Brazil) Kelic, Ivana (Belgrade, Serbia) Pinho Freitas, Ana Raquel (Porto, Portugal) Keskhikar, Maryam (Shahid Beheshti, Iran) Piskun, Dzmitry V. (Vitebsk, Belarus) Kostyanev, Tomislav (Soﬁ a, Bulgaria) Plankar Srovin, Tina (Lubljana, Slovenia ) Kruse, Eva-Brigitta (Freiburg, Germany) Podsiadly, Edyta (Warsaw, Poland) Kuloglu, Figen (Edirne, Turkey) Pool, Judith (Groningen, The Netherlands) Kurolt, Ivan-Christian (Zagreb, Croatia) Popescu, Corneliu Petru (Bucharest, Romania) Kurti, Arsim (Prishtina, Kosovo) Ramírez, Francisco Javier (Tapachula, Mexico) Labrou, Maria (Giannouli Larisa, Greece) Richards, Luke (Leicester, UK) Lim, Tze Ping (Singapore) Rimoldi, Sara Giordana (Milano, Italy) Limonta, Daniel (Pedro Kouri, Cuba) Rincón, Ma. Guadalupe Lind Jørgensen, Rikke (Copenhagen, Denmark) (Distrito Federal, Mexico) Lindemans, Anouk (Rotterdam, The Netherlands) Rodríguez, Verónica (Distrito Federal, Mexico) Loewenich, Friederike (Freiburg, Germany) Rodriguez Gonzales, Maria Cruz Luque, Marco Tulio (Tegucigalpa, Honduras) (Santander, Spain) M’Ghirbi, Youmna (Tunis-Belvédère, Tunisia) Rojas, Fabián (Colima, Mexico) MacCannell, Duncan (Atlanta, GA, USA) Romanowska, Ewa (Warsaw, Poland) Maeda, Yasunori (Belfast, UK) Rosas, Graciela (Distrito Federal, Mexico) Mahfoudh Dagdoug, Souhir (La Soukra, Tunisia) Rositas, Félix (Monterrey, Mexico) Majithya, Jayesh (Manchester, UK) Roszczenko, Paula (Warsaw, Poland) Martinez, Dilia (Coro, Venezuela) Ruiz, Juan Manuel (Distrito Federal, Mexico) Martínez, Fidel (San Luis Potosí, Mexico) Salamun, Julien (Geneva, Switzerland)

ESCMID NEWS 03/2008 SOCIETY 11 Salgado, Liliana (León, Mexico) Join ESCMID Now! Sánchez, Rosario (Distrito Federal, Mexico) Opinion Poll Receive CMI every month, Sanicas, Melvin (Singapore, Singapore) enjoy discounts at the Santaella, Mónica Gabriela (Oaxaca, Mexico) Raffl e annual ECCMID, and be part Sekeyova, Zuzana (Bratislava, Slovakia) of an organization that Selderina, Solvita (Riga, Latvia) advances the fi elds of Clinical Sfar, Nadjes (Tunis-Belvedere, Tunesia) From the ESCMID Executive Offi ce Microbiology and Infectious Silpack, Biswas (Marseille, France) Diseases. If you are already Silva, Jesús (Cuernavaca, Mexico) As a thank you to the ECCMID par- a member, give the form on Sipahi, Oguz Resat (Izmir, Turkey) ticipants who took the time to fi ll out the following pages to your Smits, Nicole (Utrecht, The Netherlands) the opinion poll, we had a drawing colleagues! Solano-Gallego, Laila (London, UK) for fi ve MP3 players. The lucky win- Soriano, Diana (Distrito Federal, Mexico) ners were: Please fi ll out both sides Soto, Araceli (Cuernavaca, Mexico) – Shaila Choi (Welwny, UK) of this form, copy or detach, Staneloni, Maria Ines (Buenos Aires, Argentina) – Ana Freitas (Maia, Portugal) and send or fax to: Stoycheva, Mariana (Plovdiv, Bulgaria) – Beata Kasztelewicz Stsepetova, Jelena (Tartu, Estonia) (Warsaw, Poland) ESCMID Svendsen, Claus Bo (Copenhagen, Denmark) – Natalie Mitchell (Attikis, Greece) P.O. Box 1131 Szabo, Edina (Kaposszekcso, Hungary) – Dianelys Quiñones Pérez 82018 Taufkirchen Tavio Perez, Maria del Mar (Las Palmas, Spain) (Ciudad de La Habana, Cuba) Germany, Ten-Din, Daniel Huang (Brussels, Belgium) Fax +49-89-612 81 76. Tinoco, Perla (Cuernavaca, Mexico) Tovar, Juana (San Luis Potosí, Mexico) Tracevska, Tatjana (Riga, Latvia) Üçel, Hüseyin (Kocaeli Gebze, Turkey) Udovicic-Gagula, Dalma (Sarajevo, Bosnia and Herzegovina) Ursu, Ramona Gabriela (Iasi, Romania) Vadovic, Pavol (Bratislava, Slovakia) van Kats, Merintje (Boxmeer, The Netherlands) Vanegas, Edgar (Distrito Federal, Mexico) Velarde, Aída Jimena (San Luis Potosí, Mexico) Velázquez, Ma. Elena (Cuernavaca, Mexico) Velázquez, Norma (Distrito Federal, Mexico) Vergara, Gilbert (Milano, Italy) Verissimo, Ana Raquel (Portugal) Villalpando, Carlos Martín (Distrito Federal, Mexico) Vojtech, Boldis (Bratislava, Slovakia) Whellams, Diana (Vancouver, BC, Canada) Willemsen, Ina (Breda, The Netherlands) Woerther, Paul-Louis (Paris, France) Xochitiotzi, Sarahi (Tlaxcala, Mexico) Zemlickova, Helena (Prague, Czech Republic)

ESCMID Grants for Training in Foreign Laboratories Boelen, Ellen (Hoeselt, Belgium) Clarke, Stuart C. (Whiteley, UK) Guinea Ortega, Jesus (Madrid, Spain) Lehours, Philippe (Bordeaux, France) Nunes, Sonia (Lisbon, Portugal) Obasuyi, Osahon (Benin City, Nigeria) Robberts, Lourens (Rochester, MN, USA)

12 ESCMID NEWS 03/2008 SOCIETY ��

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�� ESCMID NEWS 03/2008 SOCIETY 13 ��

�� 14 ESCMID NEWS 03/2008 SOCIETY Report The ESCMID Professional Affairs Workshop

