Activity of # imipenem / #relebactam against #MDR #Pseudomonas aeruginosa in #Europe: SMART 2015–17 (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Activity of imipenem/relebactam against MDR Pseudomonas aeruginosa in Europe: SMART 2015–17

Sibylle H Lob, James A Karlowsky, Katherine Young, Mary R Motyl, Stephen Hawser, Nimmi D Kothari, Melinda E Gueny, Daniel F Sahm

Journal of Antimicrobial Chemotherapy, dkz191,

Published: 13 May 2019




Relebactam is a diazabicyclooctane non-β-lactam inhibitor of Ambler class A and C β-lactamases that is in clinical development in combination with imipenem/cilastatin. The current study evaluated the in vitro activity of imipenem/relebactam against 5447 isolates of Pseudomonas aeruginosasubmitted to the SMART global surveillance programme in 2015–17 by 67 clinical laboratories in 22 European countries.


MICs were determined using the CLSI broth microdilution reference method (Eleventh Edition: M07, 2018). Relebactam was tested at a fixed concentration of 4 mg/L in combination with doubling dilutions of imipenem. MICs were interpreted using EUCAST clinical breakpoints (version 8.1); imipenem breakpoints were applied to imipenem/relebactam.


Rates of susceptibility to imipenem and imipenem/relebactam (MIC ≤4 mg/L) were 69.4% and 92.4%, respectively, for all isolates of P. aeruginosa. Over one-third of all isolates (34.9%, 1902/5447) were MDR; lower respiratory tract isolates (38.3%, 1327/3461) were more frequently MDR than were intraabdominal (28.5%, 355/1245) or urinary tract (29.7%, 212/714) isolates. Of all MDR isolates, 78.2% were susceptible to imipenem/relebactam, a rate that was 50–77 percentage points higher than the rate of susceptibility to imipenem or any other β-lactam tested; rates of susceptibility to imipenem/relebactam were similar for MDR isolates from lower respiratory tract (77.8% susceptible), intraabdominal (80.3%) and urinary tract (76.4%) infections. Overall, relebactam restored imipenem susceptibility to 75.2% (1254/1668) of imipenem-non-susceptible isolates of P. aeruginosa and to 69.6% (947/1361) of imipenem-non-susceptible isolates with an MDR phenotype.


Relebactam restored in vitro susceptibility to imipenem for most imipenem-non-susceptible and MDR clinical isolates of P. aeruginosa from European patients.

Topic: phenotype – pseudomonas aeruginosa – imipenem – lactams – respiratory system – urinary tract – infection


Keywords: Antibiotics; Drugs Resistance; Pseudomonas aeruginosa; Relebactam; Imipenem; European Region.



The #Spanish #Influenza #Pandemic: a #lesson from #history 100 years after 1918 (J Prev Med Hyg., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Prev Med Hyg. 2019 Mar 29;60(1):E64-E67. doi: 10.15167/2421-4248/jpmh2019.60.1.1205. eCollection 2019 Mar.

The Spanish Influenza Pandemic: a lesson from history 100 years after 1918.

Martini M1,2, Gazzaniga V3, Bragazzi NL4, Barberis I4.

Author information: 1 Department of Health Sciences, Section of Medical History and Ethics, University of Genoa, Italy. 2 UNESCO CHAIR Anthropology of Health, Biosphere and Healing System, University of Genoa, Italy. 3 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy. 4 Department of Health Sciences, University of Genoa, Italy.



