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Antimicrobial resistance is truly global! Impressions from ESCMID International Conference in Havana, Cuba: Antimicrobial Resistance "From Bench to Practice".


Piotr Kochan



I heard recently that antimicrobial resistance (AMR) prognostics show that by 2050 we may have AMR-related mortality in humans reaching 10 millions. Bad news is the fact that most antibiotics are used in animal production industry, so we as doctors, despite all our best efforts, may in fact be in a position of mere observers. But having all these information in my head, I think we, not only as doctors but as scientists, should unite globally, irrespective of political situation or systems. AMR conference in Cuba was on my list of interest as soon as I heard it's being organized. Thanks to online booking possibilities and a positive reply from ESCMID office, it took me 2 days to organize the journey.

My journey began well in the morning in Cracow airport, and after two transfers in Warsaw and Paris, I was sitting comfortably in the huge hull of the latest Airbus 777 flown by Air France. It was one of the best flights I had in years, with the plane being half-empty on a 10h-long journey, which made it really comfortable. I had no neighbours and could stretch my legs fully, even catching an uninterrupted nap after lunch, then waking up and watching two movies. But the bliss ended after landing in Havana and finding out that Air France lost my luggage. "How could this happen?", I kept asking myself. I personally saw the lady sticking on the right label on my bag. Furthermore the airplane was half-empty. Well, the mystery was solved when I contacted the lost luggage desk. The lady there told me: “Don’t worry sir, your bag is still in Paris. It will be here tomorrow and delivered to you the day after tomorrow”. Great. All thanks to Charles de Gaulle - I mean the airport. I was lucky enough to have taken some most important items into my carry-on, but was missing important pieces of my clothing and personal items.

From what I read in tourist guides, Cuba is one of the safest countries in the region, so I got into a taxi without any worries. When it comes to the currency exchange, I was much surprised, as already at the airport one may use automated CADECA exchange machines, with the best exchange rates for Canadian Dollars and Euros and least profitable – US Dollars, owing to extra tax. Cuba has two currencies: convertible pesos (CUC) for tourists and Cuban peso (CUP) - known as the national currency used by Cubans. An easy way to tell them apart is by looking at the shape of coins and graphics on banknotes: only CUP have national hero portraits.

The taxi driver had no problems in finding the nice private quarter in Vedado, that I booked online. There, I stayed in a pension house run by a Cuban family, resembling a huge colonial house of olden times. After getting some key information on how to get to the conference venue, it was time to sleep, as Cuba is in fact 6 hours earlier, as compared to Cracow.

The whole two day event took place from September 26 to 27 in the beautifully set, coastal Meliá Havana Hotel in Havana, Cuba (Fig. 1, 2). It was a truly global event, and besides of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) the organizers included:
- Sociedad Cubana de Mikrobiologia y Parasitologia (SCMP);
- "Pedro Kouri" Institute of Tropical Medicine (IPK);
- Ministry of the Public Health of the Republic of Cuba (MINSAP);
- Asociacion Panamericana de Infectologia (API);
- Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica (SEIMC);
- Clinical Microbiology and Infection (CMI);
- the Lancet Infectious Diseases (TLID) and
- the National Council of Health Scientific Societies (CNSCS).


figure1
Figure 1. The conference venue was Meliá Havana Hotel.
[please click on the image to enlarge]


figure2
Figure 2. The hotel's location was overlooking the Caribbean sea, surrounded by vastly beautiful, crystal-blue swimming pools.
[please click on the image to enlarge]

Contributors were made up by numerous ESCMID Study Groups, including:
  • ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS);
  • ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS);
  • ESCMID Study Group for Clinical Parasitology (ESGCP);
  • ESCMID Fungal Infection Study Group (EFISG) as well as the European Committee for Antimicrobial Susceptibility Testing (EUCAST) and European Committee for Infection Control (EUCIC).
The Scientific Committee included renowned specialists and professors in the field (Fig. 3), namely: Dianelys Quiñones Pérez (Havana, Cuba, SCMP), María G. Guzmán (Havana, Cuba, SCMP), Rafael Cantón Moreno (Madrid, Spain, SEIMC and EUCAST-ESCMID), José Miguel Cisneros, (Seville, Spain, SEIMC), John McConnell, (London, United Kingdom, TLID), Jesús Rodríguez Baño (Seville, Spain, ESCMID President), Evelina Tacconelli (Verona, Italy, EUCIC-ESCMID) and Silvio Vega (Ciudad de Panamá, Panama, API).

The programme was really intense, starting in the morning with one coffee and lunch break during the day, and continued with an afternoon session until well over 18.00. Speakers were mainly Spanish-speaking but for those that did not understand Spanish, simultaneous translation was provided, also the other way if the speaker was talking in English. This was a special event if one was interested in microbial resistance, whether an infectious disease specialist, a clinical microbiologist or public health officer.

Although Cuba is an island, antimicrobial resistance is widespread, as in many regions of the world. In general, what I learnt, is that there are some strain and drug related differences, but one may note increasing resistance to 3rd generation cephalosporins, co-trimoxazole, aminoglycosides and fluoroquinolones. Most phenotypes of resistance well known to us doctors are no strangers to Cuba. Same thing could be said about Latin America, with obvious differences between countries and islands. I remember Silvio Vega saying a few words about MRSA with 3% isolates on Jamaica and 75% (!) in El Salvador. He also mentioned KPC in Panama, NDM-1 in Guatemala and gave a nice summary of AMR in Latin America. Luckily, the field of resistance is well known to local societies and authorities in the region are conscious of the situation and are taking steps to manage and improve the problem.

