14^th World Congress on Infection Prevention and Control December 6-7, 2018 Valencia, Spain

Sumaiah Farook is the Head of Infection Prevention and Control at Apollo Hospital Muscat in the Sultanate of Oman and was formerly employed with the Royal Hospital, Oman. Somayeh is a member of the American Public Health Association (APHA). Her primary focus of study has been antimicrobial resistance and she is passionate about her study of multi drug resistant organisms and healthcare associated infections. Of particular focus is her work in collection of epidemiological evidence in surgical site infections and implementation of the Oman National Antimicrobial Guidelines. She has been a part of the launch of the National Antimicrobial Stewardship Program in

Oman where her data on antimicrobial surgical prophylaxis was one of the few presented studies. As an infection preventionist, she is a strong advocate of hospital hygiene standards and their role in lowering infection rates.

The study aims at identifying the reasons for a plateau compliance rate of 66% in spite of having implemented a strong hospital hand hygiene program. This was a quantitative study to address the issue of hand hygiene compliance among healthcare workers by assessing their perception towards the hand hygiene program at the hospital through a survey and focus group discussions. A total of 250 healthcare workers were included in the survey. The target population included doctors:interns, residents/medical officers and consultants/specialists, along with 150 nurses: unit and staff nurses. The focus group discussions facilitated a debate regarding the current program and the challenges faced by the staff in their role as the end users. The P value was calculated based on these results using a Chi square test. The P value calculated based on the audit was 0.28 with a significance of 0.05 calculated to two degrees of freedom. The χ2 value was 2.52. A 92.4% participation rate was recorded and significant differences were noted in the perception of hand hygiene between junior and senior staff. Areas of poor scores were elaborated on in the focus group discussions to understand reasoning behind the responses and reach a consensus on the best way to tackle the issues faced. The study highlights the success of the hospital wide hand hygiene program while underscoring the areas for improvement and concern, the need for constant hand hygiene education and intervention in a large hospital in spite of having an established program and establishes a benchmark for further studies in hand hygiene compliance.

Julian Hunt is a Research Officer at Swansea University. He is a sociologist with particular interest in ethnographic and participatory research methods. He has previously worked on a number of health and mental health studies, including the Welsh Assembly Government’s Sustainable Health Action Research Programme (SHARP) - An action research initiative that focused on health inequalities and community health development. He has combined this with a keen interest in historical sociology and the impact of class and place upon social, cultural and economic life. Dr Hunt has experience of working with quantitative research methods and analysis.

Introduction: Healthcare Associated Infection (HCAI) is a major cause of morbidity and mortality. HCAI remains a costly burden to health services, a source of concern to patients and the public and at present, is receiving priority from policy makers as it contributes to the global threat of antimicrobial resistance. This presentation introduces a new study that explores the ways in which adherence to IPC strategies and principles inform and shape organisational patient safety culture and vice versa.

Methods: The study involves qualitative case studies within isolation settings at two district general hospitals within one health board in Wales, UK. The study incorporates Manchester Patient Safety Framework (MaPSaF) workshops, interviews with health workers, other hospital staff, patients and their relative / carer, and periods of hospital ward observation.

Results: This presentation offers analysis drawn from the Phase 1 MaPSaF workshops. MaPSaF is designed specifically for use in the NHS and provides a view of safety culture on 10 dimensions at 5 progressive levels of safety maturity. The utilisation of MaPSaF in this study has enabled the generation of a profile of maturity of patient safety culture within each hospital setting in terms of areas of relative strength and challenge.

Discussion: Understanding the ways in which IPC is presented, implemented and engaged with by health workers and what that means for organisational patient safety culture, is essential to driving improvements in healthcare and clinical practice. This study offers an understanding of the meaning of IPC ‘ownership’ for health workers; of the ways in which IPC is promoted,

of how IPC teams operate as new challenges arise, how their effectiveness is assessed and of the positioning of IPC within the broader context of organisational patient safety culture, within hospital isolation settings.