In Europe in 1918, influenza spread through Spain, France, Great Britain and Italy, causing havoc with military operations during the First World War. The influenza pandemic of 1918 killed more than 50 million people worldwide. In addition, its socioeconomic consequences were huge. “Spanish flu”, as the infection was dubbed, hit different age-groups, displaying a so-called “W-trend”, typically with two spikes in children and the elderly. However, healthy young adults were also affected. In order to avoid alarming the public, several local health authorities refused to reveal the numbers of people affected and deaths. Consequently, it was very difficult to assess the impact of the disease at the time. Although official communications issued by health authorities worldwide expressed certainty about the etiology of the infection, in laboratories it was not always possible to isolate the famous Pfeiffer’s bacillus, which was, at that time, deemed to be the cause of influenza. The first official preventive actions were implemented in August 1918; these included the obligatory notification of suspected cases and the surveillance of communities such as day-schools, boarding schools and barracks. Identifying suspected cases through surveillance, and voluntary and/or mandatory quarantine or isolation, enabled the spread of Spanish flu to be curbed. At that time, these public health measures were the only effective weapons against the disease, as no vaccines or antivirals were available. Virological and bacteriological analysis of preserved samples from infected soldiers and other young people who died during the pandemic period is a major step toward a better understanding of this pandemic and of how to prepare for future pandemics.

KEYWORDS: Flu; History of Pandemic; Mortality rate; Public Health

PMID: 31041413 PMCID: PMC6477554 DOI: 10.15167/2421-4248/jpmh2019.60.1.1205

Keywords: Pandemic Influenza; H1N1; Spanish Flu; European Region; History.


Co-circulation of genetically distinct highly pathogenic #avian #influenza A clade (#H5N6) viruses in wild #waterfowl and #poultry in #Europe and East #Asia, 2017-18 (Virus Evol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Virus Evol. 2019 Apr 22;5(1):vez004. doi: 10.1093/ve/vez004. eCollection 2019 Jan.

Co-circulation of genetically distinct highly pathogenic avian influenza A clade (H5N6) viruses in wild waterfowl and poultry in Europe and East Asia, 2017-18.

Poen MJ1, Venkatesh D2, Bestebroer TM1, Vuong O1, Scheuer RD1, Oude Munnink BB1, de Meulder D1, Richard M1, Kuiken T1, Koopmans MPG1, Kelder L3, Kim YJ4, Lee YJ4, Steensels M5, Lambrecht B5, Dan A6, Pohlmann A7, Beer M7, Savic V8, Brown IH9, Fouchier RAM1, Lewis NS9,10.

Author information: 1 Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands. 2 Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK. 3 Staatsbosbeheer, Amersfoort, the Netherlands. 4 Avian Influenza Research and Diagnostic Division, Animal and Plant Quarantine Agency, Republic of Korea. 5 Avian Virology and Immunology, Sciensano, Brussels, Belgium. 6 Veterinary Diagnostics Directorate, Budapest, Hungary. 7 Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Insel Riems, Germany. 8 Croatian Veterinary Institute, Zagreb, Croatia. 9 OIE/FAO/EURL International Reference Laboratory for Avian Influenza, Swine Influenza and Newcastle Disease, Animal and Plant Health Agency (APHA)-Weybridge, Addlestone, Surrey, UK. 10 Department of Pathobiology and Population Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK.



Highly pathogenic avian influenza (HPAI) H5 clade viruses were first introduced into Europe in late 2014 and re-introduced in late 2016, following detections in Asia and Russia. In contrast to the 2014-15 H5N8 wave, there was substantial local virus amplification in wild birds in Europe in 2016-17 and associated wild bird mortality, with evidence for occasional gene exchange with low pathogenic avian influenza (LPAI) viruses. Since December 2017, several European countries have again reported events or outbreaks with HPAI H5N6 reassortant viruses in both wild birds and poultry, respectively. Previous phylogenetic studies have shown that the two earliest incursions of HPAI H5N8 viruses originated in Southeast Asia and subsequently spread to Europe. In contrast, this study indicates that recent HPAI H5N6 viruses evolved from the H5N8 2016-17 viruses during 2017 by reassortment of a European HPAI H5N8 virus and wild host reservoir LPAI viruses. The genetic and phenotypic differences between these outbreaks and the continuing detections of HPAI viruses in Europe are a cause of concern for both animal and human health. The current co-circulation of potentially zoonotic HPAI and LPAI virus strains in Asia warrants the determination of drivers responsible for the global spread of Asian lineage viruses and the potential threat they pose to public health.

