Research highlights from ICAAC meeting

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TUESDAY, September 10, 2013 Keynote Lecture: Rethinking Disease The reductionist attitude of classic antibacterial therapy, crystallized in the dominant "culture of monotherapy" has contributed to perversely fix the old perception of "one disease-one pathogen-one drug". Bacterial diseases are always the result of a complex array of pathogenic factors. This session will address the multifaceted and integrated therapeutic interventions aiming to restore the health of all sick compartments involved in infection. Fernando Baquero, Ramón y Cajal Inst. for Hlth. Res., Madrid, Spain Keynote Session 1 Chemotherapy, Diarrhea and the Intestinal Microbiome Researchers have identified changes to the microbiome that can indicate the potential onset of chemotherapy-induced diarrhea (CID) as early as 6 days before symptoms appear, a finding that could help identify patients at high risk for severe CID. Emmanuel Montassier, Université de Nantes, France Poster Session 6, Paper B-030 Removal of Antibiotic Leads to Loss of Resistance In the case of methicillin-resistant Staphylococcus aureus (MRSA) where the bacteria were resistant to the antibiotic linezolid due to the presence of the cfr gene, removal of the selective pressure of the antibiotic caused the bacteria to lose the gene and regain susceptibility. Emilia Cercenado, Hosp. Gen. Univ.o Gregorio Marañón, Madrid, Spain Poster Session 11, Paper C2-077 (summary available) New Generation Diagnostics Could Impact Therapy A retrospective analysis of bloodstream infections in the United Kingdom suggests that the use of a relatively new diagnostic system known as matrix-assisted laser desoption ionization time-of-flight mass spectrometry (MALDI-TOF MS) would have resulted in modification of therapy for 13% of patients within 24 hours of positive blood culture. Routine implementation of MALDI-TOF analysis of blood culture samples could have a signficant impact on clinical management of this disease. T Saluja, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom Poster Session 13, Paper D-113 Quick Identification with MALDI-TOF Use of MALDI-TOF analysis directly on positive blood cultures signficantly reduced the time required to identify the causitive agent of blood stream infections, from 27 to 17 hours. Katherine Bond, St Vincent's Hosp., Melbourne, Australia Poster Session 13, Paper D-114 New Rapid Test for Antibiotic Resistance A new test for extended spectrum betalactamase (ESBL) antibiotic-resistant bacteria can identify ESBL-resistant bacteria in blood cultures in 30 minutes compared to traditional tests which can take 24-48 hours. Laurent Dortet, Hosp. de Bicetre, Le Kremlin Bicetre, France Poster Session 13, Paper D-121(summary available) New C. difficile Drug Candidate Does Not Disrupt Gut Flora A study of the effects of a candidate drug for treatment of Clostridium difficile infection demonstrates that the drug causes only very modest changes in the normal gut flora with the exception of a signficant decrease in C. difficile. Emma Best, Leeds Teaching Hosp. NHS Trust, Leeds, United Kingdom Poster Session 18, Paper K-167 Actual Versus Ideal Body Weight: No Difference in Antibiotic Outcomes Using an adjusted body weight (based on ideal body weight) instead of actual body weight to determine dosage of the antibiotic daptomycin for treatment of vancomycin-resistant enterococcal (VRE) bacteremia in obese patients resulted in similar clinical outcomes but cost $1,200 per patient less. Jerod Nagel, Univ. of Michigan Hlth. Syst., Ann Arbor, MI, United States Poster Session 19, Paper K-169 (summary available) Shorter, Once-Daily Treatment Just as Effective In a pivotal study of two antibiotic treatment regimens for acute skin and skin structure infections, once-daily treatment with the antibiotic tedizolid for 6 days was found to be as effective as twice-daily treatment with the antibiotic linezolid for 10 days. Carisa De Anda, Trius Therapeutics, San Diego, CA, United States Poster Session 21, Paper L-203 Single Dose Drug Candidate Equal to Week of Vancomycin Phase III clinical results show that a single dose of the in-development drug oritavancin is just as effective as 7-10 days of vancomycin in adults with acute bacterial skin and skin structure infections requiring intravenous therapy. Ralph Corey, Duke Clin. Res. Inst., Durham, NC, United States Poster Session 21, Paper L-204 (summary available) Breath Test for Fungal Disease Researchers