Winfried V Kern, Head, Division of Infectious should cover infection control and antibiotic policy Diseases, University Hospital, Freiburg, among many other areas, which are also covered Germany, [email protected] by infectious disease physicians and offer excellent perspectives for cooperation. Mike McKend- One hundred forty professionals met in Rome this rick also reviewed the more recent history of the fall to review the status of the specialities, Clinical specialty of Infectious Diseases within Europe. Microbiology and Infectious Diseases, across Eu- The UEMS Section of Infectious Diseases was es- rope and to discuss initiatives to improve the or- tablished in 1997 but until today there remain a ganizational basis for medical practice in our disci- few countries in Europe that do not recognize In- plines. A photo gallery of the third ESCMID fectious Diseases as a specialty or subspecialty. Professional Affairs Workshop held at the ISS – Is- Mike McKendrick reminded the audience that 150 tituto Superiore di Sanità can be found on pages 17 years ago general medicine was dealing primarily to 19. Over six sessions, specialists in both ﬁ elds with infections such as diphtheria, smallpox, polio, from countries throughout Europe discussed facts scarlet fever, tuberculosis, measles, whooping and ideas concerning professional development cough, chickenpox and pneumococcal pneumonia and cooperation. Giuseppe Cornaglia, Gunnar to mention only some. With the advent of vaccines Kahlmeter and Robert Read – in close consultation and antibiotics this scenario has changed funda- with the ESCMID Professional Affairs Subcom- mentally, and the clinical problems to be solved mittee (see list on next page) – invited participants nowadays are much more complex. Although new to the workshop, which started with presentations skills are required and subspecialisations have by John Degener and Mike McKendrick, the cur- evolved by necessity, key competencies and skills rent presidents of the UEMS Sections of Medical of today‘s infectious disease specialist remain gen- Microbiology and of Infectious Diseases, respec- eral medicine, clinical diagnosis, guidance and ad- tively. vice for clinical colleagues based on clinical com- In discussing the medical microbiology family petency and on a strong epidemiological tree John Degener reviewed the development of understanding of diagnosis and management. The the discipline within the UEMS from being a sub- challenge remains at the bedside. section in the so-called Medical Biopathology Sec- Working with others was the title of the second tion in earlier times to the full recognition of the session in which Jos van der Meer, Niels Frimodt- discipline in UEMS and to establishing an inde- Möller and Marc Struelens presented their views pendent Section of Medical Microbiology in April not only on professional cooperation of microbiol- 2008 (see article on page 25). He reminded us that ogists and infectious diseases physicians, but also according to UEMS, the medical microbiologist on cooperation between the infection specialists

ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS 15 and pharmacists, and within anti-infective man- future microbiology laboratory service with fo- agement teams. cused, in-depth analysis of samples including con- As there appears to be a revolution happening in fi rmatory testing, modern, automated and multi- laboratory diagnosis of infection, there is an in- plex technology, and consultation. On the other creasing danger of indiscriminate ordering of new, side, there will be an increasing demand of point- commercial, expensive tests for simple clinical of-care rapid and simple testing allowing manage- situations. We must recognize an increasing need ment decisions at bedside. Automation will lead to to involve infectious disease specialists in the thor- fewer personnel in the laboratory, miniaturization ough evaluation of new – complex and simple – di- will foster the development of point-of-care tests agnostic tests – an area very attractive for success- with “syndromic approaches” to multiple pathogen ful cooperation between microbiologists and detection. Ingrid Nilsson-Ehle and Vincent Jarlier infectious disease physicians as Jos van der Meer made in their presentations clear that currently pointed out. most so-called rapid bedside tests have major limi- An attractive model for successful cooperation tations and may be of no additional value over among the different infection specialists may be a other tests if not applied in carefully defi ned clini- system in which the medical microbiologist runs co-epidemiologic settings. Whilst attractive in the diagnostic laboratory, but is, in addition, in- terms of the potential to reduce unnecessary antibi- volved in providing bedside advice and in which otic prescribing and costs, these tests are often not she or he interacts with the infectious disease spe- reimbursed and/or not approved. The best example cialist, the infection control service and hospital of this is the GAS rapid test. pharmacists. Together these specialists would cre- How can we speed up the slow workfl ow in clin- ate what L Tompkins earlier had called “the infec- ical microbiology? Emmanuelle Cambau provided tious disease service line”, a service very much ap- a few key answers to this question: adequate auto- preciated by clinicians of various disciplines but mation and new microbial detection tools, better also the hospital administration due to its compre- availability of the service with 24 hours a day and hensiveness and professionalism. The formidable 7 days a week involvement, and more commitment challenges of infectious diseases call for optimal of technicians and other laboratory personnel – a synergy between ID physicians and clinical micro- proposal in part similar to that made by Arjana biologists. New tasks for clinical pharmacists in Tambic. Isabelle Durand-Zaleski – based on cur- such a service would be better control of costs of rently available health economic studies – was not medication, improvement of guideline adherence, convinced that automation and rapid testing has reduction in medication related errors and morbid- been proven to be cost-effective. In particular, she ity, and increasing patient safety as Niels Frimodt- presented some data indicating that point-of-care Möller suggested. This could increase the work- testing might be more expensive than conventional force for the performance of audits on the prudent laboratory testing because of high reagent and Professional Affairs Subcommittee members use of antimicrobials and their impact. quality assurance costs. Infectious Diseases Current and future models for the organization Winfried Kern reviewed the niches and skills of Robert Read, Sheffi eld, UK, of anti-infective management teams was the topic infectious disease physicians. He felt that there is Chairperson of Marc Struelens’s presentation. He reviewed the more of a need to reoccupy lost or “neglected” Matthew Falagas, Athens, Greece experience with such teams in Belgium and point- niches than to fi nd new ones. For example, chronic Åsa Hallgårde, Lund, Sweden Bruno Hoen, Besancon, FR ed out the necessity of funding to be successful. He viral hepatitis care often is integrated into gastro- Winfried V Kern, stressed the need for valid and feasible measures enterology rather than into infectious disease serv- Freiburg, Germany and quality indicators of rational use of anti-infec- ices. Similarly, patients with tuberculosis are in Mike McKendrick, Sheffi eld, UK tive medicines. Based on recent experience in co- many regions cared for by pulmonary medicine Nicola Petrosillo, Rome, Italy operative multiprofessional project groups there specialists although tuberculosis is one of the “big Jos WM van der Meer, Nijmegen, The Netherlands has been progress in the design and validation of three” and one of the “very” infectious diseases indicators usable by hospital infection teams to needing professional and comprehensive manage- Clinical Microbiology identify quality gaps and to estimate quality im- ment whatever organ involvement might individu- Gunnar Kahlmeter, Vaxjo, provement. ally prevail. Other examples were travel medicine, Sweden, Chairperson Arta Olga Balode, Riga, Latvia The subsequent workshop sessions provided in- “sepsis” medicine, prevention of healthcare-asso- Emmanuelle Cambau, sight into practical aspects of improved clinical ciated infections and infections in the immuno- Creteil, France microbiology and infectious disease services. Ar- compromised patient. He emphasized the need to John Edward Degener, jana Tambic very clearly reminded us that the lim- improve skills and competencies in the effective Groningen, The Netherlands ited resources of the future clinical microbiology quality management of clinical infectious diseases Niels Frimodt-Möller, Copenhagen, Denmark laboratory should be constantly refocused and activities. He also asked the infection specialist Waleria Hryniewicz, adapted to the needs by applying more rigid speci- workforce to take responsibility for international Warsaw, Poland men rejection criteria but ascertaining at the same health aspects as there are continuously infectious Mario Poljak, Ljubljana, Slovenia time better service availability, communication and disease emergencies not to say catastrophes in Arne Rodloff, Leipzig, Germany interpretation of laboratory results. Rapid testing parts of the world that need our skills and atten- Gian Maria Rossolini, Siena, Italy Arjana Tambic, Zagreb, Croatia and automation in clinical microbiology: Where tion. Questions regarding subspecialization in In- Alkiviadis Vatopoulos, are we today? was asked by Mario Poljak. He saw fectious Diseases and Clinical Microbiology were Athens, Greece a dual development: On one side, there will be the then followed up in the session, Organizing our-