Usman Rasool Lodhi working as a Provincial MDR-TB Coordinator, and done his research in College of Physicians & Surgeons Pakistan and University of Health Sciences, Punjab. Currently he is involved in two more research studies related to DRTB in Punjab. He also supports implementation of National Guidelines for PMDT in Punjab along with technical assistance regarding regimen selection especially on New Drugs and Short Term Regimen for MDR-TB. Before joining PTP, he also worked with Association for Social Development as a Regional Coordinator and MDR Physician. Since 2013 he is working in public health intervention Program related to Drug Resistant TB

Tuberculosis still the deadliest infectious disease among all communicable infections and DRTB remains an evil for low income countries like Pakistan. Irrational use of second line drugs including fluoroquinolones and second line injections along with lack of proper awareness to both level community and treatment provider, less number of diagnostic and treatment centers, poor adherence to treatment, primary default, infection prevention and lack of technical resources in Punjab may lead to rise in incidence of DRTB. To find out treatment outcomes and their associations with type of resistance among DRTB patients in Punjab, retrospective cohort analysis was done. Of the total bacteriologically confirmed DRTB registered patients at various PMDT sites across Punjab, n=2046 patient’s records were analyzed. Bivariate analysis shows a significant positive association (relative risk [RR] 1.7 & p-value = < 0•001) between type of resistance and treatment outcome in DRTB patients. Overall treatment success rate for DRTB in Punjab was 61.14% and favorable outcomes including cured and treatment completed were 59.4% and 1.7% respectively. While the unfavorable treatment outcomes including died, LTFU, not evaluated, treatment failure were 22.3%, 9.7%, 3.5%, and 2.7% respectively. Scale up DRTB surveillance activities, contact screening,

integration of DRTB with other public health programs, active case finding among populations will have a positive impact on drug resistance tuberculosis case notification and control over spread of diseases.

Manuel R Velasco Jr is a 2nd year medical resident in internal medicine in the Philippine and has a degree of Bachelor of Science in Nursing as pre-medicine. Worked as a fulltime nurse, a certified infection control nurse, and became a clinical and academic teacher in nursing school prior to becoming a doctor for adult. He is a research enthusiast and was able to win interdepartmental research contest and has publish a case report in Hong Kong.

Statement of the Problem: Tuberculosis is an ubuiqitous organism that attacks all organ tissues of its host. Abdominal TB accounts for about 5-12% of patients with tuberculosis and is most common in developing countries. Autopsy studies have shown that the pancreas is affected by about 2.1-4.7% of those with miliary tuberculosis. Pancreatic tuberculosis is a rare condition that can present mimicking signs and symptoms of pancreatic malignancy and in abdominal imaging as pancreatic mass. The purpose of this study is to report a rare case of Pancreatic Tuberculosis in an immunocompetent Filipino, Male.

Methodology & Theoretical Orientation: A literature search and review was done to extract information about Pancreatic Tuberculosis’ prevalence and incidence, diagnostic approach and treatment approaches considering both international and local guidelines.

Findings: Pancreatic tuberculosis is a rare condition that can present mimicking signs and symptoms of pancreatic malignancy and in abdominal imaging as pancreatic mass. It occurs in the setting of miliary tuberculosis, most frequently in immunocompromised patients, very rarely in immunocompetent. Pancreatic tuberculosis was first reported in 1944 by Auerbach et. al. His study of 1656 autopsies revealed 14 cases with pancreatic involvement but none with isolated pancreatic tuberculosis.6 Reported cases of Pancreatic tuberculosis from 1966 to 2004 in a MEDLINE search of English language articles around 116 cases of pancreatic tuberculosis were identified. From 2005 up to 2014, based on PUBMED search using the MeSH terms “Tuberculosis” and “Pancreas” including literature from English and other languages, there were 49 case reports and 11 case series which include about 164 patients identified. From 2015 until 2018, using the same search engine, there were 5 case reports and 1 case series(5 cases). Based on Google Scholar search, there were 6 cases of pancreatic tuberculosis reported and published.

Conclusion & Significance: Pancreatic tuberculosis is a rare infection most especially in an immunocompetent host. It must be considered in patient presenting to have signs and symptoms of pancreatic malignancy and with radiographic findings of pancreatic mass. It is must be entertained in patients living in areas where Tuberculosis infection is endemic. The treatment of Pancreatic tuberculosis is straightforward and follows treatment protocol for extra-pulmonary tuberculosis infection. It is therefore necessary to confirm diagnosis histologically because response to therapy is predictable and complete with full compliance to regimen. 

Costin Aurel Militarul is having more than 20 years of clinical practice. The complicated cases of frail patients with debilitating pathologies including infections with antimicrobial resistance (AMR) germs that he encountered during his clinical practice fueled his interest in the collaboration with scientists developing chicken imunologically active protein (CIAP) products.

Introduction: Infections with antimicrobial resistance (AMR) germs are a strong concern of present medical practice, imposing a stringent need for efforts to identify alternative treatment approaches. Chicken Immunologically Active Proteins (CIAP) including Immunoglobulin (Ig)-Y represent powerful tools obtained from the eggs of chickens immunized with antigens of the hospital-isolated AMR germs (1-3). This study presents the use of CIAP in AMR infections of bones, joints and soft tissue in Romanian patients. 

