This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
•Describe the role of antibiotic use in the development of resistance
•Review toxicity of commonly used antibiotics
•Understand the prevalence and clinical impact of carbapenem resistant enterobacteriaceae
•State the prognosis antimicrobial resistant Staph aureus infections
ABSTRACT- Invasive fungal infections have become a major source of morbidity and mortality in post operative
patients. Critically ill patients after extended surgical procedure are more risk to post surgical fungal infections. Life
saving devices like central venous catheters can increases risk for fungal infections. Surgical infections are infections of
the tissues, organs or spaces exposed by surgeons during performances of surgical procedure. Mold infection is
increasingly common in post operative patients. Postoperative surgical infection represents an uncommon but potentially
devastating complication of surgery. Unfortunately, medical community is not much aware of such secondary infections
due to fungi in post operative patients leading to grave consequences. Better diagnostic methods are needed to improve
the outcome of successful surgery and better health care for public. The diagnosis of invasion and dissemination in the
majority of cases requires the acquisition and proper interpretation of clinical evidence.
Key-words- Postoperative, Surgical infections, Secondary infections, Diagnostic method
This lecture discusses principles of selecting antifungal agents in the intensive care unit in the treatment of suspected candidasis or confirmed fungemia.
Fungal infections can occur due to the increasing use of broad-spectrum antibiotics and patients with immunodeficiency. Some pathogens, such as Cryptococcus, Candida,and Fusarium, rarely cause serious diseases in the normal host, while other endemic fungi, such as Histoplasmosis, Coccidiodes,and Paracoccidiodes can cause disease in a normal host, but has a tendency to be aggressive on immunocompromise.
Candida species are normal flora that may be an apportunistic pathogen. Candidiasis occurs in some diseases such as gastrointestinal mucosal esophagitis, a fungal disease associated with the use of catheters and in - patients who have mucosal damage or obtain broad – spectrum antibiotics. Other candidiasis consist of skin candidiasis, funguria candidiasis, disseminated candidiasis and endocarditis candidiasis. Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States and in many of the developed country. Invasive candidiasis has a significant impact on patient outcomes, and it has been estimated that the mortality of invasive candidiasis is as high as 47%. The mortality rates are 15%-25% for adults and 10%-15% for neonates and children. Diagnostic approach to fungal infection is a priority. The knowledge of the changes in epidemiology and risk factors for fungal infections, has become the main reference to measure optimal treatment of fungal infections.
Superbug infections are resistant to most antibiotics, and are therefore difficult to treat. Symptoms of superbug infections vary by infection type, and should be treated by a physician immediately. This article explores three of the most common superbugs, their symptoms, and explains the precautions you should take to protect yourself from potential infection.
•Describe the role of antibiotic use in the development of resistance
•Review toxicity of commonly used antibiotics
•Understand the prevalence and clinical impact of carbapenem resistant enterobacteriaceae
•State the prognosis antimicrobial resistant Staph aureus infections
ABSTRACT- Invasive fungal infections have become a major source of morbidity and mortality in post operative
patients. Critically ill patients after extended surgical procedure are more risk to post surgical fungal infections. Life
saving devices like central venous catheters can increases risk for fungal infections. Surgical infections are infections of
the tissues, organs or spaces exposed by surgeons during performances of surgical procedure. Mold infection is
increasingly common in post operative patients. Postoperative surgical infection represents an uncommon but potentially
devastating complication of surgery. Unfortunately, medical community is not much aware of such secondary infections
due to fungi in post operative patients leading to grave consequences. Better diagnostic methods are needed to improve
the outcome of successful surgery and better health care for public. The diagnosis of invasion and dissemination in the
majority of cases requires the acquisition and proper interpretation of clinical evidence.
Key-words- Postoperative, Surgical infections, Secondary infections, Diagnostic method
This lecture discusses principles of selecting antifungal agents in the intensive care unit in the treatment of suspected candidasis or confirmed fungemia.
Fungal infections can occur due to the increasing use of broad-spectrum antibiotics and patients with immunodeficiency. Some pathogens, such as Cryptococcus, Candida,and Fusarium, rarely cause serious diseases in the normal host, while other endemic fungi, such as Histoplasmosis, Coccidiodes,and Paracoccidiodes can cause disease in a normal host, but has a tendency to be aggressive on immunocompromise.
Candida species are normal flora that may be an apportunistic pathogen. Candidiasis occurs in some diseases such as gastrointestinal mucosal esophagitis, a fungal disease associated with the use of catheters and in - patients who have mucosal damage or obtain broad – spectrum antibiotics. Other candidiasis consist of skin candidiasis, funguria candidiasis, disseminated candidiasis and endocarditis candidiasis. Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States and in many of the developed country. Invasive candidiasis has a significant impact on patient outcomes, and it has been estimated that the mortality of invasive candidiasis is as high as 47%. The mortality rates are 15%-25% for adults and 10%-15% for neonates and children. Diagnostic approach to fungal infection is a priority. The knowledge of the changes in epidemiology and risk factors for fungal infections, has become the main reference to measure optimal treatment of fungal infections.