16 ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS selves. Roberto Cauda made the case for subspecialization in HIV medicine but this point was somewhat controversial, and generated much discussion. Hilary Humphreys and Gijs Ruijs made the case for an integrated clinical microbiology service, Many bugs, one house, and discussed important pros and cons of off-site high-throughput laboratories and of highly specialized microbiology laboratories. Helen Giamarellou and Fernando Baquero provided their views on practical cooperation between Microbiology and Infectious Diseases. When de- signing a matrix of responsibilities and activities of infectious diseases and clinical microbiology departments, one sees relatively easily common versus complementary tasks. Fernando Baquero put forward the model “Microbiology and Infec- tious Diseases as autonomous (but collaborative) Services” as the best way to achieve success in basic and translational research, to recruit young tal- ented non-medical specialists in microbiology and to keep the balance between mutual autonomy and “phagocytosis”. In the last session, Getting ready for the future – increased effectiveness, Javier Garau, Ragnar Norrby, Gijs Ruijs and Mario Poljak presented perspectives for our professional environment regarding emerging infections, limited availability of anti-infective medicines, multiprofessional working relationships and pan-European integration. It was considered a priority area to enhance networks for emerging infections including clinical alertness groups in order to get prepared for the coming epi- demics but also for more effective research into the pathogenesis of severe, yet undefi ned infl ammato- ry syndromes likely to represent unidentifi ed infections. Openness to the new “species” of molecular microbiologists in the fi eld of Clinical Microbiology and Infectious Diseases was considered necessary. We also need to be receptive to learning and progress brought about by cooperation between East and West and Clinical Microbi- ology and Infectious Diseases.

ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS 17 18 ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS 19 Survey of Clinical Microbiology and Infectious Diseases in Europe – ESCMID Opens Country-speciﬁ c Websites

Robert Read, Professional Affairs Offi cer To fi nd out about the state of the two specialties Infectious Diseases, r.c.read@sheffi eld.ac.uk Clinical Microbiology (CM) and Infectious Dis- Gunnar Kahlmeter, Professional eases (ID) in European countries, ESCMID has Affairs Offi cer Clinical Microbiology, distributed questionnaires to affi liated societies in [email protected] Europe on two occasions over the past 10 years. The results thus far have been published as reports in ESCMID News and on the website. The 2008 questionnaire was conducted elec- tronically. Each affi liated society had appointed two national editors, one for CM and one for ID to fi ll in the information. The questionnaire was developed in concert with UEMS (Union Eu- ropéenne des Médecins Spécialistes) representa-

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Figure 2: Preview of Clinical Microbiology in Sweden Figure 3: Preview of Infectious Diseases in the UK

20 ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS Wording Explanation Registered medical A registered medical doctor is a professional who has been doctor trained at a medical school and has been registered to practice medicine. Qualifi ed physician A qualifi ed physician is a registered medical doctor who has un- dergone post-graduate physician training leading to accredita- tion as a clinically active specialist physician. CM-RMD (background Clinical Microbiologist – a registered medical doctor who is as registered medical specialized in a clinical (equals medical) speciality which may doctor) be named Clinical (or Medical) Microbiology, Clinical Bacteri- ology and Virology or Clinical Bacteriology or Clinical Virolo- gy. In most countries it is necessary to be a registered medical doctor and then undergo a training period of approximately 4-5 years to become a specialist in Clinical Microbiology (or the equivalent thereof). CM-NRMD (with Clinical Microbiologist – a person with a different background a different background (pharmaceutical sciences, molecular biology, others) than a reg- than that of a istered medical doctor who is specialized in a clinical/medical registered medical speciality which may be named Clinical (or Medical) Microbiol- doctor/non-registered ogy, Biopathology, Laboratory Medicine, or Polyvalent Labora- medical doctor) tory Medicine. Countries may differ in terms of the basic and postgraduate training that can lead to an individual being called a “Clinical (or Medical) Microbiologist“ (or the equivalent thereof). ID Infectious Disease physician – a qualifi ed physician who spe- cializes (or in some countries subspecializes) in the care of patients with infections, either as the dedicated physician responsible directly for case management, or as physician providing consultation services. Specialists A specialist is someone who has achieved a qualifi cation which allows him/her to be accredited to practice in a given medical speciality. Full speciality A full speciality is a fi eld of expertise recognized after a period of post-graduate training and which is legally qualifi ed and accredited nationally. Recognized A subspeciality is a defi ned fi eld of expertise within a full speci- subspeciality ality but not recognized as a speciality in its own right. Curriculum The agreed contents of a training programme. Polyvalent Laboratory The speciality of Laboratory Medicine (also called: biologie Medicine medicale), is based on training in the different fi elds: chemistry, microbiology, immunology, pathology and haematology. Poly- valent Laboratory Medicine is in some countries a fully recognized speciality. Medical Biopathology Term used to comprise all monovalent and polyvalent laboratory based medical specialities. CME Continuing Medical Education – formalized educational experience recognized as contributing to continuing professional development of a specialist. Inspection of training Peer review of training quality at undergraduate or postgraduate level. Recertifi cation Recertifi cation is a process of affi rmation of a specialist’s right to practice in their speciality. Genitourinary A full speciality or a subspeciality of Dermatology or Infectious Medicine Diseases or Obstetrics and Gynaecology, in which a qualifi ed physician treats patients with sexually related diseases.

Figure 1 Glossary

ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS 21 tives and the ESCMID Professional Affairs Sub- national societies. Each country takes responsibil- committee, then tested by many colleagues from ity for describing the two specialties and it is an- various countries. We also included a glossary to ticipated that ESCMID affi liated societies and ensure that the meaning of used terms was unam- UEMS representatives will collaborate to keep the biguous (see Figure 1, Glossary). In late summer pages updated (Figures 2 and 3). 2008, the questionnaire was opened to 70 editors Webpage functions allow ESCMID members to in 35 European countries via password-protected cross-tabulate most of the questions and answers access. of the questionnaire (Figure 4) and to export the The results of the ESCMID questionnaire are data fi le in full to a format which can easily be im- almost all in, and a web-based presentation will be ported into other programs. It is expected that the available in December. Each country has its own new tool will stimulate exchange over borders and webpages for both CM and ID. The webpages can the discussion and the development of the speciali- be regularly updated obviating the need for future ties in Europe. Until UEMS declared Medical questionnaires. Specialists in their respective fi elds Microbiology a speciality in 2008, microbiology can address those in charge of the content of the was an integrated part of Medical Biopathology. websites – to suggest changes, updates and links to The specialty is clearly moving forward!

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Figure 4. Excerpt from country table with all countries selected (preliminary data)

22 ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS ��

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ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS 23 ESCMID Observerships and Collaborative Centres

