Tina M. Vellozzi PhD, D(ABMM)
This year’s May 5th Annual Meeting at The Hotel Pennsylvania once again proved to be in the best tradition of meetings organized by our Branch Program Committee. The morning program began with continental breakfast, followed by opening remarks by our Branch President, Dr. Maria Aguero-Rosenfeld, who welcomed the more than 300 attendees.
Dr. Fred Tenover, Vice President of Scientific Affairs at Cepheid, Sunnyvale , CA was the first speaker of the morning with his discussion of “ The Role of Molecular Diagnostics in Antimicrobial Stewardship”. In 2017 the Joint Commission will make it mandatory for every hospital and nursing home to have a stewardship program. As Dr. Turnover pointed out stewardship programs help clinicians reduce inappropriate antibiotic use and improve the quality of patient care. In addition, implementation of these programs reduce treatment failure rates, selective pressures that promote resistance in microorganisms, and hospital C. difficile infection rates. Ultimately this too results in substantial cost savings to the hospital. Dr. Tenover presented examples where multiple nucleic acid based tests can enhance antimicrobial stewardship efforts in both hospitals and emergency departments. These include molecular diagnostics for tuberculosis, Group B Streptococcus, Enterovirus, Chlamydia trachomatis/Neisseria gonnorrhoeae, MRSA, influenza and C. difficile. “The key to successful antimicrobial stewardship is coordination”, said Dr. Tenover, “you need to get everyone on board and supportive of rapid testing”.
The next speaker of the morning session was Dr. Jennifer L. Rakeman, Assistant Commissioner and Laboratory Director of the Public Health Laboratory, NYC Department of Health and Mental Hygiene in Manhattan who discussed the infectious disease challenges confronting NYC and the response of the DOHMH PHL. Dr. Rakeman reviewed data from the 2016-2017 influenza season, and indicated that the effectiveness of this year’s vaccine was estimated to be about 48% for predominant influenza A H3N2 and about 73% for influenza B. This was consistent with previous seasons during which the vaccine was “like” the circulating viruses. She also spoke about an unusual influenza H7N2 outbreak in a NYC animal shelter system involving cats. As Dr. Rakeman pointed out, cats get respiratory illness, but not usually from influenza. A shelter staff member who tended to the sick cats subsequently became mildly symptomatic. Influenza H7N2 is a low pathogenic avian influenza virus, with rare cases reported in the U.S. according to Dr. Rakeman. The person was confirmed to have been infected with the same feline influenza H7N2 strain, and may have represented a first time cat-to-human transmission of the virus. Dr. Rakeman also discussed NYC preparedness plans for Zika virus. As Dr. Rakeman noted, there is cause for worry as there are about 100,000 pregnant women in NYC on any given day, with large numbers of immigrants from and travelers to areas with active Zika virus transmission. Also about 20% of U.S. Zika cases reported nationwide were in NYC.
Dr. Patricia J. Simner, Director of Medical Bacteriology and Parasitology at John Hopkins Hospital, in MD concluded the morning program with a presentation entitled “What’s New on the Superbug Menu?” with emphasis on the current challenges regarding Gram negative resistance mechanisms and susceptibility testing. Dr. Simner described the emerging mechanisms of resistance among the Enterobacteriacae, focusing on carbapenem and colistin resistance. All carbapenem resistant organisms (CROs) are a concern as they are likely to be multi drug resistant (MDR). Carbapenemase producing organisms (CPO) are the primary mechanism responsible for driving the spread of carbepenem resistance in the U.S. There is also an increasing global prevalence of these organisms causing high morbidity and mortality rates of up to 60%.. As pointed out by Dr. Simner, determining whether an isolate is simply carbapenem resistant or not, may not be sufficient. Determining carbapenemase production may be necessary to guide treatment decisions. In addition, Dr, Simner discussed the recent emergence of colistin resistance. Colistin is one of the last resort antibiotics for the treatment of MDR gram negative organisms, and the emergence of a transferable gene that confers this resistance is extremely disturbing. She described a new testing method in development called the Colistin Disk Elution method, which looks to be the most promising for laboratories to implement for colistin antibiotic susceptibility testing (AST). With regard to testing for carbapenem resistance, Dr Simner stated that we should go beyond simply identifying CRE based on phenotypic AST profile. Detection of carbapenemase producing CRE and more specifically molecular genotype are important for both infection control and antimicrobial stewardship purposes.
At the conclusion of the morning session, everyone gathered to enjoy a delicious luncheon and the Branch’s traditional annual awards presentations. We once again had the opportunity to pay special tribute to our sponsors who have so generously supported our educational programs throughout the years. It is their generous funding which make events such as our Annual Meeting possible. “Congratulations and Thank You!” to both our Platinum Award Members: Alere, Becton Dickinson Diagnostics, BioFire Diagnostics, Inc., bioMerieux, Inc., Cepheid, and Roche Diagnostics Corporation and to our Gold Award Members: Abbott Molecular, Beckman Coulter-Microscan, HOLOGIC, Inc., Meridian Diagnostics, and Quest Diagnostics.
The advantages of genetic sequencing tests in the detection of infectious disease pathogens was the subject matter of the afternoon’s first speaker, Dr. Niaz Banaei, Director of Clinical Microbiology and Associate Director of Clinical Virology at the Stanford Health Care system in Stanford, CT. Molecular diagnostic methods have reduced the turn-around-time from receiving a sample to the final result, and more importantly have made it possible to identify non-cultivable pathogens. However these methods require knowledge of the likely pathogenic species that could be present in the sample. As Dr. Banaei indicated by way of clinical case examples, direct targeted sequencing can come to the rescue when all else fails. Next generation sequencing (NGS) allows sequencing of the whole genome of numerous pathogens in one sequence run, either from bacterial isolates of (different) patients, or from multiple species present in patient material from one individual (metagenomics). Therefore NGScan beapplied directly to clinical specimens, not only by using a targeted approach, but also by sequencing the DNA or RNA from patient samples by shotgun metagenomics sequencing. Using this method, it is possible to investigate the presence of pathogens and the presence of virulence and/or resistance genes in one sequence run. Dr. Banaei pointed out however, that there are some limitations of pathogen identification by targeted sequencing. For example there can be false positives due to contamination. Also, in the absence of a positive culture, sequence results must be correlated with histopathology and ancillary test results (serology and antigen tests) to ensure the accuracy of the sequence results.
The afternoon session concluded with the interesting and challenging case presentations presented by Dr. Ferric C. Fang, Director, Harborview Medical Center, Clinical Microbiology Laboratory at the University of Washington School of Medicine, in Seattle, WA. This informative and entertaining session which was presented to the audience by Dr. Fang in the format of the popular program “Jeopardy”, gave the audience the opportunity to test their ability to identify the pathogens involved.
As the day’s program concluded, we all had another opportunity to visit with our many vendors and see their wonderful exhibits. It was now time to enjoy another much anticipated NYCASM tradition, the Reception and Annual Trivia Contest. While sampling many culinary treats, our membership had the chance to win one of the superb contest prizes. A special thanks to Doreen Georgopoulos, who always does a wonderful job of organizing the trivia contest.
In conclusion, the 2017 Annual Spring Meeting succeeded in delivering a memorable program with very relevant and enlightening topics. It also afforded all of us the opportunity to chat with a multitude of exhibitors and enjoy the company of friends and colleagues. Thanks to everyone who made this meeting such a success. We look forward to seeing all of you at our Fall meeting scheduled for Friday, November 3, 2017, again at the Hotel Pennsylvania in Manhattan. Our Programming Committee has put together another terrific symposium for you, so mark your calendars!