ICAAC 2014: Abstract and Poster Selection

Marta Mora RilloJosé Ramón Paño-Pardo

Infectious Diseases and Clinical Microbiology UnitDivision of Internal Medicine

Hospital Universitario La Paz-IDIPAZMadrid, Spain

www.proantibioticos.comOctober 1st, 2014

Outline• ICAAC 2014 Facts and Figures (JR)• ICAAC Keynote and other “classical” sessions (MM)

• Most relevant sessions and abstracts by topic- CPE- Other bacteria/Mechanisms of resistance/Virus

- Clinical infectious diseases (syndromes)- Clinical infectious diseases (hosts)- Advances in Micro diagnostic- Antimicrobial Stewardhip- Infection Control

- New antimicrobials

- PK/PD

ICAAC 2014 Facts and Figures

Q: What does ICAAC stand for?

A: Interscience Conference on Antimicrobial Agents and Chemotherapy

ICAAC is the main ASM* conference:

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

societies

• Multidisciplinary: Microbiologist, Infectious Diseases specialists,

PharmD and pharmacologists, biologists….

• Attendees

2014 ≈ 6,0002013: 5400 (126 españoles)Classically: +10,000

ICAAC 2014 Facts and Figures

*ASM: American Society for Microbiology

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

ECCMID y IDSA

ICAAC 2014 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

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

- High registration price (6 hours pre-ICAAC course: $470)

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

- Unacceptably bad IT experience (wifi connection)

Saturday, Sept 6th

Sunday, Sept 7th

• Antibiotic prophylaxis

– Timing

– Dosage

• Cefazoline: >80kg 2gr; >120kg 3gr.

• Vancomicine 15mg/kg

• Gentamicine 5mg/kg

– Re-dosign

– MRSA risk: Vanco+Cefazoline

• Chlorhexidine vs iodine povidone

Figure 1. Compliance with the bundle and its individual components in repeated measurements from June 2009 through October 2011.

van der Slegt J, van der Laan L, Veen EJ, Hendriks Y, et al. (2013) Implementation of a Bundle of Care to Reduce Surgical Site Infections in Patients Undergoing Vascular Surgery. PLoS ONE 8(8): e71566. doi:10.1371/journal.pone.0071566http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071566

Annual changes in the surgical site infection (SSI) rate and bundle compliance and the 95% confidence interval.

van der Slegt J, van der Laan L, Veen EJ, Hendriks Y, et al. (2013) Implementation of a Bundle of Care to Reduce Surgical Site Infections in Patients Undergoing Vascular Surgery. PLoS ONE 8(8): e71566. doi:10.1371/journal.pone.0071566http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071566

Continuous variables in relation to the occurrence of surgical site infections (SSI) after vascular surgery.

• Bundles

• Dr Widmer: (ahead of pub) Mycobacterium

chimaera outbrake associated to cooler/heating

devices

VIH HIGHLIGHTS

Monday, Sept 8th

Tuesday, Sept 9th

Poster Sessions

CPE: Epidemiology (i)C-779. Carbapenemases-Producing Enterobacteriaceae in 2013: Increasing Prevalence of Multiple Carbapenemases in Single Isolates and Expansion of OXA-48-Producers and a new KPC-Variant. M Castanheira. Iowa, USA [Poster]

C-800. Enterobacteriaceae producing ESBLs, AmpCs and carbapenemases emerging among outpatients, Italy. F Luzzaro, Florence, IT

• Consecutive 3rd generation cephalosporin-resistant strains EC/KP/PM) in 12 Italian hospitals

CPE: Epidemiology (ii)C-070. Dynamics of the KPC Transposon: Tn4401 in a Single US Hospital, 2007-2012. N. Stoesser. Oxford & NIH

K-1033. Predictors of Carbapenem-resistant Enterobacteriaceae (CRE) Acquisition Following In-hospital Exposure to Newly Diagnosed CRE Patients. M Schechner. Tel-Aviv, IL

• Case-control study of patients newly screened for CPE (CPE contacts) • Case: CPE +ve; Control: CPE -ve

• 72/841 (8%): CPE +ve• Multivariate analysis: a) Known MDRO.carrier (OR 4.8) b) Mech Vent

(3.2)…more important than vicinity (shared room)