Robert Read, Professional Affairs Offi cer Infectious Diseases, non-exotica treated at a high standard are important. r.c.read@sheffi eld.ac.uk Good examples of appropriate ECCs of Clinical Microbiol- ogy include those with particular diagnostic expertise, skills and Gunnar Kahlmeter, Professional Affairs Offi cer Clinical organization. High throughput institutions; reference laborato- Microbiology, [email protected] ries; laboratories with integrated bacteriology, virology and molecular microbiology; and laboratories with an international pro- ESCMID is launching two very exciting initiatives – the fi le are invited to apply. ESCMID Observerships and ESCMID Collaborative Centres Institutions should provide two external references (name, af- (ECC). The Observerships will be funded opportunities for any fi liation, email), preferably from another country, with their ap- ESCMID member to spend one day, one week or one month at plication. an ESCMID Collaborative Centre. We view this as a critical pro- Once we have established a list of Centres we will generate a gramme for ESCMID – it will foster trans-European cooperation web-based application procedure for individuals to become and professional and academic exchange. ESCMID Observers. Any ESCMID member will be able to ap- The fi rst step in the process will take place over the following ply to visit an ECC. Applications will not be restricted to train- 3 months. We invite departments of Infectious Disease (ID) and ees as it is acknowledged that senior members can benefi t equal- Clinical Microbiology (CM) throughout Europe to apply, singly ly from the programme. On the application form, prospective or together, for status as an ESCMID Collaborative Centre. We ESCMID observers will be asked to provide details of their func- ask prospective centres to provide a description of the depart- tion within their current institution, clinical and research inter- ment, the geography, city and hospital, together with a profi le of ests and motivation for the visit. They will be asked to state with competences, staff and services and the main interests and which ECC they have an agreement concerning a visit and the achievements of the institution. Any special epidemiological visit time and length. The application will be considered by the characteristics of the country or area should be described. Insti- ESCMID Executive and if approved, ESCMID will contact the tutions can be Clinical (Medical) Microbiology, Clinical Bacte- Observer and the ECC so that they can fi nalize arrangements for riology or Virology services, Infectious Disease Units or a com- the visit. bination of these. Microbiology and infectious disease The ESCMID Executive has approved a budget that will be departments are encouraged to apply together. We hope that in- suffi cient for approximately 50 Observerships during the fi rst stitutions from many parts of Europe will apply and be rewarded year. Successful observers will be permitted to apply for costs by the prestige and profi le that it will engender. Furthermore, covering travel and some limited subsistence costs. Ultimately, ESCMID members from Collaborative Centres will be given we hope that this will become an established feature of priority when applying for Observerships in other Collaborative ESCMID’s contribution to our disciplines. Our intention is that Centres. the successful completion of an ESCMID Observership will be A Collaborative Centre must be prepared to accept at least viewed as a positive attribute in a good curriculum vitae. one ESCMID Observer per year. The length of the visit is agreed We urge prominent ESCMID members to nominate their own between the Centre and the Observer but should normally be be- Centres as ESCMID Collaborative Centres. For the initiative to tween one day and one month. Observers will be able to study get off to a fl ying start we ask those of you who are certain that service provision, operational structures, methodologies and you will be interested to sign up on our website or send an email techniques, as well as clinical practice. If the length of the visit to [email protected] with the following key informa- is more than a day, the Observer should be prepared to give a tion: talk on the organization of CM and/or ID in his country. The Observership is not primarily meant to foster research activity ESCMID Collaborative Centre but this is not excluded. Name of Centre: Good examples of appropriate ECCs for Infectious Disease Name of contact person: include those institutions where high volumes of patients with Email of contact person: specifi c diseases are seen, particularly those which might not be seen by doctors in all parts of Europe (e.g. patients with multi- The potential future benefi ts for both hosts and visitors are le- drug resistant M. tuberculosis, Hepatitis, HIV, Congo Crimean gion, and will foster international cooperation and friendship. haemorrhagic fever, Brucellosis, or tropical disorders) but also

24 ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS The First Meeting of the Section of Medical Microbiology European Union of Medical Specialists (UEMS)

Delegates of the UEMS Section of Medical Microbiology and the country they represent at the ﬁ rst meeting of the Section in Brussels on 27 September 2008

Front (l. to r., kneeling): Bernard Maillet (UEMS Secretary General) and Ozdem Ang (Turkey)

First row (l. to r.): John Degener (The Netherlands), Milena Petrovska (Macedonia), Katja Seme (Slovenia), Gottfried Mauff (Germany), Helmut Mittermayer (Austria), Daniela Marchetti (Italy)

Second row (l. to r.): Vesna Tripkovic (Croatia), Hilpi Rautelin (Finland), Ana Kaftandzieva (Macedonia), Elisabeth Nagy (Hungary), Jørgen Prag (Denmark), Stephen Barrett – on far right (UK)

Last row (l. to r.): Helle Krogh Johansen (Denmark) , Mario Poljak (Slovenia), Gijs Ruijs (The Netherlands), Mark Hastings (UK), Truls Leegaard (Norway), Reinhard Zbinden (Switzerland), Koen Magerman (Belgium)

Katja Seme, Secretary and Slovenian Delegate of the UEMS – help harmonize training and qualifi cation Section of Medical Microbiology, [email protected] – help harmonize health care services. Members of the board of the Section were elected unanimously John Degener, President and Dutch Delegate of the UEMS (see Box). Section of Medical Microbiology, [email protected] Liaisons with the UEMS Section of Medical Biopathology and the UEMS Section of Infectious Diseases were discussed In a previous article (ESCMID News 2008; issue 2: 23) John and the appointment of liaison offi cers who would maintain con- Degener reported that an independent UEMS Section of Medical tact with Sections was suggested. Microbiology has been created at the meeting of the UEMS Following the procedural items of the agenda, development Council held in Brussels on 19 April 2008. The fi rst Meeting of of a novel training programme for residents in Medical Microbi- the new Section took place in Brussels on 27 September 2008. ology in The Netherlands was presented and a Working Group Twenty-one delegates from 16 European countries attended the for the revision of the curriculum was formed. meeting (see Figure). The countries represented were: Austria, The most important future tasks of the Section are to defi ne: Belgium, Croatia, Denmark, Finland, Germany, Hungary, Italy, – a central monitoring authority for the specialty of Medical Latvia, Republic of Macedonia, The Netherlands, Norway, Slov- Microbiology at the EC enia, Switzerland, Turkey and United Kingdom, yet 14 full – general aspects of training in the specialty UEMS member countries still had no offi cial delegate within the – requirements for training institutions Section. Those present decided by consensus to contact their – requirements for teachers within the specialty and corresponding national medical associations and invite them to – requirements for trainees. nominate delegates to the UEMS Section of Medical Microbio- Next spring, the Section meeting will be held in Helsinki on the logy who could then regularly attend and participate in the work- last day of ECCMID (19 May 2009). ing meetings of the Section. Bernard Maillet, UEMS Secretary General, was instrumental in organizing the fi rst meeting of the Section. He explained the procedures regarding membership of a Section in detail and listed the major tasks of Sections, which are to: Members of the Board of the Section – propose a Core Curriculum John Degener (The Netherlands), President of the Section – draw up a log book for training Jørgen Prag (Denmark), Vice-President of the Section – write Chapter 6 of the Training Charter of the UEMS for each Katja Seme (Slovenia), Secretary of the Section Specialty Daniela Marchetti (Italy), Treasurer of the Section

ESCMID NEWS 03/2008 PROFESSIONAL AFFAIRS 25 Report on Training in a Foreign Institution Role of Lipooligosaccharide Locus Classes in Diversity and Invasion Potential of Campylobacter Jejuni

