My track at ICAAC 2015(Sessions and Abstract Selection)

José Ramón Paño-PardoDivision of Infectious DiseasesHospital Clínico Universitario

Zaragoza, Spainwww.proantibioticos.comSeptember 29nd, 2015

Outline• ICAAC 2015 Facts and Figures • ICAAC Keynote and other “classical” sessions• Most relevant sessions and abstracts by topic

- CPE

- Bloodstream infections

- Clinical infectious diseases (syndromes)

- Antimicrobial Stewardship

- New antimicrobials

- Clinical Microbiology

- PK/PD

(S-1350) The National Antimicrobial Prescribing Survey: enabling greater regional and remote hospital participation

ICAAC 2015 Facts and Figures

Q: What did* ICAAC stand for?

A: Interscience Conference on Antimicrobial Agents and Chemotherapy

*Last ICAAC, as we all know it

ICAAC was the main ASM* conference:

• ASM + 40.000 members: one the largest (if not the largest) scientific

societies

• Multidisciplinary: Microbiologist, Infectious Diseases specialists,

PharmD and pharmacologists, biologists….

• Attendees:

ICAAC 2015 Facts and Figures

*ASM: American Society for Microbiology

ICAAC was losing appeal as compared w/ its previously back-to-back competitors:

ECCMID y IDSA

• 2015 ≈ 5,000 • 2014 ≈ 6,000

• 2013: 5400 (126 españoles)

• Traditionally: +10,000

ICAAC 2015 Facts and Figures • Medical Conference (especially ID) business model is

coming to an end- Regulatory limitations to the relationship healthcare industry and healthcare professionals…

- Antibiotics are not the most profitable drugs

- Information flows much much faster than some years ago

• but some are still trying to kill a goose that lays golden eggs

$250 early-bird ratePictures at conference forbidden (to enhance business)

- High registration price + Extras -6 hour-pre-ICAAC course: $375)

- Video scam: Slides/video library not included (as opposed to ECCMID)

San Diego Convention Center

Friday, Sept 18th

(001) Infectious Diseases 101: For Fellows Age 18-88

• Four topics

• 2-hour (07:00-09:00) interactive session (Poll everywhere®)

Antimicrobial stewardship

Tropical Infectious DiseasesP. knowlesiStrongyloidiasisMyasis and other skin problemsKatayama feverPreparedness (Ebola)

HIV

Friday, Sept 18th

(002) Keynote Session: Barbara Murray

The Enterococcus: A Tale of Survival and Success of a Second Rate Pathogen

• Comprehensieve review on the controversial topics regarding Enterococci (Epidemiology, pathogenicity and therapy)

(003)ICAAC Lecure: Keith Klugman

Pneumococcal Disease: Past, Present and Future

Friday, Sept 18th(029) Literature Review

Emerging Viral Diseases (Robert Bonomo)

• 2-hour full-speed must session

Pediatric and Vaccines (Morven Edwards)

Multi-drug resistant microorganisms (DL Paterson)

HIV (Jean Michelle Molina)

Selected articles (See handout here)Clinical Microbiology (Romney Humprhies)

Topics

Antimicrobial Stewardship #ABS• #ABS seems to be on the rise: New category (S)

(074) The Most Efficient Interventions to Reduce Antimicrobial Consumption in my Hospital (09/19 08:30-10:30)• % patients on antibiotics (K. Thursky)• De-escalation (L. Abbo)• Duration (P. Tattevin)• To Assess/Address Incorrect Use (A. Ghafur)

(132) Avoiding Common Pitfalls in Designing Healthcare Epidemiology Studies (09/20 07:00-08:15): Meet the Experts

• D Morgan/J JacobsQuestionOutcomesConfoundingIRB

Antimicrobial Stewardship #ABS• We need tools to better assess the impact of

interventions (and to enhance #ABS)

* Methodology to assess the quality of antimicrobial use

(S-1350) The National Antimicrobial Prescribing Survey: enabling greater regional and remote hospital participation

(S-1355) The Appropriateness of Antimicrobial Prescribing in Australian Hospitals

(Digression)

Antimicrobial Stewardship #ABS• Need to merge efforts: #ABS should be comprehensive

(S-1339) Surviving Sepsis and Antibiotic Stewardship: Competing Patient Safety Initiatives

Antimicrobial Stewardship #ABS• ABSSSI -> High in the list of US priorities

(S-1329) #ABS Opportunities in Patients Hospitalized for Acute Bacterial Skin and Skin Structure Infections (ABSSSIs)

(S-1331) A Retrospective Review of Emergency Department (ED) Antibiotic Prescribing Patterns for Skin and Soft Tissue Infections

(S-1334) Multicenter Study of Antimicrobial Treatment in Admitted (ADM) vs Not Admitted Patients with Acute Bacterial Skin And Skin Structure Infection

- Scores to better allocate patients (Outpatient/ED/Hospitalization)- Opportunity to decrease antibiotic pressure

(S-428) Impact of Antimicrobial Stewardship Programme (ASP) on Outcomes in Patients with Skin and Soft Tissue Infections (SSTIs) in a Tertiary Hospital

(S-925) Risk Assessment and Severity Analysis in Acute Bacterial Skin and Skin Structure Infections (ABSSSIs)

Clinical Microbiology• Blood, blood, blood!!!

