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The view from ESCMID Global 2024: AI, climate change and AMR

The European Congress of Clinical Microbiology and Infectious Diseases is one of the largest annual global gatherings of experts focused on a single topic. This year it has rebranded, emerging as the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Global congress. Here, Gerry Hughes reports on the key themes and highlights from the congress such as AI, climate change and AMR.

With hundreds of invited speakers, the ESCMID Global 2024 gathering in Barcelona, Spain (27-30 April), welcomed approximately 16,000 delegates for five days of knowledge exchange, collaboration and innovation.

As in previous years, antimicrobial resistance (AMR) was a topic of concern among speakers and delegates alike, with issues such as artificial intelligence (AI) and climate change also high on the congress agenda.

Navigating artificial intelligence: opportunities and pitfalls

  • Deploying AI in infection management

During ESCMID Global, an entire study day was dedicated to exploring the intersection of data science, machine learning and infection management. While AI is not a new concept, several presentations explored the use of large language models (LLMs) in clinical practice, which is showing increasing promise.

Dr Raksha K. Bhat, head of department – central laboratory and consultant microbiologist and infection control officer at St Martha’s Hospital, Bengaluru, India, showcased her work with ChatGPT in the clinical microbiology laboratory.

By evaluating Gram stain reports from over 7,200 retrospective sputum samples, ChatGPT was tasked with providing clinical management recommendations. Measuring five qualitative aspects – including accuracy and clinical relevance – of ChatGPT’s performance against human evaluation of these samples, it achieved an overall assessment score of 3.5 out of 5.

Although promising, there are challenges—such as the need for specific prompts during the training of the model and the absence of guidelines for integrating emerging AI technologies into clinical practice.

Dr Bhat posed a question at the beginning of her ESCMID talk: ‘Should clinical microbiologists pack their bags?’ The results of this study suggest not yet, and that AI is currently best placed to complement, rather than replace, clinical expertise.

  • Bridging evidence and clinical algorithms

The 2024 ESCMID Lifetime Achievement Award winner, Professor Evelina Tacconelli, director of the Infectious Diseases Section at Verona University Hospital, Italy, introduced a brand new innovation in the Value-Dx Clinical Algorithm.

This collaborative effort between clinical, academic and industry stakeholders aims to curb inappropriate antibiotic use for community-acquired lower respiratory tract infections.

Leveraging machine learning and a meta-analysis of point-of-care tests, the algorithm assists clinicians in managing common respiratory infections. Professor Tacconelli envisions a future where this process is automated, seamlessly integrating evidence collation and infection surveillance data.

Her vision aligns with ESCMIDs aspiration for high-quality studies to inform clinical practice, and she anticipates AI reducing the time between study publication and guideline integration in the future.

  • The darker side: AI and misinformation

A presentation from Professor Ilan Schwartz, associate professor of medicine in the department of medicine at Duke University School of Medicine, US, took a sobering turn, highlighting AI’s potential for harm.

Opening his talk on LLMs, he noted that according to the World Economic Forum, misinformation and disinformation are currently the top short-term global risks, ahead of extreme weather events.

In a recent publication on this topic, Jin and others argue that more engagement is required between the medical, scientific and local communities, addressing issues such as trust, stigma and scientific literacy to tackle misinformation and disinformation.

Professor Schwartz highlighted the destructive capabilities of AI as reported recently in the BMJ. In that study, LLMs were successfully prompted to generate health disinformation on two topics: sunscreen as a cause of skin cancer and the alkaline diet as a cancer cure.

He also demonstrated the ease with which he could generate a ‘deep-fake’ video for free and with no training on how to use the software.

ESCMID highlights the climate change-infectious disease interface

  • Ancient pathogens and the thawing permafrost

One perhaps unexpected aspect of climate change is the increasing release of ancient pathogens to the environment. Professor Jean-Michel Claverie, emeritus professor at the School of Medicine of Aix-Marseille University, France, described his research in isolating ancient viruses from Siberian and Russian permafrost.

This frozen soil acts as an ideal preservation medium for infectious pathogens because it lacks light and oxygen. However, as the planet warms, the permafrost thaws, releasing these ancient viruses into the atmosphere.

In 2014 and 2015 Professor Claverie’s team revived a 30,000-year-old virus, leading to media attention about so-called ‘zombie viruses’. A recent publication by this team describes isolation and characterisation of 13 new viruses isolated from seven different ancient Siberian permafrost samples.