Ihab Habib, PhD student, Department of (CCs) defi ned by MLST. Of note, a majority of C. Veterinary Public Health and Food Safety, Ghent jejuni strains in CC-21, the most frequent complex University, Belgium, [email protected] in the study collection, were found to express LOS locus class C (85.7 %, 24/28). Introduction There was no signifi cant correlation between In March 2008 I received an ESCMID training fel- source of strains (human/poultry) and the level of lowship in support of my PhD research project in invasion in Caco-2 cells. Interestingly, the inva- the Department of Veterinary Public Health and sion potential of C. jejuni strains with sialylated Food Safety at Ghent University, Belgium. The LOS (n=23; classes A, B, and C) was signifi cantly training fellowship allowed me to conduct part of higher (P value= 0.002) than that of C. jejuni my research under supervision of Prof Alex Van strains with non-sialylated LOS (n=13; classes D Belkum, at the Department of Microbiology and and E). Among the panel of C. jejuni strains se- Infectious Diseases, Erasmus University Medical lected to study their invasion phenotypes, the more Centre, Rotterdam, The Netherlands. I would like invasive strains with sialylated LOS classes be- to thank ESCMID for supporting this project. longed to CC-21 (all of LOS class C strains, and 3 During the four-month training, I conducted a out of 5 strains with LOS class A) and CC-206 (in study on the correlation between Campylobacter C. jejuni strains with LOS locus class B). On the jejuni multilocus sequence types, invasion pheno- other hand, the low-invasive C. jejuni with LOS types in Caco-2 cells, and lipooligosaccharide classes D and E (non-sialylated) were grouped in (LOS) gene locus class variation. C. jejuni is the CC-354 and CC-45, respectively. most common human enteric pathogen in Europe. In addition, C. jejuni is a predominant infectious Conclusion trigger in acute post-infectious neuropathies such The present study adds to the limited knowledge as Guillain-Barré syndrome (GBS) and its variant, on LOS class diversity in C. jejuni strains isolated the Miller Fisher syndrome (MFS). Many studies from chicken meat, and the invasion potential of have now provided convincing evidence that mo- such strains, compared to strains isolated from hu- lecular mimicry between C. jejuni LOS and gan- man diarrhoeal samples. The high prevalence of gliosides in human peripheral nerve tissue plays an Campylobacter in poultry, combined with the fact important causal role in the pathogenesis of GBS/ that a substantial subset of the C. jejuni strains MFS. Moreover, there is a growing body of scien- characterized in this study possesses neuropathy- tifi c evidence that indicates a possible role of LOS associated LOS, is worrisome. Therefore, strate- in adhesion and invasion of C. jejuni. gies to control Campylobacter contamination in chicken meat might reduce morbidity due to GBS, Purpose in addition to reducing the level of Campylobacter- Using PCR screening I investigated LOS class di- related human enteric illnesses. Our results support versity in C. jejuni from Belgian chicken meat and the growing scientifi c evidence that sialylation of from human cases with diarrhoea, as well as the LOS could improve C. jejuni fi tness and infectivity impact of LOS class variation on invasion poten- potential in different reservoirs and hosts. The tial of C. jejuni in a subset of isolates. Finally we present study revealed a correlation between mul- further elaborated the epidemiological relevance tilocus sequence typing clonal complexes and cer- of C. jejuni LOS gene screening by correlating its tain LOS locus classes. This correlation needs to results with results from multilocus sequence typ- be investigated further, to determine if this under- ing. lines a biological advantage of C. jejuni to colo- nize birds and to survive better in the environ- What I accomplished ment. Results of PCR screening indicate that 87.2 % (102/117) of the C. jejuni strains characterized in this study can be assigned to 1 of the 5 LOS locus classes (A-E). 42.5 % (17/40) of C. jejuni strains from human diarrhoeal samples were found to share sequence types with strains from chicken meat. Results presented in Figure 1 show a con- cordance between C. jejuni LOS locus classes as assigned by PCR and certain clonal complexes

26 ESCMID NEWS 03/2008 SCIENCE AND EDUCATION ��

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Figure 1. Correlation between C. jejuni lipooligosaccharide (LOS) locus classes and multilocus sequence typing clonal complexes

Report on Training in a Foreign Institution A Quest for Antibiotic Treatment Alternatives for Cholera in an Era of Challen- ging Antimicrobial Resistance

Sabeena Ahmed, Research Offi cer, Clinical doxycycline) has long been the antibiotic of choice Sciences Division, International Centre for for severe cholera in Bangladesh for adults where- Diarrhoeal Disease Research, B Dhaka, as erythromycin has been used to treat young chil- Bangladesh, [email protected] dren and pregnant women (1,2). Furazolidone, erythromycin, trimethoprim-sulfamethoxazole, In Spring 2008 I spent almost 2 months in the Re- and chloramphenicol are other alternatives (3). search and Development Laboratory, AB Biodisk, Data from Bangladesh has shown emergence of in Solna, Sweden for collaborative research and multi-drug resistant (MDR) V. cholerae O1 with training in various techniques of antimicrobial sus- concomitant resistance to tetracyclines, trimetho- ceptibility testing. My work in Solna was very pro- prim-sulfamethoxazole, chloramphenicol, furazo- ductive and will help me with future testing and lidone and erythromycin (4). These MDR-strains analysing of Vibrio cholerae in my home laborato- were also characterized by progressively elevated ry. minimum inhibitory concentration (MIC) of ciprofl oxacin (5,6). Quantitative antimicrobial suscepti- Introduction bility testing of currently available as well as newer Cholera associated with V. cholerae O1 is the lead- antibiotics may help to target antimicrobial therapy ing cause of severe dehydrating diarrhoea which towards these unique MDR-strains as it will help has distinct seasonality in Bangladesh (1). Effec- in optimizing choice, dose and dosing regimens tive antimicrobial treatment of cholera reduces and improving clinical effi cacy of the antibiotics stool volume, thus reducing the volume of rehy- used, as well as delaying the emergence of resist- dration fl uid required, and shortens the duration of ance. The purpose of this study was to quantify the illness. Reduced faecal excretion of V. cholerae in vitro activity of a wide range of traditional and also minimizes transmission of the organism and non-traditional compounds against a unique col- limits potential infection (2). lection of MDR V. cholerae strains from Bangla- Tetracycline (or the longer-acting derivative, desh. We also attempted antibiotic combination