(143) Rapid Identification of Pathogens in Sepsis: From Blood To Bug

• Blood cultures: Best practice (Dr. Veinstein)

• Novel Identification Technology for Flagged Positive Blood Cultures (Dr. Ozenci)

• Direct Detection of Microbes in Septic Patients (vanden Bande)

• Economic and Stewardship Benefits of Rapid Diagnostics of Sepsis (Dr. Riedel)

2h session (09/22 08:30)

(143) Rapid Identification of Pathogens in Sepsis: From Blood To Bug

Dr Ozenci

Clinical Microbiology (+ #ABS)

(S-897) Antimicrobial Stewardship Combined with MALDI-TOF and β-Lactam Test Performed on Gram-Negative Bacilli Blood Culture is Effective for Sparing the Use of Carbapenems

+ BC -> 3h subculture -> MALDI + rapid-ESBL

(S-901) Fast Bacterial Identification by Mass Spectrometry in Blood Culture Broths for Bacteriemic Patients Allows for Quick Adaptation of Empirical Antibiotic Treatment

(D-224) The Spectrum of Unidentified Bacteria/Yeast by MALDI-ToF MS in a Clinical Microbiology Laboratory• 100/10.000 -> 23 genus/48 species• Candida tropicalis (10), Escherichia coli (10), Klebsiella pneumoniae (9),

Pseudomonas aeruginosa (7), and Rothia mucilaginosa (7)

Clinical Microbiology

(S-905) Evaluation of Performances of Practices in French Microbiology Laboratories: Discrepancies Between Laboratories and Intensive Care Departments

(D-704) T2candida is More Sensitive and Rapid Than Blood Culture for Detecting and Monitoring Invasive Candidiasis in Proven Cases of Infection

T2CandidaPanel

(206) Microbiology Metrics Following Moving to an Offsite Core Laboratory and Potential Effect on Patient Care

Bloodstream infections

Comparing Clinical Outcomes in Patients Treated With Cefazolin Versus Nafcillin for Methicillin Susceptible Staphylococcus aureus Bacteremia Secondary to High-Inoculum Infections(C-1067) Epidemiology of Cefazolin-Inoculum Effect Positive Methicillin-Susceptible Staphylococcus aureus Bacteremia in Korea: A Nationwide Multicenter Study• Cefazolin inocculum effect: around 20%

(A-458) Oxacillin Minimum Inhibitory Concentration and Flucloxacillin Treatment Outcomes in Staphylococcus aureus Bacteremia

(B-521) Age-Related Gender Differences in Cytokine Response and Outcomes of Patients with Staphylococcus aureus Bacteremia

(L-343) Impact of Socioeconomic Status on Host Immune Response and Outcomes of Staphylococcus aureus Bacteremia

Bloodstream infectionsErtapenem vs Other Carbapenems for the Treatment of Bloodstream Infections Due to Extended-spectrum β-lactamase-producing Enterobacteriaceae: A Multinational Pre-registered Cohort Study

• Multinational retrospective cohort (12 countries; 37 hospitals) • Patients with monomicrobial BSI due to ESBL-E (2004-2012)

Therapy Clinical cure/improvement

30-day mortality

Early empiric therapyErtapenem (32) vs other (163)

90.6% vs 75.4%1.87 (0.24-20.08)

3.1% vs 23.3%0.27 (0.02-4.03)

Targeted therapyErtapenem (205) vs other (504)

89.8% vs 82.6%1.04(0.44-2.50)

9.3% vs 17.1%0.93 (0.43-2.03)

“These results reinforce the idea that ertapenem should be considered an alternative to other carbapenems for treating such infections”

Bloodstream infections(C-178) Is Ertapenem as Efficacious as Other Carbapenems for Infections Due to ESBL-producing Enterobacteriaceae in All Subgroups of Patients?

