ICAAC 2013: RESUMEN

SESIONES de ENF. INFECCIOSAS

José Ramón PañoU. Enf. Infecciosas/MI H. La Paz

17 de septiembre de 2013

¿Alguien sabe lo que quiere decir ICAAC?

Interscience Conference on Antimicrobial Agents and

Chemotherapy

ICAAC: ¿QUÉ ES?

CONGRESO DE LA ASM: AMERICAN SOCIETY FOR

MICROBIOLOGY• + 40.000 miembros: Sociedad Científica monotemática más

numerosa del mundo (no comprobado)

• Monotemática ≠ Unidisciplinar: Microbiólogos, infectólogos,

farmacéuticos, farmacólogos, biólogos, biólogos moleculares…

• ICAAC: principal reunión ASM. Habitualmente 10.000 asistentes. En

2013: 5400 (126 españoles)

53rd ICAAC: 10-14 SEPTIEMBRE 2013

Denver Convention Center

53rd ICAAC: 10-14 SEPTIEMBRE 2013

53rd ICAAC: 10-14 SEPTIEMBRE 2013

53rd ICAAC: 10-14 SEPTIEMBRE 2013

Lunes: “Workshops” (08:30 a 16:00)

• Introduction to PK/PD

• Application to PK/PD models

• Antibacterial Resistance: Mechanisms, Detection and Molecular Epidemiology

• Antimicrobial Stewardship in Hospitals

• New Clinical Microbiology Dx: What is (or Could Be) in Your Lab

• Transplant A-Z: Current Predicaments, Future Solutions

53rd ICAAC: 10-14 SEPTIEMBRE 2013

Martes: (07:00 a 18:45)

• Infectious Diseases 101: For Fellows Age 18-88

• Key Note Lecture: A Vision of Antimicrobial Therapy of the Future (F. Baquero )

• Poster Session (12:00-14:00)

• Literature Review / Early New Antimicrobials (14:30-16:30)

• Symposium (x15) (16:45-18:45)

53rd ICAAC: 10-14 SEPTIEMBRE 2013

Miércoles-Jueves: (07:00 a 18:45)

• Meet the Expert (x10) (07:00 a 08:15)

• Symposium (x 16) (08:30-10:30)

• Poster Session: 11:00-13:00

• Symposium (x17) 15:00-17:00

• Lectures: 13:30-14:30

• Satellite Symposium (x3) 17:30-19:30

• DISTRIBUCIÓN POR TIPO DE ACTIVIDAD

Sesiones especiales: 6 (4 “Lectures”)

Symposia: 50

Sesiones Interactivas: 12

Meet the expert”: 30

53rd ICAAC: 10-14 SEPTIEMBRE 2013

53rd ICAAC: 10-14 SEPTIEMBRE 2013

11 2

10

5

51310

8

3

6

9

3 Micro: Básicas

Micro: Diagnóstico

Micro: Resistencia

Nuevos Antibióticos

PK/PD

Inf Comunitarias

Inf Nosocomiales

Inmunodeprimidos

PROA

Control de Infección

Salud Pública

VIH

DISTRIBUCIÓN POR TEMAS

1. Carbapenemasas es un problema global y creciente: el principal de la comunidad ID-Micro

53rd ICAAC: 10-14 SEPTIEMBRE 2013

2. Nuevos antimicrobianos: no esperen cohetes

3. Inmunodeprimidos: atención a los virus y control de infección

4. Micro: USA descubre el MALDI-TOF

5. PROA: Las mismas limitaciones metodológicas de siempre

LÍNEAS GENERALES

1. Carbapenemasas

53rd ICAAC: 10-14 SEPTIEMBRE 2013

ANÁLISIS POR TEMAS

2. PK-PD

7. Nuevos antimicrobianos

3. Bacterimia/Endocarditis

5. Miscelánea Clínica

4. Dx Micro

6. Inmunodeprimido/Hemato

CARBAPENEMASASCarbapenemases: The End of Beta-Lactams as We Know Them!