CPE: Antimicrobial Susceptibility Testing (iii)D-855. Inoculum Effect of Imipenem, Meropenem and Doripenem against Klebsielle pneumoniae Producing an OXA-48 Carbapenemase with or without Extended-Spectrum Beta-lactamase. L Caillon. Nantes, FR. [Poster]

CPE: Antimicrobial Susceptibility Testing (iv)

D-878. Study of Antimicrobial Combinations Against Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp): Role of Double-Carbapenem Regimen. A Oliva. Rome, IT• Good correlation between in vitro ERT-MER sinergy (Time-Kill)

and clinical therapy with 2-carbapenem

D-883. Comparison of Etest® and Checkerboard Method for Determination of Antimicrobial Synergy against Colistin-ResistantKlebsiella pneumoniae Isolates. M. Herold. Nancy, FR [Poster]

CPE: BSI (v)K-346. Clinical and Economic Impact of a Formal Intervention Program Targeting Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Bacteremia. BA Potoski, Pittsburgh, PA

• Formal intervention program using decision support software to allow real-time recommendations for CRKP infections

• Before (83)-after (9) study: 30-day mortality, LOS, 90-day readmission

• Mortality: 34/75 (45%); LOS: 34 vs 14.5; Median cost: $395K vs $127K

L-398. Mortality of patients with Carbapenem Resistant Klesbiella Pneumoniae (CRKp) Bacteremia. Y Fraenkel-Wande. Jerusalem, IL• Retrospective case (68 CP-KP)-control study (136 (ESBL-KP)

• Mortality CP-KP 65% vs ESBL-KP 40%; p=0.0008

CPE: infection control (vi)

K-1031. Reduction in Carbapenem-Resistant Klebsiella pneumoniae at a New York City Academic Medical Center Following a Multifactorial Intervention. W Huang, NY

• Hand hygiene, enhanced cleaning and antimicrobial stewardship

Clinical Infectious Diseases: syndromes (i)

L-1075. Maternal And Neonatal Consequences Of (un)treated Asymptomatic Bacteriuria In Pregnancy, The Asb Trial. SE Geerlngs. Amsterdam (NL) & Adelaide (AUS)

• RCT: nitrofurantoin 200mg (41 pt) vs placebo (49%) in pregant women with asymptomatic bacteriuria. 159 pt refused

• Primary outcomes: Pieloneprhytis and pre-term (<34w) birth:Pyelonephritis: 2.5% (nitro) vs 2.3% (placebo) vs 1.9% (no Asb)Preterm birth: 5% (nitro) vs 6.8% (placebo) vs 5.7% (no Asb)

L-1068. Comparison of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus Aureus Bacteriuria. L Saidel-Odes. Ver-Sheeva, IL [Poster]• Predictable differences between MRSA & MSSA (HO, Foley…)• Concomitant BSI: MRSA (18%) vs MSSA (14%)

Clinical Infectious Diseases: syndromes (ii)K-1712. Surgical Care And Prognosis Of Patients With Staphyloccoccal Prosthetic Vascular Graft Infection (pvgi). E. Senneville. Tourcoing, FR• Surgery performed in 78 patients (85): MSSA 46; MRSA 19; MRSE 18

A) Autograft (vein): 12B) Prosthetic conduit: 10C) Allograft: 30D) Ablation w/o replacement: 5E) Debridement and retention: 30

ABX: IV x 6w + PO x 6w**except E: supression

• Median follow-up: 15 months A) Death 25 (PVGI-related 12 pts B) Failure 10

K-1714. Microbiology Of Prosthesis Vascular Graft Infections (pvgi): Causative Organisms, Resistance Patterns And Implications For The Prevention And Management. D. Sousa. Coruña, Spain

Clinical Infectious Diseases: syndromes (iii)

K-1717. Is Preoperative Joint Fluid Aspiration (PJA) Useful for the Diagnosis of Periprosthetic Joint Infection (PJI)?. E Bonnet. Lyon. FR• PPV 90%; NPV: 47%

L-415. Prospective Evaluation of the Incidence of Haematogenous Prosthetic Joint Infections (H-PJI) following Bloodstream Infections (BSI) E. Senneville, Torcoing, FR

• 77 patients (8: already infected): 0/69; 6 months F/U 25 pts

K-1709. Risk Factors for Multi-Drug Resistant Organisms (MDRO) in Prosthetic Joint Infections (PJIs) N Benito. REIPI, Spain