• Sensitivity analyses using multivariate logistic regression, propensity score and CART analyses were performed in different subpopulations (30-d mortality)

• Sensitivity analysis favors other carbapenems in patients with septic shock/severe sepsis (HR: 3.10; 95% CI: 0.86-11.20)

• In patients receiving ertapenem, renal failure was a protective factor for 30-day mortality (mortality, 0 vs 27.8%;p=0.08)

• Caution is needed when using ertapenem in cases of severe sepsis/septic shock in BSI due to ESBL-E

Conclusions

• The fact that renal failure have a protective effect for mortality in these patients might be due to increased ertapenem exposure in this population

Carbapenemase-producing Enterobacteriaceae

(35) Carbapenemases: Knocking on Hell’s Door

• Worldwide Spread of Carbapenemases: Update 2015 and Future Prospects (Dr. Pittout)

•Rapid Detection of Carbapenemase-Producers (Dr Limbago)

• Antibiotic Stewardship to Help Limiting the Spread of Carbapenemases

• Latest News in the Treatment of CPE (Dr Daikos)

Antibiotic Stewardship to Help Limiting the Spread of

CarbapenemasesJosé Ramón Paño-Pardo

@joserrapaHospital Clínico Universitario

Zaragoza, Spain

New Antimicrobials

Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11

New Antimicrobials: BLI

Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11.

Drug In vitro activity Comments

Ceftazidime+

Avibactam(CAZ/AVI)

Ceftazidime Plus:• ESBL• AmpC• KPC• OXA-48

ICAAC 2015: (C-138)

• Non inferiority cUTI & cIAI• FDA approved• Available in Spain (Expanded access:

€12,000/course)• Non active against MBL

Ceftaroline+

Avibactam

Ceftriaxone Plus• MRSA• ESBL• AmpC• KPC• OXA-48?

• Non active against non-fermenters (A. baumannii and P. aeruginosa)

• Phase 2 trial vs doripenem (cUTI)

Aztreonam+

Avibactam

Aztreonam Plus• KPC• Class D (OXA-48)

• Hydrolyzed by ESBL (class A) and AmpC• Phase 1 trial (safety): completed

• Limited activity against MBL (class B carbapenemases): Partial/transient solution

New Antimicrobials: BLI

Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11.

Drug In vitro activity Comments

Imipenem+

Relebactam

Imipenem Plus:• ESBL (both)• AmpC (both)• KPC• OXA-48

ICAAC 2015: (F-259)

• Remains inactive against MBL• Phase 2 trials cUTI and cIAI ongoing

Meropenem+

RX7009(serine beta-

lactamase inhibitor = anti-

KPC)

Meropenem Plus• KPC• OXA-48?

ICAAC 2015: C-152

• Phase 3 clinical trials:- cUTI- Severe infections (VAP, HAP, BSI) caused

by CRE

• Limited activity against MBL (class B carbapenemases)

New antimicrobials: new carbapenems

Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11.

Drug In vitro activity Comments

Razupenem• ESBL• MRSA• VRE

• Less active against AmpC and carbapenemases

• Phase 2 trials cUTI and cIAI ongoing

Tebipenem/pivoxil • novel oral carbapenem developed for the

treatment of upper respiratory tract infections OMG!!!

Tomopenem• Ceftazidime-R

P. aeruginosa

New antimicrobials: new cephalosporins

Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11.

Drug In vitro activity Comments

Ceftolozane/

Tazobactam

Cefztazidime + side chain• Enhanced

antipseudomonal actvity (PBP mutations and efflux pumps): x8 more active than doripenem

• ESBL, AmpC, KPC?• ICAAC2015: C-156b

• It is NOT active against class B carbapenemases

• Phase 3: superior to levofloxacin for cUTI and non-inferior to meropenem for cIAI

• FDA-approved in Dec 2014

CeftarolineCeftriaxone +:• MRSA

• FDA and EMA approved• Phase 3 trial: CAP• BSI: (B-079)• Pneumonia: (B-081)

CeftobiproleCeftriaxone +:• MRSA • EMA approved:

New antimicrobials: new quinolones

Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11.

Drug In vitro activity Comments

Delafloxacin • Enhanced activity against E.coli and K. pneumoniae

• Low potential for resistance selection (dual target)

Fenafloxacin• Enhanced activity against

E.coli and K. pneumoniae and P. aeruginosa

• FDA and EMA approved• Phase 3 trial: CAP

New antimicrobials: new tetracyclines

Everacycline• Enhanced activity as

compared with tigecycline (same spectrum) (C-619, C-563 )

• Phase 2 study (cIAI)

Clinical Infectious Diseases: PK/PD

112 Emerging Antimicrobial Combinations from the Pharmacokinetics/Pharmacodynamics (PK/PD) Laboratory

• Quantifying Antimicrobial Interactions (W Greco)

• Daptomycin, Glyco/lipo Peptides & Beta-Lactams against S. aureus (M Rybak)

• Combinations for MDR Gram-Negative Pathogens (D. Wareham)

• Advances in Combination Therapy against Fungi (J Meletiadis)

Clinical Infectious Diseases: syndromes

(K-311) Clindamycin for the Management of Orthopedic Devices Infections: A Retrospective Observational Study

(L-1253) Oral Fosfomycin for the Treatment of Chronic Prostatitis