ESCMID NEWS 03/2008 SCIENCE AND EDUCATION 27 testing of arbitrary combinations although limited 1024), fourteen to GEM (0.38-1), thirteen to LZ information is available on the use of specifi c anti- (6), ten to TC (8-24), eight to CL (8-12), three to biotic combination to treat cholera caused by re- AZ (3-8) and DC (6). All were susceptible to: CI cent MDR V. cholerae strains. (0.25-0.75), MX (0.19-1.5), GA (0.125-1.5) GM (0.75-1.5), CT (<0.016), PM (0.064-0.25), IP Methods (0.75-1.5), TGC (0.047-0.094), MM (0.75- 3) and Nineteen V. cholerae O1 strains isolated from con- TMO (2-4). fi rmed cholera patients admitted to the Dhaka hos- MIC fi ngerprinting grouped 15/19 strains into 3 pital of the International Centre for Diarrhoeal phenotypes based on co-resistance to 6 antibiotics Disease Research, B in 2005 and 2008 and charac- (EM, TC, FM, TS, NA, CL), resistant to all except: terized using standard methods (7) were examined. i) CL (n=8), ii) TC (n= 6) and iii) CL, TC (n=1). MIC of 20 antibiotics (14 classes; see Box) were Resistance against traditional antibiotics is con- determined using Etest (AB BIODISK), an agar- siderably higher compared to non-traditional com- based predefi ned gradient technique that generates pounds, except for FM, and LZ. AZ and DC resist- precise MIC values across a concentration range ant isolates showed cross-resistance to EM and TC (15 dilutions). Etest results were analyzed as MIC respectively (Figure1). A bimodal distribution with fi ngerprints and according to CLSI susceptibility a distinct resistant population can be seen for EM, categories (8) except TMO (9). Four strains with AZ, CL, TC and DC. different susceptibility patterns were subjected to NA-resistant strains exhibited reduced suscepti- combination testing: CI+EM, CI+CL, CI+DC, bility against CI, although susceptible according to CI+MM, CI+TS, CI+TMO and TS+EM. CLSI breakpoints. The MIC values of newer fl uo- For MIC testing, a 0.5 McFarland Standard tur- roquinolones were similar and differed by no more bidity suspension of bacteria in 0.85% saline was than 2-2.5-fold compared to CI-MIC refl ecting streaked on Mueller-Hinton agar plates (MHA) cross resistance among quinolones. The progres- (BBL) using the rota-plater Retro C80TM (AB sive development of low level resistance to CI over BIODISK) and dried. Automatic dispenser Sim- time may be associated with the inappropriate use plex C76TM, (AB BIODISK) was used to place of ciprofl oxacin presumed to be active due to “in- Etest strips in optimal patterns. Escherichia coli correct” CI breakpoint and/or use of inadequate ATCC 25922 was used for quality control. dosages that selects for resistance. The Etest technique for combination testing was CI in combination with EM/CL/DC/MM and used where gradient imprints of different antibiot- TS combinations with CI/EM resulted in no dif- ics were superimposed in MIC to MIC ratios ference (FICI ≥ 2) for all strains. CI+ TMO inter- (11,12). For each strain, 7 MHA plates (90 mm) actions ranged from indifference with maximum were streaked with 0.5 McFarland equivalent in- FICI 1.32, to additive with FICI 1. oculum suspension. Etest CI was placed on 6 plates and Etest TS on one. The positions of the predeter- Conclusions mined MIC values for CI and TS were marked ac- Promising in vitro activity of a number of non-tra- cordingly. Plates were left for 1h for transfer of the ditional agents (GM, CT, PM, IP, TGC, TMO) was antibiotic gradient imprints to the agar after which observed. These compounds deserve further stud- the strips were removed and saved. The strip for ies as potential options for cholera management to the second agent was then vertically positioned on encounter resistant isolates and for antibiotic rota- top of the imprint of the fi rst agent such that the tion strategies. MIC positions of the two drugs were superim- To maximize clinical effi cacy of concentration- posed. The Retro C88 (vacuum pen) was used for dependent agents such as ciprofl oxacin, the current placement and removal of Etest strips. All plates MIC breakpoints may need to be reassessed, spe- were incubated at 35°C for 16-18h. cifi cally for V. cholerae as guided by pharmacoki- MICs were read according to AB BIODISK netics (PK) and pharmacodynamic (PD) targets to guidelines (10). MICs of compounds in combina- optimize doses and dosing regimens. Important tion were read by placing the saved Etest strips on considerations for cholera management include the back of the agar plate aligned in the centre of different antibiotic pharmacokinetics to be expect- the inhibition ellipse seen. MICs of individual ed due to excessive fl uid loss and replacement. The agents and in combinations were compared by the importance of defi ning therapy (choice of antibi- activity of the most active single agent to its activ- otic and dose regimens) for better clinical outcome ity in combination. Fractional Inhibitory Concen- using MIC results and PK/PD targets (such as tration indices (FICIs) were calculated as MIC-A Monte-Carlo simulations) for diarrhoeal patients (in combination)/ MIC-A alone + MIC-B (in com- should be further investigated. Although no in vitro bination)/ MIC-B alone. synergy was found for combinations tested, various antibiotic combinations against MDR V. chol- Results and Discussion erae should be further examined. The following resistance patterns and MIC ranges (µg/mL) were found: All to TS (>32), and NA (>256), eighteen to EM (1-48), fi fteen to FM (96-

28 ESCMID NEWS 03/2008 SCIENCE AND EDUCATION ��

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� �� Figure 1. Distribution of resistance among recent Vibrio cholerae strains from Bangladesh, for abbreviations see Box

References 7. Laboratory Methods for the Diagnosis of Epidemic Dysentery and 1. Sack DA, Sack RB, Nair GB, Siddique AK. Cholera. Lancet 2004; Cholera Centers for Disease Control and Prevention Atlanta, Georgia 363(9404):223-33 1999, WHO/CDS/CSR/EDC/99.8

2. Greenough WB 3rd, Gordon RS Jr, Rosenberg IS, Davies BI, 8. Performance Standards for Antimicrobial Susceptibility testing: Benenson AS. Tetracycline in the treatment of cholera. Lancet 1964; Eighteenth Informational Supplement, M100-S18 Vol. 28 No.1 41:355-7 of Clinical and Laboratory Standards Institute (CLSI)

3. World Health Organization. Guidelines for Cholera Control, 9. Livermore DM, Hope R, Fagan EJ, Warner M, Woodford N, Potz N, Geneve: World Health Organization, 1993 et al. Activity of temocillin against prevalent ESBL- and Amp-Cproducing Enterobacteriaceae from south-east England. 4. Emergence of a unique, multidrug resistant strain of Vibrio Journal of Antimicrobial Chemotherapy 2006; 57(5): 1012-1014 cholerae O1 in Bangladesh. Health Sci Bull 2005; 3: 1-20 (accessed on July, 2005). ICDDR, B: Centre for Health and Population Research 10. www.abbiodisk.com/ETM/Etest Technical Manual: Last accessed on 5 August 2008 5. Khan WA, Bennish ML, Seas C, Khan EH, Ronan A, Dhar U, et al. Randomised controlled comparison of single-dose ciprofl oxacin and 11. Etest references on fi le at AB BIODISK. Request via doxycycline for cholera caused by Vibrio cholerae O1 or O139. [email protected] Lancet 1996; 348(9023): 296-300 12. Etest Application Sheet: EAS 023, www.abbiodisk.com/bd_litt_ 6. Saha D, Karim MM, Khan WA, Ahmed S, Salam MA, Bennish ML. A eas.html double blind randomized controlled trial comparing single dose Azithromycin or ciprofl oxacin for the treatment of cholera in adults. Abstract: 45th Annual ICAAC, Washinton DC, USA 2005

List of antibiotics and their abbreviations, for which MIC was determined Aminoglycosides: Gentamicin (GM), Phosphonic Acid: Fosfomycin (FM), Penicillins: Temocillin (TMO); Mecillinam (MM), Cephalosporin: Cefotaxime (CT), Cefepime (PM), Carbapenems: Imipen- em (IP); Macrolides: Erythromycin (EM), Azalides: Azithromycin (AZ); Sulfonamides: Trimetho- prim/sulfamethoxazole (TS); Glycylcyclines: Tigecycline (TGC); Tetracyclines: Tetracycline (TC), Doxycycline (DC); Quinolones: Nalidixic acid (NA), Fluoroquinolones: Ciprofl oxacin (CI), Gemi- fl oxacin (GEM), Moxifl oxacin (MX), Gatifl oxacin (GA); Phenicols: Chloramphenicol (CL); Oxazo- lidinone: Linezolid (LZ).