Clinical Infectious Diseases: syndromes (iv)K-1718. Minocycline as Long Term Suppressive Therapy for Orthopedic Infections. Y Hanada. Rochester, MN

• 291 patients were included, with a mean suppression of 1394.8 days (d)

• Relapse on LTMS occurred in 35 of 291 patients (12%)

• Median time to first relapse was 327 d

K-1708. F-18 FDG PET/CT As A Decision Support For Discontinuation Of Long-term Antimicrobial Therapy In Patients With Post-operative Spinal Implant Infection With High-risk Of Relapse. A Bouaziz. Lyon. FR• 14 patients (12 postsurgical: 8 acute; 2 vertebroplasty)• Mostly MSSA• ABX x 6 months. If negative PET-CT scan: discontinue ABX if not,

repeat PET-CT scan each 6-months

PK/PD: S. aureus

L-402. Comparison of Treatment Outcomes and Safety with Nafcillin or Cefazolin for the Management of MSSA Bacteremia. MA Miller, Aurora, Colorado

L-405. Evaluation of Treatment Outcomes of Cefazolin (CEZ) versus Oxacillin (OXA) for Methicillin-Sensitive Staphylococcus aureus (MSSA) Bloodstream Infections (BSI): A Multicenter Observational Study. SN Nevrekar. Chicago (Rush)Cefazolin does NOT have higher rates of treatment failure in MSSA BSI but LESS drug-related adverse eventes (nephrotoxicity)

MSSA bacteremia: Cefazolin or Anti-Staph penicillins?

PK/PD: S. aureus (ii)

L-404. Empirical combination of vancomycin and a β-lactam Improves Early Outcomes for S. aureus bacteremia (SAB) N Musallam, LA, Ca

PK/PD (iii)b-lactams + vancomycin: increased nephrotoxicity?K-372. Comparative Risk of Acute Kidney Injury in Patients Receiving Vancomycin Monotherapy or Vancomycin and Beta-Lactam Combination Therapy. J Justo. Columbia, SC,USA [Poster]

K-375. Acute Kidney Injury Associated With Beta-lactam Antimicrobials . K. Klinker. Gainsville. Florida [Poster]

PK/PD (iv)

A-1315. Evaluation of the Relationship Between the Initial Vancomycin Exposure Profile and Emergence of Heteroresistance to Vancomycin (hVISA) among Patients with MRSA Bloodstream Infections (BSIs) Who Received Vancomycin (VAN) TP Lodise, Albany, NY

A-720. Effect of First Dose of Vancomycin in Critically Ill Patients Requiring Continuous Venovenous Hemofiltration (CVVH) on Achievement of Adequate 24 hour Vancomycin Trough Concentration. H Lin. Mass Gen

Vancomycin: initial dosing is likely to be relevant

Vancomycin dosing: initial pushing

PK/PD (v)Vancomycin generics: are all created equal?

A-1322. Comparison Of In Vivo Efficacy Of Innovator And Generic Vancomycin Products In A Neutropenic Mouse Thigh Infection Model HC Yang. Korea

A-1323. Some Generics Of Vancomycin Prescribed In The United States Fail In Vivo Despite Pharmaceutical Equivalence (pe) And Bioequivalence (be) Demonstrated By The Fda. M Agudelo. Antioquia. Colombia [Poster]

PK/PD: Enterococcus (vi)

E-230. Efficacy of Daptomycin (DAP) Monotherapy at a Dose of 10 mg/kg or Combined with Ampicillin (AMP) in the Treatment of Experimental Endocarditis (EE) in Rabbits Infected by Strains of Enterococcus faecalis with High-Level Aminoglycoside Resistance (HLAR). JM Miró. Clinic

K-379. Identification of Risk Factors Associated with the Development of Daptomycin Nonsusceptible Staphylococcus aureus. B. Bastian. Chicago (Rush). [Poster]

A-1326. Dual Beta-Lactam Activity against Enterococcus faecalis in a High Inoculum In Vitro Pharmacodynamic (IVPD) Bacteremic Model. LB Rice, Providence

PK/PD: Enterococcus (vii)A-1326. Dual Beta-Lactam Activity against Enterococcus faecalis in a High Inoculum In Vitro Pharmacodynamic (IVPD) Bacteremic Model. LB Rice, Providence