Patients group: We have performed a study on 8 patients (6 male and 2 female) aged 43 to 72 years with AMR infections of bones, joints and soft tissue of the lower limbs and with diverse superposed debilitating pathologies (uncontrolled diabetes mellitus, high blood pressure, atheromatous arteriopathy) that were treated orally and topically with CIAP. Patients were subjected to thorough medical investigations including haemoleucogram, inflammatory markers, glycemia, liver and kidney function tests, vascular imaging, lower limb radiographs, microbiological culture from wounds and pus collections. In diabetic patients, glycemic control was acquired by insulin or oral antidiabetic drugs administration and in one patient the blood flow to the affected lower limbs was restored by axillary-bi-iliac by-pass. Orthopedic surgery was performed in order to correct bone and joints pathology.

Results: The evolution was favourable after orthopedic surgery in all patients treated orally and topically with CIAP in the absence of any simultaneous antibiotic treatment, thus salvaging the affected inferior limbs. CIAP treatment led to buildup of

bone, remodelling of soft tissue and recovery of independent ambulatory capabilities. The obtained results are very suggestive of the immunomodulatory actions and treatment potency of CIAP products in infections with AMR germs in humans

Nidia Leon-Sicairos has her expertise in evaluation of proteins and peptides with antimicrobial and antitumoral activities such as lactoferrin and derived peptides. Her research is focus in to describe the mechanism for which lactoferrin and its peptides exert its microbicidal and antitumoral effects in vitro and in vivo. The pathogens and tumoral cells target for these studies are those that cause infections in immunosuppressed patients, and in cells derived from leukemia, mama and lungs. The idea is to have new compounds that can help to patients in the fight against cancer and infections linked to this group of diseases.

Salmonella enterica is a Gram-negative bacterium responsible of salmonellosis, a gastrointestinal infection that causes 550 million cases each year, from which 220 million are children less than 5 years. In fact, S. enterica is one of four major etiological agent of diarrhea; worldwide. To cause infection, this bacterium contains a lot of virulence factors such as capsule, lipopolysaccharide, enterotoxins, and the capacity to forms biofilms. It has been reported that biofilm structure protects Salmonella from immune system cells and antibiotics action. Therefore, the development of new antimicrobials and anti-biofilms agents to combat salmonellosis are needed. In this work, we investigated the bactericide and biofilmicide effect of bLF and the peptides Lactoferricin17-30, D-Lactoferricin17-30, Lactoferrampin265-284, D-Lactoferrampin265-284 and LFchimera on Salmonella enterica. Materials and Methods: Strains of Salmonella enterica were incubated with bLF, LFcin17-30, D-LFcin17-30, LFampin265-284, D- LFampin265-284, LFchimera and gentamicin in different concentrations during 2 h. Then, the viability of cultures was assessed by determination of colony forming unit/ml. To form biofilms, strains of Salmonella were incubated for 12 (mature) or 8 (immature), and then; biofilms were treated with bLF, LFcin17-30, D-LFcin17-30, LFampin265-284, D-LFampin265-284, and LFchimera, during 4 and 6 h. The effect of treatment on biofilms was assessed by colony counts (CFU/ ml) and by Live/dead biofilms vitality kit. In addition; biofilms were visualized by florescence microscopy and fluorescence was measured. Results: bLF and synthetic peptides shown bactericide effect on salmonella, but bLF and LFchimera presented a greater effect. On the other hand bLF and LFchimera affected immature biofilms, but only bLF disrupted mature and established biofilms. Based in our results LF and LFchimera are alternative approaches that could prevent Salmonella colonization of the human host and perhaps against salmonellosis.

Ionel Victor PătraÅŸcu MVD, PhD president of Activeimmunity, born on February 7, 1937. Graduated in Veterinary Medicine in Bucharest in 1963. Researcher in the field of virusology at Pasteur Institute in Bucharest. Made different specializations in the field of avian and human oncogenic viruses at Houghton Poultry Research Station, Huntington, England, at Friedrich-Loeffler- Institut, Celle, Institute of Animal Pathology in Rotherdam, Netherlands, Cornell University Ithaca NY and Athens University, Athens, GA. USA. Tudor Georgescu is specialized in Oral and Maxillo-facial Surgery, in orthognathic surgery and cranio-facial reconstructive surgery. Currently he is the Director of the Romanian Medical Association -TELEMED Program -author of the “Convergent Telemedicine Concept” and co-author of the “Computerized Integrated Information Management Platform”.