Although some speakers did not get to Cuba, in general all topics were covered and all symposia manned fully. During the first day, after the official opening ceremony, the following talks were included in the programme:
1. Antimicrobial resistance: complex problem, complex solutions?
2. Symposium: The situation of bacterial antimicrobial resistance: an epidemiological overview:
(a) AMR in Cuba;
(b) AMR in the Americas;
(c) AMR in Europe, all followed by a discussion.
3. Symposium: The diagnostic revolution:
(a) Rapid diagnostic for antimicrobial resistant pathogens. Is it really possible?
(b) Diagnostic stewardship, a new kid on the block, all followed by a discussion.
4. Symposium: Established and emergent mechanisms of antimicrobial resistance in bacteria:
(a) ESBL, carbapenemases and colistin resistance in Gram negative bacteria: the big three;
(b) Resistance to aminoglycosides and fluoroquinolones in Gram negative bacteria;
(c) Emerging mechanisms of resistance in Gram positive bacteria, all followed by a discussion.
4. Symposium: Antimicrobial resistance in other bacterial pathogens:
(a) Multidrug-resistant tuberculosis: a global challenge;
(b) Antimicrobial resistance in Helicobacter pylori, a neglected problem;
(c) Resistance in bacteria causing STDs. The next pandemic? Again, this symposium was followed by a short discussion.






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figure3
Figure 3. ESCMID President - Jesús Rodríguez Baño during the opening ceremony, surrounded by co-organizers from Cuba, Spain and Latin America.
[please click on the image to enlarge]

Merit should go to the organizers for providing the opportunity to exchange knowledge between specialists from some of the very different regions of the world, i.e. Europe, Cuba and Latin American countries. This was even more possible, owing to the get together cocktail party when the first scientific day was concluded.

The next day program was just as intense as on the first conference day and included the following:
1. Symposium: Resistance in non-bacterial pathogens:
(a) Resistance in HIV, HCV and HBV: new drugs, new problems?
(b) Resistance to antifungal drugs: a silent war;
(c) AMR in malaria parasites. Where are we and where do we go from here? All were followed by a discussion.
2. Symposium: Antimicrobial susceptibility testing (AST) and clinical breakpoints:
(a) EUCAST recommendations: update and challenges;
(b) Local susceptibility testing guidelines in Cuba;
(c) The impact of PKPD for clinical decisions. Friend of foe? All were followed by a discussion.
3. Symposium: Antimicrobial resistance in the community:
(a) AMR in Mycoplasma spp.: clinical consequences;
(b) MRSA in the community;
(c) Impact of ESBLs on antimicrobial therapy for community infections, all followed by a discussion.
4. Symposium: Antimicrobial treatment for multidrug resistant bacteria:
(a) Therapy of MDR Gram negative bacteria;
(b) Therapy of MDR Gram positive bacteria;
(c) Pipeline and non-antibiotic approaches, all followed by a discussion.
5. Symposium: The fight against antimicrobial resistance: can we win this battle?
(a) Infection control for MDR/XDR bacteria. What works?
(b) Antimicrobial stewardship as a tool to fight resistance;
(c) One health approach: from WHO to Cuba, all followed by a discussion.


After certificate ceremony it was time to take some group pictures and enjoy the warm evening (Fig. 4).

figure4
Figure 4. Cuban hosts: Prof. María G. Guzmán (left) - President of the Cuban Society of Microbiology and Parasitology and Prof. Dianelys Quiñones Pérez - Head of The National Laboratory for Antimicrobial Resistance Surveillance with ESCMID President Prof. Jesús Rodríguez Baño (centre).
[please click on the image to enlarge]


As the night was young, I made a reservation to see the former Buena Vista Social Club performance and dance the night away, enjoying the Cuban hospitality. Before my flight home I still managed to tour Havana, visit the local Caribbean beach and taste some local food (Fig. 5 and 6).

figure5
Figure 5. The Capitolio in Havana looks very much like its US counterpart.
[please click on the image to enlarge]


figure6
Figure 6. The most characteristic and spectacular sight in Havana are classic American cars.
[please click on the image to enlarge]


Conclusions

The AMR conference in Cuba was a perfect opportunity not only to meet some colleagues in the field but also to learn how challenging the problem is in the global sense. AMR is beyond any political or systemic hurdle. In fact it needs strong attention from any government, irrespective of political views. Overall, the conference was a big success with high attendance rate. As the society's fellow, I am confident that the past and current Presidents are steering science in the right direction and I personally hope ESCMID will continue with the policy of global involvement in clinical microbiology and infectious diseases, not only via the biggest congress in the world, namely ECCMID, but also through smaller satellite conferences in remote locations of the globe.


Acknowledgements:
To ESCMID for the conference grant covering the conference fee.

Conflict of interest: none declared

To cite this article: Kochan P. Antimicrobial resistance is truly global! Impressions from ESCMID International Conference in Havana, Cuba: Antimicrobial Resistance “From Bench to Practice”. World J Med Images Videos Cases 2018; 4:e46-51.

Published on: 25 October 2018






































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