Plasmids and Clones Supporting the Success of Carbapenemases

CARBAPENEMASASC1-1071 - Deciphering The Genetic Bases Sustaining The Su

ccessful Spread Of The blaOXA-48 Carbapenemase Gene¿Por qué blaOXA-48 se transmite tanto?

• Complete sequence of pOXA-48 allowed to identify a truncation in the tir gene sharing similarities with some genes known to encode transfer inhibition proteins (Tir)

• Trans-complementation assays were realized in Escherichia coli by obtaining recombinant strains harboring either plasmid pOXA-48a alone or plasmid pOXA-48a together with plasmid pTir encoding an intact Tir protein (pNDM-OM as control)

• Conjugation frequencies differed 40-fold higher in pOXA-48a as compared to pNDM-OM (pOXA-48a had +++ capability of transfer compared to another IncL/M-type plasmid

• Conjugation frequency of E. coli (pOXA-48a + pTir) were ca. 100-fold lower compared to that of E. coli (pOXA-48a): (role of Tir production in decreasing the conjugation freq)

• Interestingly, that truncation occurred through the integration of the transposon carrying the blaOXA-48 gene, thus showing that a single genetic event provided 2 main advantages to pOXA-48a, i.e. an higher frequency of conjugation and the integration of a carbapenemase gene.

CARBAPENEMASAS

• Comprobación de actividad microbiológica de distintos b-lactámicos frente a KP-NDM1 en un modelo animal (infección en muslo de ratón neutropénico)

• En OXA-48 el genotipo parece anticipar mejor la actividad microbiológica q CMI ¿?

• Tres tipos de cepas problemas: a) cepa salvaje b) cepa isogénica (NDM-1) y c) cepas salvajes con NDM-1 y otros mecanismos de resistencia

• Los resultados fueron los esperables: caída de recuento bacteriano esperable según CMI en todas las cepas: carbapenem fueron los b-lactánicos más activos en las cepas clínicas

A-463. in vivo Efficacy of Humanized Regimens of Carbapenems and Comparators against NDM-1 ProducingEnterobacteriaceae

CARBAPENEMASAS

• Comprobación de actividad microbiológica de distintos b-lactámicos frente a KP-OXA-48 en un modelo animal (infección en muslo de ratón neutropénico/inmunocompetente)

• En OXA-48 el genotipo parece anticipar mejor la actividad microbiológica q CMI ¿?

A-462. Efficacy of Humanized Antibiotic Exposures against Enterobacteriaceae Producing the OXA-48 Carbapenemase in a Murine Infection Model

CARBAPENEMASASK-178 - Epidemiology, Risk Factors and Clinical Outcomes of P

atients with Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp) Bacteriuria• Cohorte retrospectiva de 128 pacientes con bacteriuria por KP-RC (KPC)

de los que excluyen a 23 pacientes por infecciones a otros niveles

• Bacteriuria asintomática 80%; Infección clínica: 20%

• Factores de riesgo de ITU clínica:

a) Sexo (varón) p= 0.0004 OR 4.69 [95% CI 1.44-15.26]b) Vejiga neurógena p= 0.001 OR, 4.50 [95% CI 1.39-14.52]c) Talla vesical p= 0.03

d) Trasplante órgano sólido p= 0.03 OR, 18.62 [95% CI 1.75-197.52]

análisis univariante análisis multivariante

• 10% (8/84) de pacientes con bacteriuria asintomática recibieron AB

• No recurrencias entre los que tuvieron ITU

CARBAPENEMASAS

• Estudio observacional unicéntrico con 14 pacientes con infecciones por KPRC (8 PDR) tratados con doble carbapenem entre Feb 2012 y Feb 2013

• Bacteriemia 5 pac; ITU 9 pac; Shock séptico 2 pacientes

K-186 - Double Carbapenem (DC) Regimens for Infections in Humans Due to Carbapenemase-Producing Klebsiella pneumoniae (CPKP)

• Ertapenem 1g iv/24h seguido de Meropenem 2g iv/8h (infusión prolongada)

• Buena evolución clínica y analítica a 14 d: 100%

• Recurrencia ITU a 28d: 4

• Efectos adversos: Rash (1); Eosinofilia (1); Meningitis aséptica (1)