have identified specific volatile organic compounds found only in the breath of patients with the invasive fungal disease apergillosis, which could lead to the development of a diagnostic breath test for the disease. Sophia Koo, Brigham & Women's Hosp., Boston, MA, United States Poster Session 23, Paper M-219 (summary available) Can Vitamins and Nutritional Supplements Prevent or Treat Disease? There is much interest in the role of nutrients and micronutrients in the support of host defense against infections. However, there is controversy in the ability of supplements to help prevent or treat infections. This session sheds light on the intersection of human nutrition and infectious diseases. Presentations will focus on the role of vitamin D supplements on tuberculosis and the common cold, micronutrients in HIV and zinc therapy for infection in special populations. Symposium 32 Toxin Reduces Antibiotic Efficacy Neutralization of the S. aureus alpha-toxin (AT) makes the bacteria more susceptible to antibiotic treatment. Anti-AT antibodies may be a useful adjunct therapy for treatment of biofilm-forming S. aureus infections. Michele Anderson, Univ. of Minnesota, Minneapolis, MN, United States Slide Session 35, Paper B-306 (summary available) C. difficile Rate Nearly Double Since 2001 The incidence of C. difficile infections in hospitals in the United States nearly doubled from 2001 to 2010. Kelly Daniels, The Univ. of Texas at Austin, Austin, TX, United States Slide Session 38, Paper K-327 (summary available) Treatment Helps Prevent Recurrence of C. difficile In patients who had previously been diagnosed with C. difficile infection and also required antibiotic treatment for other conditions, the addition of oral vancomycin to the necessary antibiotic treatment helped reduce the recurrence of C. difficile infection. Alex Carignan, Universite de Sherbrooke, Sherbrooke, QC, Canada Slide Session 38, Paper K-334 Dosages Equally Effective for C. difficile There appears to be little difference in the effectiveness of low-dose versus high-dose oral vancomycin for the treatment of C. difficile infections in hospitals. Use of low-dose oral vancomycin can potentially decrease treatment costs. Philip Chung, Albert Einstein Coll. of Med., Bronx, NY, United States Slide Session 38, Paper K-335 (summary available) WEDNESDAY, September 11, 2013 Anti-Infective Therapy in the 21st Century: Target the Host! Since the discovery of sulfonamides, the goal of anti-infective therapy has been to kill the pathogen. However, recent science indicates that the host response to the pathogen profoundly influences the clinical course and outcome of infections. This symposium will review cutting edge approaches to find new ways to treat infections, modulate host response to the pathogen, and find new ways to screen for lead anti-infective compounds. Symposium 55 Respiratory Viruses: New Treatment Options and Other Issues The session on respiratory viruses will update the audience on promising treatment modalities for RSV and rhinoviruses, review the impact and management of influenza and other respiratory viruses in transplant recipients and discuss the genetic basis for adaptation of avian influenza viruses to humans. Symposium 65 Shingles Vaccine Coverage Low in Elderly Americans Despite the approval and recommendation by the FDA of a shingles vaccine for adults over 50, only 16% of American seniors over 60 are vaccinated. Vaccinations are even lower for those aged 50-60. Only 4.3% have been vaccinated. Melissa Johnson, Duke Univ. Med. Ctr., Durham, NC, United States Poster Session 71, Paper B-493 Superbug Develops Resistance to Disinfectants Acinetobacter, bacteria already infamous for developing resistance to most available antibiotics, also appear to develop resistance to disinfectants when exposed to them at sublethal concentrations. Charalampos Tsoukalas, Nottingham Trent Univ., Nottingham, United Kingdom Poster Session 72, Paper C1-505 (summary available) New Compound Active Against C. difficile A new compound, MBX 249A, exhibits potent activity against drug-resistant and toxigenic C. difficile in vitro and in multiple animal infection models. Michelle Butler, Microbiotix, Inc., Worcester, MA, United States Poster Session 82, Paper F-629 MRSA Infection Rates Lower in Previously Colonized Patients who acquire MRSA after hospital admission are at higher risk of developing active MRSA infection than patients who were already colonized at admission. Marie Roger, Univ. of Texas Hlth. Sci. Ctr., San