• No regrowth with ampicillin + cefepime

PK/PD: b-lactam dosing (vii)A-711. Optimal Dosing of Continous Administration of Piperacillin-Tazobactam in Septic Obese and Non Obese Critically Ill patients M, Mahul, Bourdeaux, FR

• 16g/2g Pip/Tazo continuous Infusion muy be insufficient for 25% of critically ill patients (MIC 64)

A-713. Population Pharmacokinetics and Monte Carlo Dosing Simulations of Meropenem during the Early Phase of Severe Sepsis and Septic Shock in Critically Ill Patients in an ICU S Thengyai, Thailand

PK/PD: b-lactam dosing (vii)PTA (t>40%MIC): 1h/4h

PTA (t>80%MIC): 1h/4h

Clinical Infectious Diseases: hosts*

*immunecompromised

Viral infectionsT-468. Astrovirus HMO-C: an Emerging Neurotropic Pathogen in Immunocompromised Patients. J. R. Lockwood, London,UK [Poster]• High throughput DNA sequencing technologies (deep sequencing of the

transcriptome) on biopsy material taken from a child’s brain to evaluate a case of encepahlitis of unknown cause

T-466. Immune Monitoring with the T-SPOT®.CMV assay of Allogeneic Hematopoietic Cell Transplant (allo-HCT) Recipients: A Proof of Concept in the Clinical Setting L. Nesher, E. MD Anderson Cancer Ctr., Houston, USA

T-464. The Impact of IL28b Polymorphism in Allogeneic Hematopoietic Cell Transplant (allo-HCT) Recipients on Interferon (IFN γ) Production and CMV Reactivation. L. Nesher, E. MD Anderson Cancer Ctr., Houston, TX

T-467. Functional Monitoring of Cell-Mediated Immune Response Predicts the Occurrence of Cytomegalovirus (CMV) Disease in Kidney Transplant (KT) Recipients. M. A. Pérez-Jacoiste Hosp. 12 de Octubre, Spain. [Poster]

T-467. Functional Monitoring of Cell-Mediated Immune Response Predicts the Occurrence of Cytomegalovirus (CMV) Disease in Kidney Transplant (KT) Recipients. M. A. Pérez-Jacoiste Hosp. 12 de Octubre

T-467. Functional Monitoring of Cell-Mediated Immune Response Predicts the Occurrence of Cytomegalovirus (CMV) Disease in Kidney Transplant (KT) Recipients. M. A. Pérez-Jacoiste Hosp. 12 de Octubre

Clinical Infectious Diseases: hosts*

*immunecompromised

Bacterial infections

K-1040. Fecal Colonization with ESBL-Escherichia coli as Risk Factor for Bloodstream Infection and Related Complications in Patients with Severe Neutropenia. P. Cornejo-Juárez. México

K-1656. Bloodstream Infections in Hematological Patients and the Role of Multi-Drug-Resistant Strains. A. Fernandez-Cruz, HGUGM• 193 consecutive episodes in 129 pts: 62% neutropenia

• GP 62% vs GN 32% vs anaerobes 2% vs yeasts 4%

• Inappropriate Rx> if: GP (catheter) & Pseudomonas (17): 76% carba-R

• Prospective cohort study (N=126): ESBLEC (col) vs non-ESBLEC• ESBLEC-BSI. a) ESBLEC (col): 17 EC-BSI: 14 ESBLEC (83%)

b) Non-ESBLEC: 22 EC-BSI: 5 ESBLEC (23%)

Clinical Infectious Diseases: hosts*Fungal infections

M-1758. Mycoses Study Group-06: A Registry of 50 cases of Phaeohyphomycosis. S. G. Revankar (Multicenter)• Alternaria (9) > Scedosporium (prolificans) (7) > Exophiala (5) >

Cladophialophora (4) > Curvularia (3) > Ochroconis (3) > Phialophora (3)

• Immunecompromise: 76% (mainly SOT/HSCT)

• Clinical syndromes: Skin (13); Pulmonary (8); CNS (6); Bone-Joint (4)

• Mortality (F/U 1-36 mths): 28%

M-1083. Epidemiology of Invasive Aspergillosis and Resistance Patterns of Aspergillus spp. in Germany - Interim Analysis of a Multicenter Observational Study. MJ Vehreschild, Germany• Multicenter prospective registry: 780 AML/189 ALL: IFI: 6.1% (AML) and 6.9% ALL