ESCMID NEWS 03/2008 SCIENCE AND EDUCATION 29 Report on Training in a Foreign Institution Rotavirus Surveillance in Bulgaria – Present State and Future Directions

Zornitsa Mladenova, virologist in the – show the medical community and authorities National Reference Laboratory of Enteroviruses, the necessity of rotavirus detection Department of Virology, National Center – evaluate disease burden and clinical severity of of Infectious and Parasitic Diseases, Sofi a, rotavirus gastroenteritis Bulgaria, [email protected] – monitor rotavirus G and P types circulating in different regions of the country For the last 3 years I have been working in the area – collect relevant epidemiological data on rotavi- of rotavirus detection and strain characterization. rus gastroenteritis cases In June 2008 I spent one month in the laboratory of – assess the need for introduction of rotavirus Dr. Jim Gray in the Enteric Virus Unit at the Health vaccine in Bulgaria and the related benefi ts and Protection Agency in London, UK, under the su- risks. pervision of Dr Miren Iturriza-Gomara to acquire skills for detailed characterization of rotavirus Objective of the training strains through sequence and phylogenetic analy- In my home lab we tested from January 2005 to ses and primer design and to extend my knowledge May 2008 more than 3’000 stool samples from on rotavirus diversity and evolution. This training hospitalized children with acute diarrhoea for the was supported by an ESCMID Training Fellow- presence of rotavirus. Within this sample group a ship. high incidence of rotavirus infection between 36% and 42% was found. Either in our laboratory or in Background collaboration with our colleagues from Istituto Su- Acute diarrhoeal diseases are a main public health periore di Sanita (Italy) and MEDUNSA (South problem worldwide and rotaviruses are recognized Africa) over 400 rotavirus isolates were strain as the leading viral agent affecting children under characterized. Since a high percentage (30–35%) the age of fi ve. Because of the high rotavirus bur- of rotavirus strains were partly or fully untypeable den and frequently a severe progression of the dis- using one-step semi-nested RT-PCR using previ- ease, a number of international organizations such ously published primers, we needed to learn and as World Health Organization, GAVI Alliance, introduce new methods and algorithms for effec- Center for Disease Control, Children’s Vaccine tive rotavirus G-P genotype characterization into Program and the Rotavirus Vaccine Program our routine laboratory practice. (PATH) have made the development of a rotavirus vaccine their priority goal. Today rotavirus disease The training is considered to be one of the vaccine-preventable During the training some Bulgarian rotavirus illnesses as are poliomyelitis, measles, rubella and strains which we could neither G- nor P-genotype, many others. Two rotavirus vaccines approved in were successfully identifi ed using a new genera- February 2006 – „Rotarix” (GlaxoSmithKline Bio- tion of primers and methods. It is well known that logicals) and „Rotateq” (Merck&Sanofi Pasteur) – rotaviruses evolve through two major mechanisms are the main instruments to dramatically decrease – antigenic shift, reassortment of genes during the the 450’000 to 700’000 lethal cases as well as high dual infection of a single cell, and antigenic drift, medical and non-medical costs associated with 140 accumulation of point mutations, which are the ba- million rotavirus diarrhoeal episodes each year all sis for the emergence of novel G-P combinations over the world. Along with faster investigations or antibody escape mutants. Moreover, the accu- and development of a rotavirus vaccine, some new mulation of point mutations at primer-binding sites initiatives have also become accepted. One such also makes molecular methods for genotyping un- initiative is long-term and detailed surveillance of successful. The recently developed primers which the rotavirus disease burden and rotavirus strain have been designed and optimized through exten- diversity by building local and regional networks. sive surveillance studies, a different nucleic acid In response to the high requirements for diagnos- extraction method and different amplifi cation algo- tics of rotavirus infections, which have been im- rithm – reverse transcription using random primers posed in the European Union countries, in 2005 followed by a semi-nested PCR which we used led the National Reference Laboratory of Enterovirus- to a successful characterization of these previously es (NCIPD) in Sofi a, Bulgaria, established the Na- untypeable rotavirus strains. Direct sequencing tional Rotavirus Surveillance Network. The main was performed on the 15 rotavirus strains to con- goals of the network are to: fi rm the genotypes detected through PCR. By se- – resume rotavirus diagnostics in the country quence analysis of two other rotavirus isolates, we

30 ESCMID NEWS 03/2008 SCIENCE AND EDUCATION were the ﬁ rst group to detect the G12P[8] rotavirus dred thousand mild episodes each year. In order to strain in our country and the zoonotically transmit- successfully survey, control and prevent rotavirus ted rotavirus with G3P[3] SGI speciﬁ city with ca- disease, obligatory rotavirus testing is needed in nine-like origin. our country. Moreover, detailed strain characterization using new methods and algorithms will al- Summary low monitoring of the most common circulating Annually, 9’000 to 12’000 cases of acute gastroen- genotypes, genotype changes over time and emer- teritis of unknown origin have been reported in gence of new rotavirus strains – information of Bulgaria among children less than 9 years of age. major importance in the pre-vaccination and post- Using the incidence rate for rotavirus established licensure eras. Concerning my research interests of in our investigations and a statistical model used rotavirus evolution and relationships between hu- by Soriano-Gabaro and colleagues for an assess- man and animal rotaviruses, the detection of the ment of the risk of rotavirus infection, we specu- G3P[3] rotavirus strain with a likely animal origin late that rotavirus disease is an important health poses a question for the need of studies of rotavi- problem in Bulgaria accounting for three to four rus strains circulating in pets, farm animals and thousand hospitalizations and more than one-hun- humans.

Jim Gray (fourth f. r.), Dr. Miren Iturriza-Gomara (ﬁ fth f. r.) and some staff from the Enteric Virus Unit (Enteric Virus Unit, Virus Reference Department, Centre of Infections, Health Protection Agency, London, UK) – one of the leading laboratories in the ﬁ eld of detection and strain characterization of enteropathogens

ESCMID NEWS 03/2008 SCIENCE AND EDUCATION 31 7th ESCMID Summer School 2008 Course Review

Bernd Salzberger, Director of the 7th ESCMID Summer School, – How to conduct a study according to Good Regensburg, Germany, [email protected] Clinical Practice. After the morning lectures, participants presented medical cases The 7th ESCMID Summer School was held from 19 – 25 July in from their own experience which stimulated lively discussion Regensburg, Germany. Organized by the ESCMID Education and exchange of experiences from the different countries and Subcommittee, the Summer School was hosted by the University regions. In the afternoon facilitators worked with participants in of Regensburg, Germany, and was locally directed by Bernd small groups. The different groups discussed further medical Salzberger and his team. An international group of facilitators - cases, focussed on presentation techniques, fought a mysterious Murat Akova (Ankara), Christoph Lange (Borstel), Falitsa Man- outbreak of hepatitis B and worked “hands-on” on bronchoscop- draka (Regensburg) and Achim Schwenk (London) – was in- ic techniques. volved early in the development of the Summer School ESCMID supported 17 participants with an attendance grant programme. covering the full tuition fee. Further fi nancial support for the This course now can build upon much experience with a well Summer School was granted as unrestricted educational grants tried format, continually developed since the fi rst Summer by the German branches of Abbott, Astra-Zeneca, Bayer Health- School: Lectures are held in the morning, followed by partici- care, Boehringer-Ingelheim, Bristol-Myers-Squibb, Essex, Gile- pants’ case presentations and interactive small group sessions in ad, Infectopharm, Jansen-Tibotec, MSD, Novartis, Pfi zer, Roche the afternoon. The number of participants rose again to a new and Wyeth. record: 55 participants from 21 countries were present. The A diverse social programme kept the motivation up after the number of clinicians and clinical microbiologists was well bal- often long hours of lectures and group work. All participants’ anced. This year a completely new chapter was added to the fi ve accommodations were in the historical centre of Regensburg, a major lecture chapters present in the last Summer Schools: recent addition to the UNESCO world heritage list, and had am- – microorganisms and pathogenesis ple opportunity to experience the city’s atmosphere. A guided – antimicrobial resistance city tour on the fi rst evening was followed by a welcome dinner. – epidemiology, infection control and public health On Tuesday afternoon we visited the monastery of Weltenburg, – major clinical syndromes one of the oldest monasteries and breweries in Bavaria, situated – immunocompromised hosts picturesquely on the Danube. On the fi nal evening the partici- – skill-building lectures. pants and lecturers dined and celebrated afterwards in a histori- Three new skill-building lectures were integrated into the pro- cal Regensburg building. gramme this year: The atmosphere between the participants, lecturers and facili- – How to write a paper or a thesis tators was open and relaxed. All lectures gave rise to lively dis- – How to fi nd a good mentor cussion, the small group sessions brimmed with activity. During