KEYWORDS: H5N6; avian influenza; emerging diseases; highly pathogenic avian influenza; phylogeny; virology

PMID: 31024736 PMCID: PMC6476160 DOI: 10.1093/ve/vez004

Keywords: Avian Influenza; H5N6; H5N8; Reassortant Strain; Poultry; Wild Birds; European Region; Asia Region.


In vitro activity of #cefepime-#enmetazobactam against #Gramnegative isolates collected from #USA & #European #hospitals during 2014-2015 (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

In vitro activity of cefepime-enmetazobactam against Gram-negative isolates collected from United States and European hospitals during 2014-2015

Ian Morrissey, Sophie Magnet, Stephen Hawser, Stuart Shapiro, Philipp Knechtle

DOI: 10.1128/AAC.00514-19



Enmetazobactam, formerly AAI101, is a novel penicillanic acid sulfone extended-spectrum β-lactamase inhibitor. The combination of enmetazobactam with cefepime has entered clinical trials to assess safety and efficacy in patients with complicated urinary tract infections. Here, the in vitro activity of cefepime-enmetazobactam was determined for 1,993 clinical isolates of Enterobacteriaceae and Pseudomonas aeruginosa collected in the US and Europe during 2014 and 2015. Enmetazobactam at a fixed concentration of 8 μg/ml lowered the cefepime MIC90from 16 to 0.12 μg/ml for Escherichia coli, >64 to 0.5 μg/ml for Klebsiella pneumoniae, 16 to 1 μg/ml for Enterobacter cloacae, and 0.5 to 0.25 μg/ml for Enterobacter aerogenes. Enmetazobactam did not enhance the potency of cefepime against P. aeruginosa. Applying the CLSI ‘susceptible-dose dependent’ (SDD) breakpoint of 8 μg/ml to cefepime-enmetazobactam for comparative purposes resulted in cumulative inhibitions of 99.9% for E. coli, 96.4% for K. pneumoniae, 97.0% for E. cloacae, 100% for E. aerogenes, 98.1% for all Enterobacteriaceae surveilled, and 82.8% for P. aeruginosa. Comparator susceptibilities for all Enterobacteriaceae were 99.7% for ceftazidime-avibactam, 96.2% for meropenem, 90.7% for ceftolozane-tazobactam, 87% for cefepime (SDD breakpoint), 85.7% for piperacillin-tazobactam, and 81.2% for ceftazidime. For the subset of ESBL-producing K. pneumoniae isolates, addition of 8 μg/ml enmetazobactam to cefepime lowered the MIC90 from >64 to 1 μg/ml, whereas the shift for 8 μg/ml tazobactam was from >64 to 8 μg/ml. Cefepime-enmetazobactam may represent a novel carbapenem-sparing option for empiric treatment of serious Gram-negative infections in settings where ESBL-producing Enterobacteriaceae are expected.

Copyright © 2019 Morrissey et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Antibiotics; Drugs Resistance; Enterobacteriaceae; Cefepime; Enmetazobactam.


#Isoniazid (INH) mono- #resistance and #tuberculosis (TB) #treatment success: analysis of #European #surveillance data, 2002 to 2014 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014

Basel Karo1,2,3,4, Anke Kohlenberg4,5, Vahur Hollo5, Raquel Duarte6, Lena Fiebig33,7, Sarah Jackson8, Cathriona Kearns9, Csaba Ködmön5, Maria Korzeniewska-Kosela 10, Dimitrios Papaventsis11, Ivan Solovic12, Dick van Soolingen13, Marieke J. van der Werf5

Affiliations: 1 EPIET: European Programme of Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden; 2 Field Epidemiology South East & London, National infection Service, Public Health England, London, United Kingdom; 3 Infectious Disease Department, Robert Koch Institute, Berlin, Germany; 4 These authors contributed equally to this article and share first authorship; 5 European Centre for Disease Prevention and Control, Stockholm, Sweden; 6 Directorate General of Health, Lisbon, Portugal; 7 Apopo, Sokoine University of Agriculture, Morogoro, Tanzania; 8 Health Protection Surveillance Centre, Dublin, Ireland; 9 Public Health Agency, Belfast, Northern Ireland; 10 National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland; 11 National Reference Laboratory for Mycobacteria, ‘Sotiria’ Chest Diseases Hospital, Athens, Greece; 12 National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia; 13 Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

Correspondence: Anke

Citation style for this article: Karo Basel, Kohlenberg Anke, Hollo Vahur, Duarte Raquel, Fiebig3 Lena, Jackson Sarah, Kearns Cathriona, Ködmön Csaba, Korzeniewska-Kosela Maria, Papaventsis Dimitrios, Solovic Ivan, van Soolingen Dick, van der Werf Marieke J.. Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014. Euro Surveill. 2019;24(12):pii=1800392.

