Selection of preferred sessions and abstracts presented at ICAAC 2014. Titles are linked to abstracts. If available, posters are linked

2. ICAAC 2014: Abstract and
Poster Selection
Marta Mora Rillo
José Ramón Paño-Pardo
Infectious Diseases and Clinical Microbiology Unit
Division of Internal Medicine
Hospital Universitario La Paz-IDIPAZ
Madrid, Spain
October 1st, 2014 www.proantibioticos.com

3. 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
- New antimicrobials
- PK/PD
- Clinical infectious diseases (syndromes)
- Clinical infectious diseases (hosts)
- Advances in Micro diagnostic
- Antimicrobial Stewardhip
- Infection Control

4. ICAAC 2014 Facts and Figures
Q: What does ICAAC stand for?
A: Interscience Conference on
Antimicrobial Agents and
Chemotherapy

5. ICAAC 2014 Facts and Figures
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 ≈ 6,000
2013: 5400 (126 españoles)
Classically: +10,000
ICAAC is losing appeal as compared w/ its
previously back-to-back competitors:
ECCMID y IDSA
*ASM: American Society for Microbiology

6. 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)

7. Saturday, Sept 6th

16. Sunday, Sept 7th

18. • 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

20. 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.0071566
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071566

21. Annual changes in the surgical site infection (SSI) rate and
bundle compliance and the 95% confidence interval.
Continuous variables in relation to the occurrence
of surgical site infections (SSI) after vascular surgery.
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.0071566
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0071566

22. • Bundles
• Dr Widmer: (ahead of pub) Mycobacterium
chimaera outbrake associated to cooler/heating
devices

23. V
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25. Monday, Sept 8th

28. Tuesday, Sept 9th

31. Poster Sessions

32. 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

33. 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)

34. 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]

35. 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]

36. 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

38. 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

39. 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%)

40. 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): 12
B) Prosthetic conduit: 10
C) Allograft: 30
D) Ablation w/o replacement: 5
E) 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

41. Clinical Infectious Diseases: syndromes (iii)
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-1717. Is Preoperative Joint Fluid Aspiration (PJA) Useful for the
Diagnosis of Periprosthetic Joint Infection (PJI)?. E Bonnet. Lyon. FR
• PPV 90%; NPV: 47%
K-1709. Risk Factors for Multi-Drug Resistant Organisms (MDRO) in
Prosthetic Joint Infections (PJIs) N Benito. REIPI, Spain

42. 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

44. PK/PD: S. aureus
MSSA bacteremia: Cefazolin or Anti-Staph penicillins?
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)

45. 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

46. 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]

47. PK/PD (iv)
Vancomycin dosing: initial pushing
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

48. 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]

49. PK/PD: Enterococcus (vi)
K-379. Identification of Risk Factors Associated with the Development
of Daptomycin Nonsusceptible Staphylococcus aureus. B. Bastian.
Chicago (Rush). [Poster]
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
A-1326. Dual Beta-Lactam Activity against Enterococcus faecalis in a
High Inoculum In Vitro Pharmacodynamic (IVPD) Bacteremic Model. LB
Rice, Providence

50. 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

51. 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

52. PK/PD: b-lactam dosing (vii)
PTA (t>40%MIC): 1h/4h
PTA (t>80%MIC): 1h/4h

53. Clinical Infectious Diseases: hosts*
*immunecompromised
Viral infections
T-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

54. 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

55. 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

56. 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]

57. 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

58. 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

59. Clinical Infectious Diseases: hosts*
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
*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
• 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%)

60. Clinical Infectious Diseases: hosts*
Fungal infections
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%
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%

61. Clinical Infectious Diseases: hosts*
Fungal infections (ii)
T-475. Invasive Fusariosis in the Voriconazole Era: Single Center 12-
year Experience. JM Stemple J. Boston
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

62. 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)

63. Fungal infections (iv)
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
• 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
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):
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

64. Fungal infections (iii): isavuconazole
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]
• 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
• 516 ITT patients: 433 with underlying hematological malingancy (217
*immunecompromised
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%

65. Fungal infections (iv): isavuconazole (ii)
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]
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]
*immunecompromised

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

67. Antimicrobial Stewardship
link