Antonio, TX, United States Poster Session 88, Paper K-687 New Arrival in Austria Sandflies are apparently much more widely distributed in Austria than previously thought and the period of sandfly activity in the country is much longer than presumed. These findings are of high relevance for a potential emergence of sandfly-borne diseases, such as leishmania, in that part of Europe. W. Poeppl, Med. Univ. Vienna, Vienna, Austria Poster Session 95, Paper P-804 Hot Topics in Pediatric Infectious Diseases In this session, experts will present state-of-the-art advances in pediatric infectious diseases including the return of mumps, toxic shock syndrome, new insights into meningococcal disease and the challenges of multidrug-resistant infections in children. Symposium 109 The Role of the Microbiome in Infection Control The disruption of the human microbiome through use of antimicrobials is a topic of growing interest among healthcare epidemiologists, not only because it is a major risk factor for C. difficile infection (CDI), but also because it could be a driving force behind the introduction and proliferation of multidrug-resistant organsms (MDROs) in healthcare settings. A greater understanding of the protective role of the microbiome could have major implications for the future direction of infection control. The speakers will review the current understanding of the role of microbiome disruption in the epidemiology of diseases such as CDI and MDRO colonization and transmission, and what the future may hold with regard to intervention. Symposium 110 THURSDAY, September 12, 2013 How MALDI-TOF is Changing Clinical Microbiology MALDI-TOF is increasingly used in clinical microbiology laboratories for rapid bacterial and fungal identification. Newer applications such as strain typing and antimicrobial susceptibility testing are evolving. This session, delivered by experienced users of the technology, will be a state-of-the-art presentation on this technology and its clinical application. Symposium 132 New Treatment for Lung Infection Treatment with interleukin-18 binding protein (IL-18BP) in a mouse model of Pseudomonas aeruginosa acute lung infection resulted in significantly increased survival, decreased lung injury and decreased weight loss. P. aeruginosa is a significant cause of lung infections in hospitalized and cystic fibrosis patients and one of its virulence factors is its ability to cause inflammation by inducing the immune system to secrete IL-18. Emmanuel Faure, Lille 2 Teaching Hosp., Lille, France Poster Session 143, Paper B-1055 (summary available) ESBL Antibiotic Resistance in Netherlands A large scale study of antibiotic resistance in the Netherlands finds approximately 7% of enterobacteriaceae harbored extended-spectrum betalactamase (ESBL), a slight increase relative to earlier studies. The good news is 95% of ESBLs were still suceptible to the antibiotic ertapenem and other alternate therapies. Wouter van den Bijllaardt, St. Elisabeth Hosp., Tilburg, Netherlands Poster Session 148, Paper C2-1116 (summary available) Antibiotic Synergy Overcomes Multidrug Resistance Synergistic or additive effects between the antibiotics tigecycline and colistin may be useful therapies against multidrug-resistant bacteria such as those carrying the plasmid for NDM-1. Jonathan Betts, Queen Mary, Univ. of London, London, United Kingdom Poster Session 152, Paper E-1157 (summary available) New Compound Active Against Multiple STDs An experiemental compound displays potent activity against a variety of bacterial pathogens that cause sexually transmitted diseases. Susanne Paukner, Nabriva Therapeutics AG, Vienna, Austria Poster Session 153, Paper E-1183 (summary available) Can Vitamin D Prevent Ear Infections? Children receiving vitamin D supplements are significantly less like to have recurring acute otitis media than children on placebo. Susanna Esposito, Univ. degli Studi di Milano, Milan, Italy Poster Session 158, Paper G-1249 (summary available) Antiretroviral Drugs in HIV-infected Patients with Cancer In what may be the largest series analyzing the effectiveness of antiretroviral therapy in HIV-infected patients with cancer undergoing chemotherapy, researchers find the most effective and safest antiretroviral drug for these patients to be the integrase strand-transfer inhibitor raltegravir. Harrys Torres, UT MD Anderson Cancer Ctr., Houston, TX, United States Poster Session 159, Paper H-1255 (summary available) ED Drugs Associated with Syphilis Among HIV-infected men, the