32 ESCMID NEWS 03/2008 SCIENCE AND EDUCATION this week the participants successfully functioned as an active international team and updated their knowledge of all ﬁ elds �� covered. This was reﬂ ected by the excellent evaluation of the �� School given by the participants at the end of the course. The new topics covering general skill building were all rated excellent. The seventh edition of the ESCMID Summer School, as the �� ones in the past, also proved to be a very successful concept. The �� opportunity to learn through interactive and open discussions was highly appreciated by all participants, lecturers and facilitators. The potential for further development of the course through �� constant evolution and incorporation of new and important top- �� ics was proven. �� We hope that all participants left Regensburg with good mem- �� ories and that they will spread the news and the spirit of the �� ESCMID Summer Schools among their colleagues for the next

editions. � �� Visit the Summer School 2008 website for Powerpoint pres- � entations and pictures at � � www.akm.ch/ESCMIDsummerschool2008. ��

Our impressions from the Summer School A very exciting postgraduate event was recently held in Regensburg, Germany. The Summer School was very successful from every aspect. We had the chance to acquire knowledge by attending presentations and discussions and by preparing and presenting our own cases. It was a week full of intensive interdisciplinary communication, discussion and exchange of ideas, experiences and insights. Apart from the intellectual experience, we also had an amazing time in the free part of the day. We had three dinners together, one of which resulted in a party with lots of dancing and happy faces! Besides this, we had the chance to see places and monuments reﬂ ecting Bavarian architecture Maria Lambrou, Larissa, Greece, and culture. Although the weather was not ideal for [email protected] sightseeing, the chosen town was traditional, romantic and peaceful. Eleni Ntokou, Larissa, Greece, It was an experience we will never forget! [email protected] Thank you for this!

ESCMID NEWS 03/2008 SCIENCE AND EDUCATION 33 Forthcoming Events

More detailed information about ESCMID courses and Postgraduate 21 – 23 Oct ESCMID Postgraduate Education conferences as well as general Education Courses 2009 Course information about other Antibiotic Resistance and events can be found on the and Workshops Healthcare-associated Infections ESCMID website (www.escmid. 10 – 11 Mar ESCMID Postgraduate Education Sibenik, Croatia org) under Dates & Events. 2009 Course Beta-lactamases in Community- 22 – 24 Oct ESCMID Postgraduate Education acquired Infections: from Lab to Clinic 2009 Course Ankara, Turkey Diagnosing and Treating Fungal Infections: from Neonates to Adults 30 – 31 Mar ESCMID Postgraduate Technical Thessaloniki, Greece 2009 Workshop Advanced Course in Clinical 7 – 8 Nov ESCMID Postgraduate Education Parasitology 2009 Course Paris, France From Bench to Bedside: Viral Hepatitis Antalya, Turkey 8 – 12 Jun ESCMID Postgraduate Technical 2009 Workshop Late Nov ESCMID Postgraduate Education Postgraduate Course in Clinical 2009 Course Parasitology ESCMID-SHEA Training Course in Amsterdam, The Netherlands Hospital Epidemiology Spain 17 – 20 Aug ESCMID Postgraduate Technical 2009 Workshop ESCMID Summer School Medical Bioﬁ lm Techniques 2009 Copenhagen, Denmark 12 – 17 Jul 8th ESCMID Summer School 2009 Porto, Portugal 3 – 5 Sep ESCMID Postgraduate Education A one-week course dedicated to post- 2009 Course graduate and continuous medical Acinetobacter Infections: Microbiologi- education in the ﬁ eld of clinical microbi- cal, Clinical and Therapeutical Aspects ology and infectious diseases Istanbul, Turkey ESCMID Conferences 7 – 8 Sep ESCMID Postgraduate Technical 16 – 19 May 19th ECCMID 2009 Workshop 2009 Helsinki, Finland Histopathology in Experimental Neuroinfection 22 – 25 Sep ASM/ESCMID Conference Berne, Switzerland 2009 Methicillin-resistant Staphylococci in Animals: Veterinary and Public Health 12 Sep GRACE Postgraduate Education Implications 2009 Course London, UK Vaccination and Preventive Measures for LRTI in the Community 4 – 8 Oct ESCMID/FEMS Conference Vienna, Austria 2009 From Microbial Pathogenesis to the Discovery of Antivirulence Drugs 14 – 16 Oct ESCMID Postgraduate Education Villars-sur-Ollon, Switzerland 2009 Course Zoonoses and Vector-borne Nov ESCMID Conference Diseases in Europe 2009 Enterococci: from Animals to Man Grenoble, France Barcelona, Spain 19 – 21 Oct GRACE Workshop Autumn ESCMID Conference 2009 New Challenges in Primary Care: 2009 Antibiotic Treatment Failure in Back to the Future the Absence of Bacterial Resistance Rome, Italy Germany

34 ESCMID NEWS 03/2008 CALENDAR Feb/Mar ESCMID Conference 2010 Invasive Fungal Infections Rome, Italy

10 – 13 Apr 20th ECCMID 2010 Vienna, Austria Endorsed by ESCMID 23 – 24 Jan 14th International Symposium on 2009 Infections in the Critically Ill Patient Berlin, Germany [email protected] www.infections-online.com

13 – 16 Feb International Meeting on Emerging Di- 2009 seases and Surveillance (IMED 2009) Vienna, Austria [email protected] http://imed.isid.org

4 – 7 Mar 6th International Conference on 2009 Management and Rehabilitation of Chronic Respiratory Failure Naples, Italy

25 – 28 Apr 10th International Symposium on 2009 Modern Concepts in Endocarditis and Cardiovascular Infections Naples, Italy

7 – 9 May Oxygen & Infection 2009 Stockholm, Sweden www.oxygeninfection.se

2 – 5 Sep EUROBIOFILMS 2009 Erratum 2009 Rome, Italy We regret that in the last issue Figure 5. Gram-stained smear eurobioﬁ [email protected] of ESCMID News(2/2008, p. of pneumococci in sputum www.ptsroma.it/EUROBIOFILMS2009/ 51), we presented an from a patient with pneumonia. image of Gram staining that Gram’s original smears do not 6 – 10 Sep 6th European Congress on Tropical was not optimal. This image exsist. (x 1000, photo:N Høiby) with the following legend 2009 Medicine and International Health should have been printed. and 1st Mediterranean Conference on Migration and Travel Health Verona, Italy www.tropicalmed.eu/name/Congress+T ropical+Medicine.html

19 – 22 Oct Clostridia: The Impact of Genomics 2009 on Disease Control Rome, Italy [email protected]

ESCMID NEWS 03/2008 CALENDAR 35 ESCMID’s mission is to improve the diagnosis, treatment and prevention of infectious diseases by promoting and supporting research, education and training in the infection disciplines. This is achieved by scientiﬁ c exchange, educational programmes, grants and awards, certiﬁ cation and consultation with professional and government agencies. Front Page: A scheme from Helen Giamarellou’s excellent talk about better cooperation between Clinical Microbio- logy and Infectious Disease Specialists. Her presentation slides and others are available on the ESCMID website.

Below: Participants at the ESCMID Professional Affairs Workshop who helped make the event a great success.

ESCMID e.V. Hainbuchenstrasse 65 P.O. Box 1131 DE-82018 Taufkirchen Gemany [email protected] www.escmid.org