Guest Blogger Barley Chironda (bio below) writes…

IDWeek was held this year from Oct 3 to 7, 2018 in beautiful San Francisco. This was my fourth year in a row attending; having first attended and blogged about my first experience here in 2014. The pressure to offer IDWeek attendees a stellar conference was palpable. A week before, the city of San Francisco had hosted Dream Force. Dream Force is one of the world’s largest tech conventions with over 150,000 attendees. I’m glad to say IDWeek did not disappoint; boasting it’s highest ever attendance of over 8,000 people from over 85 countries. Given its wide and diverse audience, there are many targeted streams that allow a range of topics.

I attended IDWeek2018 with a mission to attend many sessions on the Epidemiology and Infection Control track. However, my plan was immediately challenged by some great talks in many other tracks. So, I did what I’ve always done in previous years when such a challenge presents itself: I made sure to follow the #IDWeek2018 hashtags on Twitter. It’s a really good way to manage one’s FOMO*.

Plenary Sessions

Opening plenary was out of this world! Featuring a real life Astronaut Dr. Kathleen Rubin’s. Aside from the amazing images of a spaceship, Dr. Rubin shared how on her first spaceflight on Expedition 48/49, she became the first person to sequence DNA in space. She spent 115 days in space and conducted two spacewalks. It was amazing to see images of lab specimens floating away if they were not held down by Velcro; and even more fascinating to see a power tool used as a makeshift centrifuge. For her work, Dr. Rubin has received many accolades and recognition.

In 2014, IDWeek was all about Ebola; with multiple sessions including the plenary on the topic.  So it makes sense to also continue from there.

Hospital Preparedness

Dr Angela Hewlett gave a talk on lessons learned from her US Biocontainment Units that also treated Ebola patients in the US. It is the largest US site located in Nebraska. It was interesting to hear that the Nebraska Biocontainment Unit personnel consists of an multi-disciplinary team specially trained in high level isolation and bio-preparedness. Most work full-time in other areas of Nebraska Medicine but remain on-call to report promptly for duty when the unit is activated. With some cases of Ebola in West Africa this year, it was reassuring to see the resources available for download from Dr Hewlett’s team.

One Health in Combating Antimicrobial Resistance

An entire symposium was dedicated to One Health and updates related to combating AMR. I am very excited and intrigued by this concept of One Health as it pertains to Stewardship. I was very impressed with this session. Presented in three parts:

1. Dr Lonnie King started the session with an update from Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB). A task force of multiple stakeholders aimed at :

• Slowing the emergence of resistant bacteria and preventing the spread of resistant infections
• Strengthen national One Health Surveillance Efforts
• Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria
• Accelerate Basic and Applied Research and Development for New Antibiotics

(entire 65 page plan is here for download)

Dr. King showed that the continued increase in the earth’s population will lead to more demand for cheap protein sources. This demand will see more antimicrobials used in Veterinary medicine and subsequently more antimicrobial resistant pathogens.

2. Dr Louise Watkins from the CDC discussed real life outbreaks that exemplify when AMR runs rampant.

• Outbreak of Salmonella Heidelberg Infections Linked to a Single Poultry Producer — 13 States
• Outbreak in Salmonella Infantis-ESBL leading to increase in human cases of ESBL
• Multidrug-Resistant Campylobacter jejuni Outbreak Linked to Puppy Exposure

Her conclusions from these outbreaks were that One Health is a critical strategy that can help to promptly identify and contain stewardship lapses via surveillance of The National Antimicrobial Resistance Monitoring System and prompt deployment of CDC resources. However, at the root of these outbreaks was the lack of adequate Antimicrobial Stewardship in Veterinary settings.