Superbug infections are resistant to most antibiotics, and are therefore difficult to treat. Symptoms of superbug infections vary by infection type, and should be treated by a physician immediately. This article explores three of the most common superbugs, their symptoms, and explains the precautions you should take to protect yourself from potential infection.
Webinar: Defeating Superbugs: Hospitals on the Front Lines Modern Healthcare
About the Webinar: Defeating Superbugs: Hospitals on the Front Lines
http://www.modernhealthcare.com/article/20140917/INFO/309179926
Hospitals across the country are facing a grim reality in which some of the most deadly healthcare-associated infections they encounter are untreatable with first- or even second-line antibiotics. These “superbugs” affect at least 2 million Americans each year and lead to 23,000 deaths. And their threat is growing, public health officials warn. This editorial webinar and “Defeating Superbugs” white paper will explore the steps providers must take to ramp up surveillance efforts, promote appropriate antibiotic use and control outbreaks. Our panel of experts will share their organizations' experiences as well as proven strategies for success.
Registration for this webinar includes Modern Healthcare's “Defeating Superbugs” white paper, with proven tips and strategies for promoting appropriate antibiotic use, improving infection surveillance, identifying drug-resistant infections and dealing with outbreaks.
KEY TAKEAWAYS
- Best practices for effective antimicrobial stewardship
- Real-world examples of effective interventions, including universal rapid testing for drug-resistant MRSA
- Tips for engaging senior leadership
- Aggressive strategies for controlling outbreaks
PANELISTS
Lance Peterson
Director of the Clinical Microbiology and Infectious Disease Research Division
NorthShore University HealthSystem, Evanston, Ill.
Anurag Malani
Medical Director for the Infection Prevention and Antimicrobial Stewardship Programs
St. Joseph Mercy Hospital, Ann Arbor, Mich.
Robert Weinstein
Chief Medical Officer for Population Health
Chairman of the Department of Medicine, Cook County Health and Hospitals System; Professor, Rush University Medical Center, Chicago
MODERATOR
Maureen McKinney
Editorial Programs Manager
Modern Healthcare
The research interest of the investigator has focused on the molecular and cellular pathogenesis of sepsis. In particular, he has worked on soluble proteins involved in the innate recognition of bacteria such as soluble CD14 and MD-2, as well as in the Toll-like receptors activated by Gram-negative and Gram-positive bacteria. Another area of study is the molecular pathogenesis and cell signaling of ventilator-induced lung injury, and lung inflammation in the context of acute respiratory distress syndrome. He has also identified and tested biomarkers in the field of clinical sepsis.
Watch the presentation on Youtube: https://www.youtube.com/watch?v=CyWN7JlhlmI&
Trends on Health-Care Associated Infections and Infection Control in Estonia ...Kazimierz Murzyn
Presentation given during Cost AMiCI meeting in Tallinn Nov 2017
by Pille Märtin
Infection control doctor
West-Tallinn Central Hospital
Chief specialist
Dep. Of Communicable Diseases surveillance and control
Health Board of Estonia
Fighting the growing threat of antimicrobial resistance webinar4 All of Us
Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).
Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.
In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.
This webinar will focused on the importance of understanding the need for diagnostics, what is being done in development and the solutions that are available now.
Introduction: Bloodstream infections (BSIs) are associated with a high mortality rate of 20%-50%. Blood culture is paramount to identify causative agents of BSIs to choose an appropriate antimicrobial therapy. Objectives: The present study was undertaken to analyze the various microorganisms causing BSIs and study their antimicrobial resistance patterns in a tertiary care hospital, Eastern India. Materials and Methods: A total of 239 blood specimens from clinically suspected cases of BSIs were studied for 6 months from July 2015 to December 2015. Blood specimens were incubated in BacT/ALERT ® 3D system (bioMerieux, Durham, NC, USA) a fully automated blood culture system for detection of aerobic growth. Identification and antimicrobial susceptibility testing were conducted on VITEK ® 2 (bioMerieux, Durham, NC, USA) as per Clinical Laboratory Standards Institute guidelines. Results: Out of 239 specimens, 41 (17.2%) yielded growth of different microorganisms. From these isolates, 20 (48.8%) were Gram-negative bacilli, 18 (43.9%) were Gram-positive cocci and rest 3 (7.3%) were yeasts. Among Gram-negative bacilli, Klebsiella pneumoniae sub spp. pneumoniae (70%) was most commonly isolated. Coagulase-negative staphylococci (88.9%) were the most common isolate among Gram-positive cocci. All three Candida spp. isolated were nonalbicans Candida (two Candida tropicalis and one Candida krusei). Gram-negative isolates were least resistant to tigecycline and colistin. All Gram-positive cocci were sensitive to linezolid. Conclusion: Monitoring of data regarding the prevalence of microorganisms and its resistance patterns would help in currently prescribing antimicrobial regimens and improving the infection control practices by formulating policies for empirical antimicrobial therapy.
