Top Infectious Disease News of the Week—IDWeek 2019

IDWeek 2019 is underway in Washington DC. Check out the top 5 articles of the meeting so far.

#5: Infectious Disease Research and Treatment in the Genomics Era

In the Opening Plenary of IDWeek 2019, 2 bright lights in infectious disease research spoke on the sea-change brought by genomics to biomedicine and the response to infectious disease outbreaks.

Francis Collins, MD, PhD, director of the National Institutes of Health (NIH), was in on the first “enterprise of big biology,” the sequencing of the human genome. At the time there were skeptics who felt that computational power and biology were like oil and water. The ensuing few years quelled that storm. It was a dauntingly expensive enterprise, to the tune of about $100 million. With time and refinements, the cost nosedived. Today, the same sequence can be generated for about $500. “I know of no other technology in the course of history that has dropped in cost this rapidly. This was accompanied by the increased speed and accuracy of sequencing. This is one-time things got better, faster, and cheaper,” Collins said.

The success turned research thinking to the use of genomic applications in patient health, with infectious diseases topping the list. NIH was one of the agencies that helped assemble a battery of genomic databases of different diseases and made the data freely available. “A small laboratory did not have to do all the work to generate all this data. That meant a small laboratory could become a pretty big genomic engine in discoveries,” Collins said.

Read the full article.

#4: Early Detection and Quick Infection Prevention Support Key to Tackling Candida Auris

Candida auris is an emerging scourge in health care facilities, including long-term acute care hospitals (LTACHs) and skilled nursing facilities with ventilator units (VSNFs). Patients in either of these facilities are at risk for C auris colonization, which can lead to invasive disease in 5-10% of patients and carry a mortality rate of >45%.

An LTACH-affiliated laboratory in California began enhanced surveillance of C auris in September 2018 to monitor rates of colonization and transmission. In February 2019, a case was identified in Orange County in a patient who had not traveled outside the region, indicating local acquisition.

An interdisciplinary team from US Centers for Disease Control and Prevention, California Department of Public Health, and Orange County Health Care Agency performed point prevalence surveys (PPS) and infection prevention assessments at all LTACH and VSNF subacute units in Orange County to record all C auris colonization and control the spread of the emerging pathogen.

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#3: IDWeek Perspective: What's Happening in Public Health: Public Health Watch

IDWeek 2019 is upon us and, not surprisingly, an oral abstract session entitled “What's New and Happening in Public Health” caught our eye.

The name could (hopefully) be used to describe the subject matter of this column, after all.

The session will be held on Friday, October 4^th, and feature 5 abstracts, many of which are being presented by researchers affiliated with the US Centers for Disease Control and Prevention (CDC). Topics range from an assessment of water-borne diseases in the United States to descriptions of an outbreak of invasive pneumococcal disease (IPD) in Israel and case clusters of invasive group A streptococcus infections in Denver nursing homes. In addition, an abstract will provide an overview of the clinical features of enterovirus A71- vs enterovirus D68-associated acute flaccid myelitis, while another will address “missed clinical opportunities” for infection prevention and substance use disorder treatment among people who inject drugs.

Read the full article.

#2: ACX-362E a Promising Potential Treatment for C difficile, First-in-Human Phase 1 Trial Demonstrates

A first-in-human trial evaluating the safety, pharmacokinetics, and fecal microbiome effects of a novel DNA polIIIC inhibitor demonstrated the antibacterial’s promise as a potential treatment alternative to vancomycin for the treatment of Clostridioides difficile.

In a late breaking presentation at IDWeek 2019, a team of investigators detailed the 3-part phase 1, double-blind, randomized healthy volunteer trial of the narrow-spectrum antibacterial ACX-362E.

The trial evaluated the safety profile, food effect, and systemic/stool pharmacokinetics of escalating single (150, 300, 600, and 900 mg) and multiple (300 and 450 mg) doses oral ACX-362E compared with placebo. A safety oversight committee reviewed the safety and pharmacokinetic data prior to dose-escalation within each cohort. Investigators compared the fecal microbiome effects of multiple doses of ACX-362E with 6 subjects receiving concomitant open-label vancomycin 125 mg 4 times daily.

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#1: All-Cause Mortality of Cefiderocol Versus Meropenem in Nosocomial Pneumonia

Cefiderocol is an experimental novel siderophore cephalosporin that has activity against a broad range of gram-negative bacteria. In a new study, investigators assessed rates of all-cause mortality at Day 14 for Cefiderocol and meropenem in patients with nosocomial gram-negative pneumonia.

The study team’s findings were presented in a late-breaking oral abstract session at IDWeek 2019.

The trial was a phase 3, international, double-blind, non-inferiority study that enrolled patients with ventilator-associated, hospital-acquired, or health care-associated pneumonia caused by gram-negative bacteria.

Participants were randomized to receive either 2 grams of Cefiderocol every 48 hours, or 2 grams of meropenem every 48 hours, both of which were infused for 3 hours for 7-14 days. In both treatment arms adjunctive linezolid (600 mg, every 12h, ≥5 days) was given to cover gram-positive bacteria.

The primary end point was non-inferiority of Cefiderocol to meropenem for all-cause mortality at Day 14 in the modified intent-to-treat population. Secondary end points included clinical and microbiological outcomes at test of cure and Day 28 mortality. The study team also assessed safety up to 28 days following the termination of treatment.

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