Professor Claverie advised that large-scale industrial projects near thawing permafrost areas should have on-site medical surveillance to detect any emerging pathogens. Indigenous populations in these regions should also be involved in monitoring, he said.

  • The spread of zoonotic diseases

In another talk at ESCMID Global on the interplay between land degradation and climate change, Professor Kris Murray, professor of environmental change and health, and co-director of the centre on climate change and planetary health at the London School of Hygiene and Tropical Medicine’s Medical Research Council Unit The Gambia, UK, described how climate change and biodiversity loss impact the spread of zoonotic diseases.

He showed how even small changes in temperature and rainfall can affect disease ecology, altering incubation periods and growth rates. For instance, zoonotic viruses such as dengue are finding increasingly suitable breeding and survival conditions due to climatic shifts.

Land use also plays a significant role. In south-east Asia, people working in agricultural land are more likely to be infected with disease-causing pathogens. Murray welcomed mitigating measures addressing land degradation. However, he warned that impact of these efforts varies substantially, and evidence remains scarce regarding their direct effect on reversing disease spread.

Communications in infectious diseases

In times of global crisis, like the threat of AMR or the Covid-19 pandemic, scientists and healthcare professionals play a crucial role in communicating trusted and relevant information to the public. But translating complex medical and scientific advice into friendly and easy-to-understand content is a challenge.

Professor Siouxsie Wiles, a microbiologist from the Bioluminescent Superbugs Lab at the University of Auckland, New Zealand, took up that challenge.

In her session at ESCMID Global, Professor Wiles discussed innovative ways to engage with the public beyond traditional media responses. One impactful approach of hers was teaming up with illustrators and local communities to produce messaging in graphic interchange formats (GIFs).

Joining forces with cartoonist Toby Morris, they produced GIFs on topics such as flattening the curve and the power of individual actions in infection control. Over 70 graphics, including alternatives to handshakes and explanations of mRNA vaccines, were then created and published online by The Spinoff, a New Zealand news outlet. Dr Wiles also made sure these visuals were accessible to all by sharing them under a Creative Commons license.

However, not all experiences have been positive. Dr Wiles faced abusive messages and even death threats arising from her media presence and contribution to the public debate. She highlighted the SafeScience (WetenschapVeilig) initiative, which was set up in the Netherlands to support researchers facing harassment. This sector-wide initiative allows scientists to log abuse incidents and access supportive resources.

Safeguarding public health: ESCMID and AMR mitigation

During the five-day ESCMID Global congress, a central theme emerged: the urgency to safeguard public health. This was a theme that particularly resonated with one of the keynote speakers, the British economist Lord Jim O’Neill.

Lord O’ Neill chaired the widely cited ‘Review on Antimicrobial Resistance: Tackling drug-resistant infections globally’ in 2016, which made strong recommendations on actions that need to be taken to avoid an AMR-driven public health and financial disaster by 2050.

While he lauded achievements in areas such as reductions in the antimicrobial use in certain agricultural sectors, he warned ESCMID delegates that much is still left to achieve. In particular, he underscored the integration of emerging technologies, such as AI, as a pivotal driver for AMR mitigation.

Recent data from the European Centre for Disease Prevention and Control (ECDC) stresses the magnitude of the challenge at hand. Earlier this month, the ECDC released a report based on a point prevalence survey (PPS) conducted in European acute care hospitals in 2022/23.

The survey revealed that approximately 4.3 million patients experience at least one healthcare-associated infection (HAI) annually. In microbiologically documented HAIs, 32% of microorganisms were resistant to antimicrobials. Furthermore, the prevalence of patients receiving antimicrobials in the EU/EEA sample had risen to 35.5% (with a country range of 20.8% to 56.5%), compared to the previous PPS conducted in 2016/17 (prevalence of 32.9%).

This continued threat of AMR, as highlighted by Lord O’Neill and in the ECDC report, is a stark reminder of the urgent need for action.

The ECDC report was published in the same week that the UK Government released its new policy paper ’Confronting antimicrobial resistance 2024 to 2029’, which sets out its latest five-year national action plan to support its 20-year vision for AMR.

Following ESCMID Global 2024, the infectious diseases community will now look towards the United Nations General Assembly, due to convene this September in New York, which will further address the pressing topic of AMR. Hopes are high for accelerated international action.