CARBAPENEMASASD-581. Rapid Detection of Bacterial Resistance by MALDI-TOF

MS in Combination with Stable Isotope Labeling

CARBAPENEMASASD-581. Rapid Detection of Bacterial Resistance by MALDI-TOF

MS in Combination with Stable Isotope Labeling

CARBAPENEMASASD-581. Rapid Detection of Bacterial Resistance by MALDI-TOF

MS in Combination with Stable Isotope Labeling

CARBAPENEMASASD-581. Rapid Detection of Bacterial Resistance by MALDI-TOF

MS in Combination with Stable Isotope Labeling

CARBAPENEMASAS

• One 10 µL-calibrated oese of bacteria was incubated at 37°C for 3.5 hours in a solution of ertapenem (ETP, 0.5 g/L in 0.45% NaCl), and centrifuged for 2 min at 12 000 g

• One µL of the cell-free supernatant from each tube was analyzed in duplicate by Vitek-MS Plus (Biomérieux, France) with 1 µL of matrix CHCA

• 9 EPC strains producing class A (KPC-2, IMI-NMCA, GES-1; 3 strains), class B (VIM-1, NDM-1; 2 strains), and class D (OXA-48, 4 strains) enzymes were analyzed. 5 negative controls were used

• Calibration was performed by using the peak of matrix at 379 Da

• The spectrum of the ETP solution shows three peaks at 476 Da, the main pic of the native molecule, 498 and 520 Da (sodium salts).

• The hydrolysis by a carbapenemase is visualized by the decrease or the disappearance of these peaks, especially for classes A and B. A significant decrease from 100% (KPC, NDM, and VIM) to 50% (OXA, IMI, and GES) in this ratio was observed between T0 and T3.5 h for all carbapenemase-positive strains vs. no change for negative controls.

D-580. Rapid Detection of Carbapenemase-Producing Enterobacteriaceae (CPE) by MALDI-TOF MS

CARBAPENEMASAS

• Descripción de aislamientos de EPC desde 2006 a 2012

K-689. Sequential occurrence of VIM-1, KPC-3, and OXA-48-Producing Enterobacteriaceae in a Spanish University Hospital

• Fuente de infección

- ITU: 41%- Intrabdominal 14%- Neumonía 13%

CARBAPENEMASAS

• K-690. Case-Case-Control Study of Patients with Third-Generation Cephalosporin-Resistant (3GCR) and Carbapenem-Resistant (CR) Klebsiella pneumoniae (KP) Bloodstream Infections (BSIs)

• K-692. A Case-control Study to Determine the Risk Factors of Carbapenem-Resistant Enterobacteriaceae (CRE) Among Adult Patients in an Acute Tertiary Hospital

• K-693. Exposure to Antimicrobials in General, Not Carbapenems in Particular, Promotes Isolation of Carbapenem-ResistantEnterobacteriaceae (CRE)

• K-698. Risk Factors for The Acquisition of Carbapenem-resistant Escherichia coli in A Tertiary Care Hospital in South Korea: A Matched Case-control Study

PK/PD• K-181 - Application of a Loading Dose of 9 MU Colistin Methanesulphonate (C

MS) and Incidence of Nephrotoxicity in Critically Ill Patients: A Preliminary Report (Rifle)

• A-1054b. Colistin (C) Pharmacokinetics (PK) after Application of a Loading Dose (LD) of 9 MU Colistin Methanesulfonate (CMS) in Critically Ill Patients

• A-1045. Oral Fosfomycin Tromethamine (FOS) Achieves Good Intra-Prostate Levels Suggesting it May Be a Prophylaxis & Treatment Option for Multidrug-Resistant (MDR) Prostatitis

• A-023. Vancomycin (VAN) and Piperacillin-Tazobactam (PT) against Methicillin-Resistant Staphylococcus aureus (MRSA) and VAN-Intermediate Staphylococcus aureus (VISA) in an In Vitro Pharmacokinetic/Pharmacodynamic (PK/PD)

• A-1054 - Individually Designed Optimum Dosing Strategies (ID-ODS), a multi-model based online application to individualize antibiotic dosing in critically ill patients