• 50% IFI in patients on AF prophylaxis

• 30-day mortality: 9%

Clinical Infectious Diseases: hosts*Fungal infections (ii)

M-1766. Malignant External Otitis Due To Aspergillus Spp, Our Seven Years' Experience. Marchionni. Paris, FR

• 12 patients: 100% diabetics; 50% North-African

• 10/12: A. flavus

• Median delay: 240 days

T-475. Invasive Fusariosis in the Voriconazole Era: Single Center 12-year Experience. JM Stemple J. Boston

Clinical Infectious Diseases: hosts*Fungal infections (iii)M-1765. Diagnostics for Invasive Pulmonary Aspergillosis in Bronchoalveolar Lavage Fluid of Patients with Underlying Pulmonary Diseases: Comparison of Aspergillus Lateral Flow Device, Galactomannan-Antigen-Test, Beta-D-Glucan-Tests and Conventional Culture. J Prattes (Austria/UK)

M-1776. The Combination of Candida albicans Germ Tube Antibody (CAGTA) AND β-D-Glucan (BDG) May Be Useful to Stop Empiric Antifungal Therapy in ICU Patients with Suspected Candidasis N Martinez-Jimenez, HGUGM

M-1085. Investigating Aspergillus PCR-negative Tissue Biopsy Samples from immunocompromised Patients using DNA Microarray Technology improves Diagnosis of Invasive Fungal Infections (IFI) B. Spiess (Germany)

Fungal infections (iv)

• Retrospective pharmacoeconomic evaluation (direct costs) of 106 patients with Posaconazole (POS) as compared with 106 patients with POS-MIC bridging**

• €60,300 vs €58,100 (p=0.570) ** Micafungin (MIC) while intolerance to POS

M-1755. A Cost and Resource Utilization Analysis of Micafungin-Bridging for Hemato-Oncological High-Risk Patients Undergoing Allogenic Stem Cell Transplantation (aSCT) O Cornely, Cologne

M-1759. Clinical Experience Using Posaconazole (pos) Extended Release Tablet (tab) For The Prevention Of Invasive Fungal Infections In Hematological Cancer Patients (pt): Does One Size Fit All? MH Micelli, U of Michigan

A-703. Posaconazole Serum Concentrations of the Delayed-Release Tablets Compared to the Oral Suspension T Jancel. NIH• Extended released tablets (300mg QD) achieve higher serum levels than oral

suspension (200mg TID):

*immunecompromised

Fungal infections (iii): isavuconazole

• Phase 3, multi-center, randomized, double-blind, non-inferiority trial: ISA vs VRC for the primary treatment of IMIs caused by Aspergillus spp. and other FF

M-1757. A Phase 3 Randomized, Double-Blind, Non-Inferiority Trial Evaluating Isavuconazole Vs. Voriconazole for the Primary Treatment of Invasive Mold Infection (SECURE): Outcomes in Subset of Patients with Hematologic Malignancies (HM) K Marr (Multicenter) [Poster]

• 516 ITT patients: 433 with underlying hematological malingancy (217 proven/probable infections)

• Efficacy: Non inferiority of ISA vs VRC: a) 42-day all-cause mortality (22% vs 24%) b) Overall treatment response (39% vs 34%)

• Safety: Less drug related adverse events (ISA): 40 vs 60%

M-1756. A Phase 3 Randomized, Double-Blind, Non-Inferiority Trial Evaluating Isavuconazole (ISA) vs. Voriconazole (VRC) for the Primary Treatment of Invasive Fungal Disease (IFD) Caused by Aspergillus spp. or other Filamentous Fungi (SECURE): Outcomes by Malignancy Status A Ullmann (Mulicenter) [Poster]

*immunecompromised

Fungal infections (iv): isavuconazole (ii)

M-1761. Outcomes by Minimum Inhibitory Concentrations from Isavuconazole Phase 3 Trial of Invasive Aspergillosis (SECURE). D Andes. (Multicenter) [Poster]

M-1760. Outcomes in Patients with Invasive Mold Disease Caused by Fusarium or Scedosporium spp. Treated with Isavuconazole: Experience from the VITAL and SECURE Trials O Cornely (Multicenter) [Poster]

Fungal infections (iv): isavuconazole (ii)A-699. Killing of Selected Antifungal Drugs Is Inhibited by Pulmonary Surfactant in Vitro P. Matzneller, Austria

Antimicrobial Stewardship

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