3. Dr James Tiedje closed the session by reinforcing a scary point; hospitals seem to be at the end of the chain of AMR transmission with the journey having been started way before the hospital in our water, soil, and food. Talking extensively about soil, he introduced the concept of Resistome– speaking to the collective AMR potential of soil organisms, both pathogenic and nonpathogenic. In particular, calling attention to how effluent from farms and pharmaceutical factories all add selective pressure and alter the soil Resistome. All this becomes a bedrock for the spread of AMR.

I left the One Health session concerned about how my role as an Infection Preventionist seems to be very downstream compared to the upstream and greater AMR impact of soil, veterinary, food, water, and animals. I was glad however, to hear about One Health and will look to participate in more of its initiatives.

Microbiome and Multi-Drug Resistant Organisms

This session covered the Microbiome in specialty populations such as Hematopoietic Stem Cell Transplant (HSCT), patients in long-term care (LTC), and the impact of Fecal Microbiota Transplant (FMT) on the Microbiome.

• Dr Eric Pamer up first; shared studies on developments of the role of the microbiome in outcomes of Allogeneic-HSCT patients and how certain bacteria seem to have a protective effect to ward off C.difficile in these populations. He also shared that allo-HSCT patients have a high risk for VRE and that his study has shown that certain parts of the microbiome offer a protective effect.
• Dr Mary Hayden shared her work in LTC in particular an interesting study that showed patients at risk for CPE with unique pathogens in decubitus ulcers all speaking to the role of the collective microbiome. She also added that carbapanam antimicrobials can spark CPE in certain LTC populations.
• Dr Jennie Kwon had an awesome talk on FMT and whether it’s a panacea for all illnesses. Taking a journey through various studies and ending with the hope that there is promise for many illnesses; however, much work is still required.

Pathogenic threats

C.auris

In my opinion (and not as obvious), the show stealer this year was the fungus Candida auris with multiple sessions. Here are the “Coles/Cliff” notes;

• Dr Elenor Adams shared the C. auris outbreak from New York area. She cited and shared some insight on C. auris; such as: its tenacity in the environment, its difficulty to detect, its co-infection manifestation with problematic CPE, and also how it seems to be affecting the elderly disproportionately. The publication and the presentation are worth a read for anyone in Infection Prevention. Also, please do read up on your relevant country guides as follows US-CDC, Canada-PHAC and UK-PHE recommendations.
• Chicago public health shared their outbreak of C. auris which was further complicated by co-infection as in NYC. Other similarities also noted were: difficulty in detection, tenacious environmental persistence, resistance to antifungals, and complex infection prevention demands.
• Dr Cornelius Clancy shared why C. auris has emerged and he hypothesized that its thermotolerance, expansion of environmental persistence, antifungal selection pressure and leap of fungi from unknown environmental niches to hospital environments all could be possible causes. He even pointed to more potential gloom citing that antifungals are used way more in agriculture than in healthcare as such more resistance might be coming. In addition, he showed that C. auris found in a swimming pool in the Netherlands could also speak to wider presence of C. auris. To me, all I saw was another example of upstream versus downstream effect and how One Health could be the silver bullet.

I could do a separate post on posters alone as there were lots of them. However, they seemed to echo the C. auris theme and CPE in sinks/drains. With that said, I think the appropriate ending is to reiterate the need to figure out how to be proactive in our infection prevention. As the old adage goes, “An ounce of prevention is worth a pound of cure.” This adage means more today than ever.

If you have Twitter, I highly recommend #IDWEEK and #IDWEEK2018 hashtags on Twitter and Instagram, where attendees where tweeting from the various sessions.

Barley Chironda Bio

 

Barley Chironda a Registered Practical Nurse, is Infection Control Specialist with Clorox Canada. Barley is typically found engaged in motivating Hospital Staff, Patients and the public on proper infection prevention practices. He also volunteers as the Infection Control Specialist with the Cdiff Foundation and is a former IPAC-GTA President as well as IPAC-Canada Social Media Manager.

Presenting author details:

Twitter account: @barleychironda

Linked In account: Barley Chironda

* FOMO = fear of missing out!