Concurrent Sessions S9 baumannii infections. Tigecycline, a glycylcycline antibiotic, is active against A. baumannii and it has been used in the treatment of VAP caused by this pathogen in some countries or regions. CS5-03 MDR, XDR, and PDR Gram-Negative Bacterial Infections: An Evolving Global Public Health Problem Matthew E. Falagas *. Director, Alfa Institute of Biomedical Sciences, Athens, Greece; Adjunct Associate Professor of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA The advanced antimicrobial resistance of Gram-negative bacilli (mainly A. baumannii, Pseudomonas aeruginosa, and extended spectrum beta-lactamase producing Enterobacteriaceae, includ- ing Klebsiella pneumoniae) has become a global public health threat. The intrinsic or acquired antimicrobial resistance in these clinically important pathogens is mediated with various mech- anisms (production of beta-lactamases and/or enzymes inacti- vating aminoglycosides, efflux pumps, lower permeability of the outer membrane, mutations in antibiotic targets, etc.). Broad- spectrum beta-lactam antibiotics have been considered the first choice for the treatment of patients with multiple drug resistant A. baumannii and Pseudomonas aeruginosa infections. However, the worrisome pattern of increasing antimicrobial resistance of these pathogens has led to re-evaluation and use of intravenous and aerosolized polymyxins (mainly colistin) in various parts of the world. In addition, various agents with novel mechanisms of antibacterial action have been investigated, although there are no available clinical data regarding their effectiveness and safety. Also, the developments in the advancing pattern of antimicrobial resistance of Gram-negative bacilli has been asso- ciated with the use of a diversity of definitions of multiple drug resistant (MDR), extensively drug resistant (XDR), and pandrug resistant (PDR) pathogens on which we have commented (Falagas ME et al. Clin Microbiol Infect 2005;11:1049, J Med Microbiol 2006;55:1619, and Clin Infect Dis 2008;46:1121). Considering various issues, the terms “pandrug resistance”, “extensive drug resistance”, and “multidrug resistance” should designate resis- tance of a pathogen to all, resistance to all but 1 or 2, and resistance to at least three, respectively, classes of antimicrobial agents, among those that are available at the time of use of the definition in most parts of the world and are regarded as potentially effective against the respective pathogen. Concurrent Session 6 – Parasitology and Tropical Infectious Diseases CS6-01 Leishmaniasis as a Neglected Tropical Disease in the World, Eastern Mediterranean Region and Iran Hossein Nahrevanian *. Department of Parasitology, Pasteur Institute of Iran, 69 Pasteur Avenue, Tehran, Iran Background and aims: Leishmaniasis is caused by parasitic proto- zoa of the genus Leishmania; humans are infected via the bite of phlebotomine sandflies. It is prevalent in 88 countries, affecting an estimated 12 million people with approximately 2 million new cases per year, 500,000 of which are Visceral Leishmaniasis (VL) and l,500,000 Cutaneous form (CL), representing a significant rank among communicable diseases. Moreover, Leishmania/HIV coinfection has been reported in 35 countries worldwide. There are four main types of the disease: In CL, skin ulcers usually form on exposed areas, which usually heal within a few months, leaving scars. Diffuse cutaneous leishmaniasis (DCL) produces disseminated and chronic skin lesions resembling those of lep- romatous leprosy which is difficult to treat. In muco-cutaneous form (MCL), the lesions can partially or totally destroy the mucous membranes of nose, mouth and throat cavities and sur- rounding tissues. VL is characterized by high fever, substantial weight loss, swelling of the spleen/liver and anaemia with high fatality rate within two years. The aim of this study is to analyze current situation of leishmaniasis as a neglected tropical disease in the world, Eastern Mediterranean Region and Iran. Methods: The global burden of leishmaniasis was discussed with respect to financial and political impacts; relation to poverty; stigma of pathologies; effective implemented tools, available re- sources and lack of input from pharmaceutical and biotechnology companies to develop new drugs and vaccines. Criteria by which different types of leishmaniasis could be prioritized as target disease were set. These criteria included: incidence, prevalence and severity of the disease, lack of response to available drugs; the impact of treatment of individuals on control of transmission and lack of other major parties involved in drug development. There are no adequately effective therapies, but some encour- aging results have been obtained with immuno-modulators plus antimonials and herbal extracts. Immunogenicity clinical trials are currently ongoing with whole killed Leishmania parasites, second generation and DNA vaccines. Results: According to the current data, the overall inci- dence/prevalence rates, and social/financial burdens of leish- maniasis are high. The analysis of published trials indicates that the available drugs are inadequate; the quality of most trials is poor and requires both improvement and standardization. The mechanism for controlling Leishmania infection to reach a stable self healing process is a balanced immune response, however immune stimulation during chemotherapy can enhance cure. Conclusions: Neglected tropical diseases are a symptom of poverty and disadvantage. With little political voice, neglected leishmaniasis has a low profile and status in public health pri- orities. In addition, the problem of Leishmania/HIV coinfection is spreading to the countries that are the world’s major foci of leishmaniasis. There is an urgent need for new treatments for all leishmaniasis. Immuno-chemotherapy with therapeutic vaccines or immunomodulators has a strong potential to make an impact as a new therapy with shortening duration and reducing dose of drug treatment and preventing resistance. There is also a need for safe, affordable and efficacious novel chemotherapeu- tics. The quality of clinical trials needs to be enhanced and standardized. CS6-02 Spatial and Temporal Distribution of Falciparum Malaria in China Hualiang Lin 1,2,5,# , Liang Lu 1 § , Linwei Tian 2 , Shuisen Zhou 3 , Haixia Wu 1 , Yan Bi 4 , Suzanne C. Ho 2 , Qiyong Liu * ,1,5 . 1 Department of Vector Biology and Control, National Institute for Communicable Disease Control and Prevention, China CDC, Beijing, China; 2 Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Hong Kong SAR, China; 3 National Malaria Office, National Institute for Parasitic Diseases, Shanghai, China; 4 Yunnan Center for Disease Control and Prevention, Kunming, China; 5 State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China # These authors contributed equally to this work Background: Falciparum malaria is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China. This paper aimed to analyse the geographic distribution, demographic patterns and time trends of falciparum malaria in China. Methods: The annual numbers of falciparum malaria cases dur- ing 1992-2003 and the individual case reports of each clini- cal falciparum malaria during 2004-2005 were extracted from communicable disease information systems in China Center for