Activeimmunity specialists, due to having extensive experience in the field of antibiotic resistance, have produced different generations of antimicrobial biologicals using hen as the immunized organism and the hyperimmune egg as the source of immunologically active proteins. The first generation of products were prepared using the I-PC-2 immunogens and the following generations using the I-SPGA and I-Gary immunogens. The “standard” biological products obtained from hyperimmune eggs contain up to 24 types of antibodies originating from immunization of hens with hospital-collected germs and are used in medical programs for the prevention and treatment of infections with susceptible or antibiotic resistant bacteria. The second category of biological products, the “personalized” ones, are prepared from samples of pathological material harvested from individual patients The idiotype (Id) of an antimicrobial resistant bacterium (ARB) is a unique collection of antibodies produced by the immunized organism against the bacterial antigenic determinants called idiotopes. An idiotype is specific to a particular ARB strain that immunized the organism. Despite being proteins of the humoral immune system, the idiotypes (Ids) can be immunogenic. For this reason ARB-specific Ids have been exploited as therapeutic immunogens in the treatment of specific ARB infected patients. The authors are not aware of documented studies describing the use of hyperimmune eggs targeting antibiotic-resistant bacteria as oral anti-idiotypic vaccine in human beings. We supported this hypothesis by demonstrating the capacity of human beings orally fed hyperimmune eggs to induce systemic immune responses against the same idiotype (active immunity by passive immunity). The first set of study was to demonstrate that chicken that were immunized with the inactivated antimicrobial-resistant bacteria (ARB) produced specific anti-ARB antibodies; the second set of study was to demonstrate that ARB-infected patients presenting clinical symptoms, after being fed anti-ARB hyperimmune eggs developed antibodies that were able to inhibit the binding of egg yolk anti-ARB antibodies to the ARB (original antigen), showing that the anti-ARB antibodies raised in human beings after feeding, were anti-anti-idiotypic antibodies [1,2]. The samples of bacterial strains and cells were collected as skin-scrapings, prostate, urine or sputum samples from clinically affected subjects. Moreover, nasal swabs were taken to determine the nasal colonization with Staphilococcus aureus. These samples were processed in the laboratory and used for immunization of specially bred chickens for this program. The immune response of the immunized chickens was controlled by blood and egg samples. The chicken immunologically active proteins (CIP) were isolated from the hyperimmune eggs and were then used for the treatment of the particular patients from which the pathological materials originated. These technologies have been carried out for the first time in the world and they prove that personalized biologic products may act specifically and efficiently in case of infections with specific pathogenic germs sensitive or resistant to antibiotics. These new personalized biological products may replace antibiotics which have been proved inefficient

in each patient. The treatment with the hyperimmune egg and with the products extracted from it was well tolerated by patients for a long period of time (at least 12 months). Activeimmunty has a telephone call center and a group of specialists who are available for information, a clinic and laboratories specifically designed for this program, in order to prepare the described personalized biological products.

Statement of the Problem: The emergence of multidrug resistant bacteria in urinary tract infections (UTIs) is a challenge to medical professionals. According to ECDC (2018), more than a third of K. pneumoniae and half of E. coli strains reported were resistant to at least one of the antibiotics under surveillance. Moreover, the emergence of Colistin resistance among Enterobacteriaceae leave few therapeutic options against these”superbugs”. Thus, immunological active proteins (IAP) have emerged as a potential therapeutic agent.

Material and methods: In this study, CIAP (egg proteins: IgY, holo-ovotransferrin, ovomucin, ovoalbumin and lysozyme) were obtained from Rhode Island red chickens immunized with antigens from E. coli, Klebsiella pneumoniae, Enterococcus spp, Pseudomonas sp, Proteus sp, Candida sp, and MRSA strains. 90 patients were included in the study, 87 of them compliant with the treatment; 20 were inpatients and 67 outpatients at Teaching Hospital of Nephrology dr.Carol Davila, Bucharest. 65% of them were known to have recurrent UTIs. The etiology of the UTIs: 68% E. coli, 12.6% multiple bacteria, 11.5% Klebsiella, 7.9% others. 35% of the isolates were MDR. CIAP efficiency was demonstrated in vitro by: quantitative assay for Chicken IgY ELISA Kit - ABCAM, rapid and slow agglutination test and bacterial growth inhibition test - HB&L ALIFAX (IAP + live bacterial cultures). CIAP were administered at diagnosis together with antibiotics, and as follow-up treatment for an average of 2 months. 

Results: 8 patients were non-responsive (7F+1M), 79 were responsive as follows: 90% of the patients were cured with no recurrence, 10% had one recurrence during the study. For these patients, personalized treatment was made, using the strain isolated by urine culture after recurrence; the new treatment was curative.