Received: 17 Jul 2018;   Accepted: 09 Feb 2019




Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome.


We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB.


In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries.


A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2).


This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.

© This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Tuberculosis; European Region; Isoniazid.


#Challenges and opportunities for the #management of #infectious diseases in #Europe s’ #prisons: evidence-based guidance (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Challenges and opportunities for the management of infectious diseases in Europes’ prisons: evidence-based guidance

Lara Tavoschi, PhD, Éamonn O’Moore, MD, Dagmar Hedrich, MSc

Published: March 19, 2019 / DOI:



People in prison have multiple complex health and social care needs. These are likely to be the result of a combination of overlapping, and sometimes interlinked, risk factors for infection, ill-health, and incarceration, such as problem drug use. Incarceration can represent a unique opportunity to make high-quality health care available to people in prison and to target socially deprived groups who are often medically underserved when living in the community they originate from. In recent years, international and European institutions have increasingly acknowledged the importance of treating prison health as an inseparable component of public health. However, numerous challenges hamper the successful implementation of such a concept, including the need for evidence-based decision making, intersectoral partnerships, and better monitoring systems. New initiatives are ongoing in the EU that might contribute to bring about positive changes, such as the publication of the first evidence-based public health guidance on prevention and control of communicable diseases in prison settings.

Keywords: European Region; Society; Infectious diseases; Public Health.


#Emerging #arboviruses of medical importance in the #Mediterranean region (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 16 March 2019 / In Press, Accepted Manuscript

Emerging arboviruses of medical importance in the Mediterranean region

Anna Papa, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece

Received 12 January 2019, Revised 6 March 2019, Accepted 11 March 2019, Available online 16 March 2019. DOI:



  • The epidemiology of arboviral infection in the Mediterranean region is changing.
  • 2018 was a record year for West Nile virus infections.
  • Crimean-Congo hemorrhagic fever emerged in the Western Europe.
  • Autochthonous chikungunya and dengue cases occurred in the Mediterranean countries.
  • The “One Health” initiative is required for tackling the emerging diseases.



The epidemiology of viral infections transmitted by arthropods is changing due to a variety of parameters related to the virus, the host and the environment. The Mediterranean region is highly affected by changes in the intensity and extension of global-scale climate patterns, and, due to its location, provides a vulnerable environment for emergence of arboviral diseases. The main arboviruses that pose currently a public health threat in the Mediterranean region are West Nile virus and Crimean-Congo hemorrhagic fever virus and, in less extend, tick-borne encephalitis virus. Usutu virus that affects mainly birds can infect also humans, while Dengue and Chikungunya viruses showed that they are capable to cause sporadic autochthonous cases, and even outbreaks in the Mediterranean region. Sandly-transmitted viruses continue to have a public health impact, and novel ones have been identified. The presence of competent vectors (mainly mosquitoes), combined by arbovirus introduction through viremic travelers returning from endemic regions, prompt for increased surveillance to mitigate the risk for local transmission. In order to tackle efficiently and effectively the emerging arboviral diseases, an integrated “One Health initiative” is required to be maintained, involving public health, animal health and environmental authorities. Awareness of medical and veterinary staff and laboratory capacity are crucial for the early detection of pathogens, while reporting the unusual and enhance surveillance are important.

Keywords: Arbovirus – Mediterranean countries – Emerging – Humans

© 2019 Elsevier B.V. All rights reserved.

Keywords: Arbovirus; Climate Change; European Region; Chikungunya fever; Dengue fever; Zika Virus; WNV; CCHF.