Presented by Dr. Hall at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Sesión general del Hospital Clínico Universitario de Zaragoza sobre el antibiograma presentada por miembros del equipo PROA del hospital sobre el antibiograma:
- Conceptos básicos
- Dosificación en categoría EI
- Utilización del antibiograma para toma de decisiones clínicas
¿Qué esperan PROA y el infectólogo de M. Preventiva?PROANTIBIOTICOS
¿Qué esperan el infectólogo y el equipo PROA de M. Preventiva?: Un modelo de cooperación (pro)activa que potencie el resultado de las capacidades de todos
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. My track at ICAAC 2015
(Sessions and Abstract Selection)
José Ramón Paño-Pardo
Division of Infectious Diseases
Hospital Clínico Universitario
Zaragoza, Spain
www.proantibioticos.comSeptember 29nd, 2015
2.
3. 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
4.
5. (S-1350) The National Antimicrobial Prescribing Survey: enabling
greater regional and remote hospital participation
6.
7. 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
8. 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
9. 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 rate
Pictures 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)
12. 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 Diseases
P. knowlesi
Strongyloidiasis
Myasis and other skin problems
Katayama fever
Preparedness (Ebola)
HIV
13. 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
14. 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)
16. 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 Jacobs
Question
Outcomes
Confounding
IRB
17. 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
19. Antimicrobial Stewardship #ABS
• Need to merge efforts: #ABS should be comprehensive
(S-1339) Surviving Sepsis and Antibiotic Stewardship: Competing
Patient Safety Initiatives
20. 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)
21. 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)
23. 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)
24. 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
25. 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
26. Bloodstream infections
Ertapenem 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 therapy
Ertapenem (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 therapy
Ertapenem (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”
27. 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
28. 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)
29. Antibiotic Stewardship to
Help Limiting the Spread of
Carbapenemases
José Ramón Paño-Pardo
@joserrapa
Hospital Clínico Universitario
Zaragoza, Spain
31. 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
32. 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)
33. 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
34. New antimicrobials: new cephalosporins
Bassetti M. Curr Opin Crit Care. 2015;21(5):402–11.
Drug In vitro activity Comments
Ceftolozane
/Tazobacta
m
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
Ceftaroline
Ceftriaxone +:
• MRSA
• FDA and EMA approved
• Phase 3 trial: CAP
• BSI: (B-079)
• Pneumonia: (B-081)
Ceftobiprole
Ceftriaxone +:
• MRSA • EMA approved:
35. 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)
36. 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)
37. 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
Editor's Notes
ICAAC Keynote and other specific sessions (MM): ID Fellows, Keynote session (la cuelgan el 15, poner el link), literature review y ID quizz (contar un poco de qué iban)
ICAAC Keynote and other specific sessions (MM): ID Fellows, Keynote session (la cuelgan el 15, poner el link), literature review y ID quizz (contar un poco de qué iban)
ICAAC Keynote and other specific sessions (MM): ID Fellows, Keynote session (la cuelgan el 15, poner el link), literature review y ID quizz (contar un poco de qué iban)
Ejemplo del grado de discordancia entre expertos a la hora de evaluar prescripciones antibióticas, en este caso en UCI.
Abstract:
Background: There is universal awareness of the difficulties faced by doctors when prescribing antimicrobials.
Methods: Over a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or antifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists. Once completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on the data received, the evaluator completed a form automatically generated on the e-mail and returned it to the original mailbox for further analysis. We assessed the level of agreement between infectious disease specialists and the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the appropriateness of the regimen prescribed.
Results: Among the antimicrobial regimens prescribed to the 177 patients, 36 % were considered inappropriate by specialist #1 and 38 % were considered inappropriate by specialist #2. We found 78 % agreement by at least one of the infectious disease specialists with the prescribed antimicrobial regimen, and in 49 % of cases both specialists agreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22 % of the cases and they disagreed between themselves in 29 % of the cases.
Conclusion: This study highlights the difficulties in prescribing effective empirical antimicrobial therapy - they are of such magnitude that even two specialists in infectious diseases, well acquainted with our hospital’s resistance patterns and our patients’ profiles have considerable disagreement.
----- Notas de la reunión (18/09/15 01:39) -----
Good evening. First of all I would like to thank the organizing committee for the invitation. I am honoured to be here presenting this challenging topic.