icaac 2013: resumen
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Resumen de pósters y comunicaciones del 53rd ICAAC (9-12 Septiembre 2013)TRANSCRIPT
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