(Web)

BACTERIEMIA Y ENDOCARDITIS

• L-208 - The Outcomes Of Patients With Liver Cirrhosis And Infective Endocarditis According To Their Surgical Fate

• K-1281. Transesophageal Echocardiography is Necessary in All Patients with Enterococcal Bacteremia

• K-1286. Transcatheter Aortic Valve Implantation (TAVI) Infective Endocarditis (IE): Clinical Characteristics and Outcome

• L-210 - Oxacillin (OX) versus Cefazolin (CFZ) for Complicated Methicillin-Susceptible Staphylococcus aureus (MSSA) Bacteremia

• K-710. Ceftaroline fosamil (CPT-F) for therapy of Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB): Laboratory and Clinical Outcomes

DIAGNÓSTICO MICROBIOLÓGICO• D-582. Inter-Observer Variability in Interpretation of Vancomycin

Minimum Inhibitory Concentration (MIC) by Etest

• D-603. Performance and Impact of Direct Antimicrobial Susceptibility Testing (AST) in Ventilator Associated Pneumonia (VAP)

• D-115. Integration of Rapid Organism Identification via MALDI-TOF plus Real-Time Stewardship Intervention Improves Antimicrobial Utilization and Decreases Costs for Patients with Blood Cultures Positive for Coagulase-Negative Staphylococci

• D-114. Clinical Impact of Direct MALDI-TOF on Positive Blood Cultures: A Trend Towards Improved Antimicrobial Prescribing

• M-219 - An Aspergillus fumigatus(AF)-specific Breath Volatile Organic Compound (VOC) Profile is Diagnostic of Invasive Aspergillosis (IA)

DIAGNÓSTICO MICROBIOLÓGICO• M-219 - An Aspergillus fumigatus

(AF)-specific Breath Volatile Organic Compound (VOC) Profile is Diagnostic of Invasive Aspergillosis (IA)

INMUNODEPRIMIDO/HEMATOLOGÍA• M-245 - Breakthrough Invasive Aspergillosis In Patients Receiving A

ntifungal Prophylaxis (Poster)

• M-228 - Breakthrough Mycosis in Patients with Hematological Malignancies Receiving Posaconazole Prophylaxis

• T-808 - Clinical Efficacy of Posaconazole Prophylaxis in Combination with Micafungin Bridging for Patients Undergoing Allogeneic Stem Cell Transplantation: A Six Year Analysis from the Cologne Cohort for Neutropenic Patients (CoCoNut)

• M-250 - Different Doses of Micafungin for Prophylaxis of Invasive Fungal Diseases: A Web-based Non-Interventional Trial in Four Large University Hospitals in Germany

MISCELÁNEA CLÍNICA• K-145 - Evaluation of Management of Ventriculo-peritoneal Shunt Inf

ections in Adults(poster)

• K-727. Antibiotic-related Serious Adverse Events (SAE) During Treatment Of Methicillin-susceptible Staphylococcus aureus(MSSA) Bone And Joint Infections (BJI)

• K-732. Suppressive Anmicrobial Therapy (SAT) in the management of prosthetic joint infection (PJI). Role of Co-trimoxazole

• K-733. Predictors of Treatment Failure in Complex Hip or Knee Prosthetic Joint Infections (poster)

• K-734. Outcome of Gram-Negative Bacilli (GNB) Prosthetic-Joint Infections (PJI)

NUEVOS ANTIMICROBIANOS• F-1226. Structure, Potency and Bactericidal Activity of ACHN-975, a Fir

st-in-Class LpxC Inhibitor (Poster)

• F-1227. in-vitro Activity Of ACHN-975, An Lpxc Inhibitor, vs. Carbapenem-resistant Gram-negative Bacteria (Poster)

• E-1165. In vitro Activity Of Avibactam in Combination with Ceftazidime, Ceftaroline and Aztreonam Against Class A, C, and D β-lactamases Expressed in an Isogenic Escherichia coli Background

• A-1019 - Pharmacokinetics of Avibactam (AVI) and Ceftazidime (CAZ) Following Separate or Combined Administration in Healthy Volunteers