Conclusion: Preliminary results reveal the possibility of using passive immunity to stimulate the active immunity in preventing infection recurrence and antibiotic resistance.

Introduction: According to Jerne’s network theory, antibodies contain in their variable region a representation of the ‘universe’ of antigenic structures, the idiotype. It is possible to induce antibodies against the antigen-binding site of other antibodies (2-6); these new antibodies, called anti-idiotypic (Ab2B), can be used to manipulate the immune system (1,5,6). They have been successfully used in the induction of humoral immune responses against several antigens including bacteria and viruses (2,3,5,6). Chicken Immunologically Active Proteins [CIAP] including Immunoglobulin (Ig)-Y, that are produced by immunizing chickens, have further advantages compared with mammalian IgG (1,2,5,6). This study investigates the use of the chicken and egg system for the development of an immune response against antimicrobial resistance (AMR) bacteria.

Methodology: Stage I: Brown leghorn chickens were immunized with I-spga immunogen which contained antigens from more than 20 inactivated AMR bacteria. Indirect ELISA was used to measure anti-bacterial antibody titers in the watery soluble fraction of eggs up to 14 weeks after the third immunization. Stage II: chicken groups have been formed that have individually consumed yolk or white egg from either hiperimune eggs or from eggs produced by unimmunized chicken. At the end of the experiment, presence of antibodies against original AMR bacteria was checked by ELISA in blood samples and eggs of birds used in the Stage II of the experiment.

Results: Antibodies against AMR bacteria were detected only in the blood and eggs of chicken that consumed hiperimmune eggs; these antibodies inhibited the growth of AMR bacteria in vitro.

Conclusion: The results of this study suggest that eggs from immunized hens could be considered as a CIAP source in the management of AMR infections. The chicken and egg system is a potential and novel approach for the development of antiidiotypic vaccines that could prove useful in the treatment of microbial infections.

Violeta Ionescu obtained DVM and PhD degrees in Veterinary Medicine from the University of Agronomic Sciences and Veterinary Medicine in Bucharest, Romania. Her focus and publications during doctoral studies targeted veterinary parasitology.Due to her interest in the One Health concept, she joined the group of Romanian scientists at Activeimmunity, Bucharest led by company president, Dr. Ionel Victor Patrascu, a well-known specialist in virology and vaccinology, that develop alternative immunological approaches for infections with antimicrobial resistance (AMR) microorganisms in humans. Her work also targets novel immunomodulatory approaches in psoriasis.

Introduction: Psoriasis is an inflamatory condition of the skin, of which chronic plaque psoriasis is the most common form (1). Psoriasis is associated with alteration in the composition of skin bacterial biota (2). Staphylococcus aureus (3), group A Streptococcus and Streptococcus pyogenes are involved in psoriasis pathogenesis in genetically predisposed individuals (2,4-6). S. aureus colonization of lesional skin was associated with a significantly higher PASI (Psoriasis Area Severity Index) score, even more evident when isolated strains were toxigenic (5,7).

Methodology: This study aimed to investigate the prevalence of infections with pathogenic bacteria in psoriasis plaques. For this purpose, randomly selected patients with plaque psoriasis were tested for bacterial infections in skin lesions using conventional microbiological methods.

Results: S. aureus was cultivated in 75 of the 205 samples (36.6%), while methicillin-resistant S. aureus (MRSA) was identified in 45 of 205 samples (21.9%). Other Gram–positive and Gram–negative cocci and bacilli were cultivated from psoriasis plaques: Staphylococcus spp. (representing coagulase negative staphylococci – S.Co.N.) in 122 samples (59.5%), Bacillus/Paenibacillus spp. in 58 samples (28.3%), Streptococcus spp. in 25 samples (12.2%), Enterobacteriaceae in 19 samples (9.3%) (of which Klebsiella spp. was present in 4 samples, Enterococcus spp. in 3 samples, and Escherichia coli in 2 samples, representing 2%, 1.5% and 1%, respectively), Enterococcus spp. in 14 samples (6.8%), non-fermenting bacteria in 14 samples (6.8%) (including Pseudomonas aeruginosa which was cultivated in 2 samples, 1% respectively), and Corynebacterium spp. in 7 samples (3.4%).

Conclusion: Gram-positive bacteria were the most frequently found bacteria in psoriasis plaques. Of them, S. aureus was the most prevalent, represented especially by MRSA strains. This study is intended as a warning about the necessity of evaluating bacterial infections in psoriasis plaques, in order to clarify the connection between skin infection and onset or worsening of psoriasis pathology.