use of erectile dysfunction drugs is strongly associated with the incidence of syphilis infection. Nimish Patel, Albany Coll. of Pharmacy and Hlth. Sci., Albany, NY, United States Poster Session 161, Paper H-1265 (summary available) Pertussis on Rise in U.S. Elderly Between 2006 and 2010, the estimated incidence of cough illnesses attributed to Bordetella pertussis has nearly doubled in Americans aged 50-64 and more than doubled in Americans over the age of 65. Cristina Masseria, GlaxoSmisthKline Vaccines, King of Prussia, PA, United States Poster Session 166, Paper L-1318 New Aerosol-Delivered Antibiotic for TB A new experimental drug for tuberculosis, delivered as an aerosol instead of oral formulation, is a safe and promising option for the treatment of tuberculosis, resulting in the eradication of more than 99% of bacteria from the lungs of mice in 4 weeks. Mercedes Gonzalez Juarrero, Colorado State Univ., Fort Collins, CO, United States Poster Session 168, Paper L-1344 New TB Drugs Work with Existing Antibiotics Spectinamides, a new class of antibiotics under development for the treatment of tuberculosis, do not antagonize current anti-tuberculosis drugs and appear to display interactions with some FDA-approved antibiotics. David Bruhn, St. Jude Child. Res. Hosp., Memphis, TN, United States Poster Session 168, Paper L-1346 New Variant of Candida in US Researchers report five isolates of the Candida africana from 4 patients residing in Virginia and North Carolina suggesting that the organism may now be endemic in the United States. First identified in Africa in 1995, C. africana has been previously isolated in Europe and Japan but until now not the United States. Kevin Hazen, Duke Univ. Hlth. Syst., Durham, NC, United States Poster Session 169, Paper M-1382 (summary available) Alternative Strategies for Dosing Anti-Infective Agents This symposium is aimed at providing clinicians and researchers with the latest developments on alternative techniques for administering anti-infective agents including aerosol delivery of antibiotics, extended infusions of beta-lactams and individualized drug regimens. Symposium 173 Herd Immunity following Meningococcal Vaccine A ten-year surveillance study following the introduction of a meningococcal vaccine for children aged 1-19 in the Netherlands finds a marked decline in invasive meningococcal disease in not only vaccinated but unvaccinated individuals as well with the overall disease rate in 2011 being the lowest since 1971. Merijn Bijlsma, Academic Med. Ctr., Amsterdam, Netherlands Slide Session 183, Paper G-1454 (summary available) Single-Dose HIV Drugs Increase Adherence Single-tablet therapy improves adherence rates compared to multiple-tablet therapy and subsequently decreases hospitalizations in veterans with HIV/AIDS. Charles Bennett, Univ. of South Carolina, Columbia, SC, United States Slide Session 184, Paper H-1464 (summary available) High-Dose Therapy Superior in Flu Drug Critically ill patients with the pandemic H1N1 influenza who received triple the standard dose of the influenza drug oseltamivir were 7 times more likely to completely clear the virus from their system in 5 days than those who received the standard dose. Anand Kumar, Hlth. Sci. Ctr., Winnipeg, MB, Canada Slide Session 185, Paper V-1470

FRIDAY, September 13, 2013 Decolonization No More Effective than Placebo In patients colonized with Gram-negative bacteria expressing ESBLs, active measures to decolonize them appear to be no more effective than placebo. Approximately 50% become ESBL-negative after one year, regardless. Christoph Fux, Klinik fⁿr Infektiologie, Kantonsspital Aarau, Aarau, Switzerland Slide Session 205, Paper K-1535 (summary available) How Safe are Antimicrobials Approved by the FDA in the Past 7 Years? Of the 11 new antimicrobial drugs approved by the Food and Drug Administration over the last 7 years, there appear to be significant adverse affects associated with at least 6, many of which are not included in package inserts. Tina Khadem, State Univ. of New York at Buffalo, Buffalo, NY, United States Slide Session 206, Paper K-1544 (summary available) PCR Alters Clinical Management DNA-based broad range polymerase chain reaction (BR-PCR), when used as a diagnostic tool for undiagnosed infectious disease syndromes (IDS), was able to identify a causitive agent in 21% of specimens where culture could not. Eric Richards, Oregon Hlth. and Sci. Univ., Portland, OR, United States Poster Session 215, Paper D-1666 (summary available) ### END